卓佳兵 张翠莲 张临燕 陈瑞 高恺屿 石瑜

摘要：目的 观察“心脑同治”针刺法结合认知康复改善脑梗死恢复期认知障碍的临床疗效。方法 筛选47例满足纳入标准的患者，按随机数字表及单盲法分成治疗组和对照组。2组均予以支持治疗和常规康复治疗，治疗组加以“心脑同治”针刺法结合计算机认知康复治疗，对照组予以计算机认知康复治疗。在治疗前和治疗3个疗程后，2组均借助蒙特利尔认知量表（Montreal Cognitive Assessment，MoCA）评估。结果 治疗3个疗程后，2组患者的认知能力均有明显提高（P<0.01），且治疗组改善更显著（P<0.05）;2组总有效率比较，差异有统计学意义（P<0.05）。结论 “心脑同治”针刺法结合认知康复较单纯认知康复能够更有效地提高脑梗死恢复期患者的认知功能。

关键词：“心脑同治”针刺法;认知康复;脑梗死;认知障碍;临床研究

中图分类号：R246 文献标志码：B 文章编号：1007-2349（2021）06-0024-04

【Abstract】Objective： To observe the clinical effect of "Heart and Brain Simultaneous Treatment" acupuncture combined with cognitive rehabilitation to improve cognitive impairment during recovery from cerebral infarction. Methods： 47 patients who met the inclusion criteria were selected and divided into a treatment group and a control group according to random number table and single blind method. Both groups received supportive treatment and conventional rehabilitation. The treatment group was added "Heart and Brain Simultaneous Treatment" acupuncture and computer-based cognitive rehabilitation while the control group only received computer-based cognitive rehabilitation. Before treatment and after 3 courses of treatment， both groups were assessed with the Montreal Cognitive Assessment （MoCA）. Results： After 3 courses of treatment， the cognitive abilities of the two groups were significantly improved （P<0.01）， and the improvement in the treatment group was more significant （P<0.05）. The total effective rate of the two groups was compared， and the difference was statistically significant （P<0.05）. Conclusion： The "Heart And Brain Simultaneous Treatment" acupuncture combined with cognitive rehabilitation can improve the cognitive function of patients with cerebral infarction in the recovery phase more effectively than simple cognitive rehabilitation.

【Key words】Heart and Brain Simultaneous Treatment Acupuncture; Cognitive Rehabilitation; Cerebral Infarction; Cognitive Impairment; Clinical Research

腦梗死，是“脑卒中”最常见的类型，中医称之为“中风病”，占所有卒中的 69.6%～77.8%[1]，是由于大脑部分血流受阻致使机体神经功能缺损的一类综合征[2]。临床上将脑梗死分为3期，急性期为起病2周内，恢复期为2周～6个月，后遗症期则指卒中发病6个月以上[3]。近年来，随着治疗技术的不断提高，急性缺血性脑卒中死亡率较前降低[4]，使恢复期功能障碍的患病比例相应增加，其中认知损害是最常见的类型之一，患者的生活质量因此下降、日常交流也因此受阻。由于患者认知障碍进而导致无法很好的配合治疗，也会阻碍其它功能的恢复，制约脑梗后的全面康复，其影响甚至超过肢体功能障碍[5-6]。所以2011版《卒中康复指南》中就提到要重视认知康复[7]。但该病病情复杂，尚缺乏针对性药物，《中国脑卒中早期康复指南》（2017版）推荐恢复期进行认知障碍评测并针对性认知康复治疗[8]。……