兰琳

[摘要] 目的 探讨以患者为中心的认知康复训练在老年血管性痴呆患者中的应用效果。 方法 选取2014年11月～2016年7月在四川省成都市第二人民医院住院的63例老年血管性痴呆患者为研究对象，根据患者入院编号随机分为训练组（32例）和对照组（31例）。对照组给予常规护理，训练组在对照组基础上给予以患者为中心的认知康复训练，训练时间为8周。训练前后采用功能獨立性评定量表（FIM）、电脑神经心理测验（CNT）、简易智能精神状态检查量表（MMSE）评估两组患者的日常生活活动能力和认知功能。 结果 训练前两组患者FIM和MMSE评分比较，差异无统计学意义（P > 0.05）；训练结束后，两组上述评分均高于训练前，且训练组均明显高于对照组，差异均有统计学意义（P < 0.05）。训练前两组患者CNT测验的各项评分比较，差异均无统计学意义（P > 0.05）；训练结束后，除言语学习测试（LLT）外，训练组记忆力评估项目记忆广度测验（DST）、视觉广度测验（VST）、视觉学习测试（VLT）及注意力评估项目视觉持续性能测验（VCPT）、听觉控制持续性能测验（ACCPT）测验结果均明显优于对照组，差异均有统计学意义（P < 0.05）；组内比较显示，训练组训练后DST、VST、VLT、VCPT和ACCPT测验结果均优于训练前，差异均有统计学意义（P < 0.05）而对照组训练前后上述指标比较，差异均无统计学意义（P > 0.05）。 结论 老年血管性痴呆患者护理过程中，应用以患者为中心的认知康复训练有助于帮助患者改善日常生活活动能力和认知功能，值得在临床上推广使用。

[关键词] 以患者为中心的认知康复训练；血管性痴呆；日常生活活动能力；认知功能

[中图分类号] R473.2 [文献标识码] A [文章编号] 1673-7210（2018）04（b）-0158-04

[Abstract] Objective To investigate the application effect of patients-oriented cognitive rehabilitation training in elderly patients with vascular dementia. Methods From November 2014 to July 2016， 63 cases of hospitalized elderly patients with vascular dementia in the Second People′s Hospital of Chengdu were selected as the research object and divided into the training group （32 cases） and the control group （31 cases） randomly according to the admission number. The control group was given routine nursing care， while the training group was given patient-oriented cognitive rehabilitation training on the basis of control group and the training time was 8 weeks. The functional independence scale （FIM）， computer neuropsychological test （CNT） and mini mental state examination scale （MMSE） were used to evaluate the activities of daily living and cognitive function before and after training. Results Before training， there were no statistically significant differences in the scores of FIM and MMSE between the two groups （P > 0.05）. After training， the scores above were all higher than those of before training， and the scores in the training group were higher than those of control group， with statistically significant differences （P < 0.05）. Before training， there were no statistically significant differences in the scores of each item in CNT between the two groups （P > 0.05）. After training， except the language learning test （LLT）， the testing results of digit span test （DST）， visual span test （VST）， visual learning test （VLT） and visual continuous performance test （VCPT）， auditory controlled continuous performance test （ACCPT） in the training group were all significantly superior to the control group， and the sores in the training group were all superior to the control group， with statistically significant differences （P < 0.05）. Within the groups， after training the sores of DST， VST， VLT， VCPT and ACCPT in the training group were all significantly superior to those of before training； but there were no statistically significant differences in the control group （P > 0.05）. Conclusion During the process of caring elderly patients with vascular dementia， implementation of patients-oriented cognitive rehabilitation training may help to improve their activities of daily living and cognitive function， which is worthy of promotion and application in clinical.

[Key words] Patient-oriented cognitive rehabilitation training； Vascular dementia； Activities of daily living； Cognitive function

血管性癡呆（vascular dementia，VD）是一组由脑血管疾病（如缺血性脑血管病、出血性脑血管疾病、急性脑血管疾病即中风等）导致的智能及认知功能障碍综合征[1-2]。随……