強(qiáng)化認(rèn)知干預(yù)對缺血性腦卒中恢復(fù)期患者非癡呆型認(rèn)知功能障礙的影響

孫紅霞　龐秀娥　洪文武　甘泉　陳光

[摘要] 目的 探討強(qiáng)化認(rèn)知干預(yù)對缺血性腦卒中恢復(fù)期患者非癡呆型認(rèn)知功能障礙的影響。 方法 選取2016年1月～2017年2月神經(jīng)內(nèi)科就診的缺血性腦卒中恢復(fù)期非癡呆型認(rèn)知功能障礙患者90例，隨機(jī)分為干預(yù)組與對照組。兩組均給予活化腦細(xì)胞、控制血脂、血糖和血壓及抑制血小板聚集等基礎(chǔ)治療，對照組在此基礎(chǔ)上加常規(guī)康復(fù)訓(xùn)練，干預(yù)組在再加以強(qiáng)化認(rèn)知干預(yù)，干預(yù)時間12周。與干預(yù)前后檢測比較兩組神經(jīng)、肢體運(yùn)動和認(rèn)知功能指標(biāo)變化。 結(jié)果 干預(yù)12周后，兩組MMSE、畫鐘試驗和積木試驗評分均有不同程度上升（P<0.05或P<0.01），且干預(yù)組上升幅度更明顯（P<0.05）；同時兩組患者CSS評分均有不同程度下降，F(xiàn)MA評分和Barther評分均不同程度上升（P<0.05或P<0.01），且干預(yù)組變化幅度更大（P<0.05）。 結(jié)論 強(qiáng)化認(rèn)知干預(yù)用于缺血性腦卒中恢復(fù)期非癡呆型認(rèn)知功能障礙患者能減輕或延緩其認(rèn)知功能的損害，改善其認(rèn)知功能，并能可改善其神經(jīng)和肢體運(yùn)動功能，提高其日常生活能力。

[關(guān)鍵詞] 缺血性腦卒中恢復(fù)期；非癡呆型認(rèn)知功能障礙；強(qiáng)化認(rèn)知干預(yù)；認(rèn)知功能

[中圖分類號] R246.6 [文獻(xiàn)標(biāo)識碼] B [文章編號] 1673-9701（2017）36-0038-04

[Abstract] Objective To investigate the effect of intensive cognitive intervention on non-dementia cognitive dysfunction in patients with recovery period of ischemic stroke. Methods 90 non-dementia cognitive dysfunction patients with recovery period of ischemic stroke admitted in the Department of Neurology from January 2016 to February 2017 were randomly divided into intervention group and control group. The two groups were given basic treatment including activating brain cells， controlling blood lipids， blood sugar and blood pressure and inhibiting platelet aggregation. The control group was also given routine rehabilitation training based on the above treatment. The intervention group was added with intensive cognitive intervention. The intervention time was 12 weeks. The changes of nerve， limb movement and cognitive function were compared between the two groups before and after the intervention. Results After 12 weeks of intervention， MMSE， bell-drawing test and building block test scores of both groups increased to some extent（P<0.05 or P<0.01）， and the increase magnitude of intervention group was more obvious（P<0.05）. At the same time， CSS scores of both groups declined to some extent. The scores of FMA and Barther increased in different degrees（P<0.05 or P<0.01）， and the changes in intervention group were more significant（P<0.05）. Conclusion Intensive cognitive intervention applied in non-dementia cognitive dysfunction patients with recovery period of ischemic stroke can reduce or delay the impairment of cognitive function， improve their cognitive function， improve the nerve and limbs motor function and improve their daily living ability.

[Key words] Recovery period of ischemic stroke； Non-dementia cognitive dysfunction； Intensive cognitive intervention； Cognitive function

缺血性腦卒中是中老年患者的常見病和多發(fā)病，治療后恢復(fù)期患者除神經(jīng)和肢體功能障礙以外，半數(shù)以上患者常伴有不同程度的認(rèn)知功能障礙，以非癡呆型認(rèn)知障礙多見[1，2]。非癡呆型認(rèn)知障礙以視覺空間感覺障礙、記憶功能下降、執(zhí)行困難、定向力障礙和注意力下降為主，如不及時給予控制部分患者可發(fā)展為癡呆，影響其軀體和運(yùn)動恢復(fù)，給社會和家庭帶來較大的負(fù)擔(dān)[3，4]。目前對腦卒中的干預(yù)措施以肢體與語言功能干預(yù)為主，而對認(rèn)知障礙的干預(yù)國內(nèi)外鮮有報道[5]。強(qiáng)化認(rèn)知干預(yù)是一種對獲得性腦受損導(dǎo)致的認(rèn)知障礙而采取的干預(yù)措施，近年來逐漸應(yīng)用于缺血性腦卒中干預(yù)治療中[6，7]。……