补阳还五汤联合个体化认知训练对脑卒中后认知功能障碍及神经功能的影响

王国军; 雷海军; 杨莉; 景蓉; 高莉; 付春爱

doi:10.16766/j.cnki.issn.1674-4152.003769

补阳还五汤联合个体化认知训练对脑卒中后认知功能障碍及神经功能的影响

doi: 10.16766/j.cnki.issn.1674-4152.003769

王国军^1, ,,
雷海军¹,
杨莉¹,
景蓉¹,
高莉²,
付春爱²

1.
延安大学附属医院心脑血管病医院康复医学科，陕西延安 716000
2.
延安市中医医院针灸科，陕西延安 716000

基金项目:

陕西省延安市科技计划项目 2022SLSFGG-032

延安大学附属医院科学技术研究发展计划项目 2022PT-34

陕西省卫生健康科研基金项目 2021B008

第七批全国老中医药专家学术经验继承工作项目(国中医药人教函〔2022〕76号)

详细信息

通讯作者:
雷海军，E-mail: 1048767454@qq.com

中图分类号: R743.3 R749.13
计量
- 文章访问数: 13
- HTML全文浏览量: 10
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2023-11-29
- 网络出版日期: 2024-12-31

Effect of Buyang Huanwu Decoction combined with individual cognitive training on post-stroke cognitive dysfunction and neurological function

1.
Rehabilitation Medicine Department of Cardiovascular and Cerebrovascular Disease Hospital of Yan' an University Affiliated Hospital, Yan' an, Shaanxi 716000, China

摘要

摘要: 目的探讨经典方剂补阳还五汤联合个体化认知训练对脑卒中后认知功能障碍(PSCI)及神经功能的影响。方法选择2022年8月—2023年8月于延安大学附属医院康复医学科住院治疗的98例PSCI患者，使用随机数表法将患者分为对照组和治疗组，每组49例。对照组给予脑卒中后综合康复治疗，治疗组在对照组治疗基础上，进行个体化认知训练及对患者进行中医辨证，并以补阳还五汤为基础，加减辨治。比较2组患者治疗前后蒙特利尔认知评估量表(MoCA)、日常生活能力量表(ADL)、美国国立卫生院卒中量表(NIHSS)、简易精神状态检查表(MMSE)、非语言性神经心理测验量表(NLCA)评分。观察2组患者治疗过程中的药物不良反应率。结果治疗后，治疗组患者总有效率为95.92%(47/49)，高于对照组[81.63%(40/49), χ²=5.017, P=0.025]。治疗后，治疗组患者MoCA评分、ADL评分、MMSE评分、NLCA评分均高于对照组, NIHSS评分低于对照组，差异均有统计学意义(P＜0.05)。2组不良反应发生率均为4.08%(2/49)。结论补阳还五汤联合个体化认知训练治疗PSCI患者，可显著增强患者认知功能效应，提升患者生活质量，且安全性高，可作为PSCI患者的良好治疗方案选择之一。
- 脑卒中后认知功能障碍 /
- 补阳还五汤 /
- 中医治疗 /
- 个体化认知训练
Abstract: Objective To explore the effects of combing the classic formula Buyang Huanwu Decoction with personalized cognitive training on cognitive dysfunction and neurological function after stroke. Methods A total of 98 post stroke cognitive impairment (PSCI) patients were selected form those admitted to the Rehabilitation Medicine Department of Yan' an University Affiliated Hospital for treatment between August 2022 and August 2023. The patients were randomly divided into a control group and a treatment group using a random number table method, with 49 patients in each group. The control group received comprehensive rehabilitation treatment after stroke, while the treatment group received individualized cognitive training and traditional Chinese medicine syndrome differentiation on the basis of the control group' s treatment. The treatment group also used Buyang Huanwu Decoction as the basis for modified syndrome differentiation. Compare the scores of Montreal cognitive assessment (MoCA), activities of daily living (ADL), National Institutes of Health stroke scale (NIHSS), mini mental state examination (MMSE), and nonverbal neuropsychiatric assessment (NLCA) between two groups of patients before and after treatment. Observe the incidence of adverse drug reactions in both patient groups during the treatment process. Results After treatment, the total effective rate of the treatment group was 95.92% (47/49), which was higher than that of the control group [81.63% (40/49), χ²=5.017, P=0.025]. Following treatment, the MoCA score, ADL score, MMSE score, and NLCA score of the treatment group were significantly higher than those of the control group, while the NIHSS score was lower than that of the control group (P < 0.05). The incidence of adverse reactions in both groups was 4.08% (2/49). Conclusion The combination of Buyang Huanwu Decoction and personalized cognitive training can significantly enhance the cognitive function effect of PSCI patients, leading to a substantial improvement in their quality of life while ensuring high safety. Thus, it can be considered as a favorable treatment option for PSCI patients.
- Post stroke cognitive impairment /
- Buyang Huanwu Decoction /
- TCM treatment /
- Individualized cognitive training

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表 1 2组脑卒中后认知障碍患者临床基线资料比较

Table 1. Comparison of clinical baseline data between two groups of patients with post-stroke cognitive impairment

