陈鑫成　沈俭　张路

【摘要】 目的：觀察酸枣仁汤加味治疗老年脑卒中后认知障碍伴失眠的效果及对脑血流的影响。方法：选取2018年7月-2019年12月于本院门诊就诊的86例老年脑卒中后认知障碍伴失眠患者为研究对象。采用随机数字表法将患者分为对照组和观察组，每组43例。两组均进行基础治疗，对照组在基础治疗上予以尼莫地平片口服，观察组在对照组的基础上予以酸枣仁汤加味口服。比较两组临床疗效，比较两组治疗前后MMSE、PSQI及TCD相关指标。结果：治疗前，两组MMSE、PSQI评分和TCD相关指标比较，差异均无统计学意义（P>0.05）;治疗后，两组的MMSE、PSQI评分均优于治疗前，且观察组均优于对照组，差异均有统计学意义（P<0.05）;治疗后，两组MCA、ACA、PCA、VA水平均高于治疗前，且观察组均高于对照组，差异均有统计学意义（P<0.05）。观察组治疗总有效率高于对照组，差异有统计学意义（P<0.05）。结论：酸枣仁汤加味治疗老年脑卒中后认知障碍伴失眠效果显著，值得在临床上应用及推广。

【关键词】 酸枣仁汤 脑卒中 认知障碍 失眠 脑血流

Effect of Modified Suanzaoren Decoction on Cognitive Impairment with Insomnia after Stroke in the Elderly and Its Influence on Cerebral Blood Flow/CHEN Xincheng， SHEN Jian， ZHANG Lu. //Medical Innovation of China， 2021， 18（23）： -104

[Abstract] Objective： To observe the effect of modified Suanzaoren Decoction on cognitive impairment with insomnia after stroke in the elderly and its influence on cerebral blood flow. Method： A total of 86 elderly patients with post-stroke cognitive impairment and insomnia treated in the outpatient department of our hospital from July 2018 to December 2019 were selected as the research objects. Patients were divided into control group and observation group by random number table method， 43 cases in each group. Both groups were given basic treatment， the control group was given Nimodipine Tablet orally on the basis of basic treatment， and the observation group was given Suanzaoren Decoction orally on the basis of the control group. The clinical efficacy of the two groups was compared， and MMSE， PSQI and TCD related indexes were compared before and after treatment between the two groups. Result： Before the treatment， comparison of MMSE， PSQI score and TCD related indicators between the two groups， there were no significant differences （P>0.05）; after treatment， MMSE and PSQI scores of the two groups were better than those before treatment， and the observation group were better than those in the control group， the differences were statistically significant （P<0.05）; after treatment， MCA， ACA， PCA and VA levels in two groups were higher than those before treatment， and the observation group were higher than those in the control group， the differences were statistically significant （P<0.05）. The total effective rate of the observation group was higher than that of the control group， the difference was statistically significant （P<0.05）. Conclusion： The modified Suanzaoren Decoction has a significant effect on cognitive impairment with insomnia after stroke in the elderly， which is worthy of clinical application and promotion.

[Key words] Suanzaoren Decoction Stroke Cognitive impairment Insomnia Cerebral blood flow

First-author’s address： Jiujiang Traditional Chinese Medicine Hospital， Jiujiang 332000， China

doi：10.3969/j.issn.1674-4985.2021.23.025

脑卒中为临床常见危险性疾病，发病急，常伴有神经功能受损，多发于中老年人。脑卒中后认知障碍是脑卒中患者常见的一种功能障碍，主要包括记忆障碍、失语、失认、失读、失用、视空间障碍等临床表现[1]。文献[2]报道，脑卒中患者出现认知障碍的概率为24%～58%，而相关研究显示，其在我国的发生率为29.47%[3-4]。除了认知功能障碍外，脑卒中患者由于肢体活动不利、心理变化及外界环境等多种因素相互作用，也容易产生失眠症状，其发生率为30%～45%，也有报道认为可高达70%～95%，这一数据远远高于普通人群[5-7]。……