组别	例数	性别(例)		年龄 (x±s，岁)	体重 (x±s，kg)	病程 (x±s，d)	脑卒中分型(例)		中医证型(例)
组别	例数	男性	女性	年龄 (x±s，岁)	体重 (x±s，kg)	病程 (x±s，d)	脑出血	脑梗死	气滞血瘀	阴虚风动	风痰阻络	肝阳暴亢	痰热腑实
对照组	49	30	19	63.86±8.37	71.27±10.22	15.74±10.80	25	24	27	5	9	4	4
治疗组	49	27	22	62.06±9.51	71.61±10.95	15.31±9.05	22	27	29	3	5	8	4
统计量		0.377^a		0.992^b	0.162^b	0.213^b	0.368^a		3.048^a
P值		0.539		0.324	0.872	0.832	0.544		0.550
注：^a为χ²值，^b为t值。

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表 2 2组脑卒中后认知障碍患者认知障碍情况比较[例(%)]

Table 2. Comparison of cognitive impairment between two groups in patients with post-stroke cognitive impairment[cases (%)]

组别	例数	痊愈	显效	有效	无效	总有效
治疗组	49	16(32.65)	24(48.98)	7(14.29)	2(4.08)	47(95.92)
对照组	49	7(14.29)	27(55.10)	6(12.24)	9(18.37)	40(81.63)
统计量		-2.248^a				5.017^b
P值		0.025				0.025
注：^a为Z值，^b为χ²值。

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表 3 2组脑卒中后认知障碍患者治疗前后MoCA评分比较(x ±s，分)

Table 3. Comparison of MoCA scores before and after treatment in two groups of patients with cognitive impairment after stroke (x ±s, points)

组别	例数	治疗前	治疗后	t值	P值
治疗组	49	5.90±1.65	24.35±5.14	-28.936	＜0.001
对照组	49	6.39±2.24	20.76±6.15	-18.600	＜0.001
统计量		1.231^a	18.694^b
P值		0.221	＜0.001
注：^a为t值，^b为F值。

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表 4 2组脑卒中后认知障碍患者治疗前后ADL评分比较(x ±s，分)

Table 4. Comparison of ADL scores between two groups before and after treatment (x ±s, points)

组别	例数	治疗前	治疗后	t值	P值
治疗组	49	22.04±10.30	87.65±15.62	-30.861	＜0.001
对照组	49	22.76±9.21	76.22±23.82	-20.591	＜0.001
统计量		0.365^a	13.339^b
P值		0.719	＜0.001
注：^a为t值，^b为F值。

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表 5 2组脑卒中后认知障碍患者治疗前后NIHSS评分比较(x ±s，分)

Table 5. Comparison of NIHSS scores before and after treatment in two groups of patients with cognitive impairment after stroke (x ±s)

组别	例数	治疗前	治疗后	t值	P值
治疗组	49	37.29±2.38	9.61±8.21	24.102	＜0.001
对照组	49	36.71±3.12	14.53±10.09	17.309	＜0.001
统计量		1.019^a	10.645^b
P值		0.311	0.002
注：^a为t值，^b为F值。

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表 6 2组脑卒中后认知障碍患者治疗前后MMSE评分比较(x ±s，分)

Table 6. Comparison of MMSE scores before and after treatment in two groups of patients with cognitive impairment after stroke (x ±s)

组别	例数	治疗前	治疗后	t值	P值
治疗组	49	5.82±1.72	24.39±5.10	-28.539	＜0.001
对照组	49	6.53±2.46	20.76±6.56	-17.833	＜0.001
统计量		1.668^a	20.499^b
P值		0.099	＜0.001
注：^a为t值，^b为F值。

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表 7 2组脑卒中后认知障碍患者治疗前后NLCA评分比较(x ±s，分)

Table 7. Comparison of NLCA scores between two groups before and after treatment (x ±s, points)

组别	例数	治疗前	治疗后	t值	P值
治疗组	49	14.20±3.56	70.20±15.24	-29.327	＜0.001
对照组	49	16.16±6.04	62.18±21.73	-18.420	＜0.001
统计量		1.958^a	26.049^b
P值		0.053	＜0.001
注：^a为t值，^b为F值。

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表 8 2组脑卒中后认知障碍患者治疗前后不良反应/毒副作用情况(例)

Table 8. Adverse reactions and toxic side effects before and after treatment in two groups of post-stroke cognitive impairment patients (cases)

组别	例数	皮肤过敏	消化道	泌尿系统	神经系统	肝损伤	肾损伤	总发生
对照组	49	0	1	0	0	1	0	2
治疗组	49	1	0	0	0	1	0	2

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参考文献(17)

[1]	RENJEN P N, GAUBA C, CHAUDHARI D. Cognitive impairment after stroke[J]. Cureus, 2020, 7(9): 1-9.
[2]	彭丹涛, 邵文. 脑小血管病相关认知功能障碍中国诊疗指南(2019)[J]. 阿尔茨海默病及相关病, 2019, 2(3): 405-407, 403. PENG D T, SHANG W. Chinese diagnosis and treatment guidelines for cognitive dysfunction related to cerebrovascular disease(2019)[J]. Chinese Journal of Alzheimer's Disease and Related Disorders, 2019, 2(3): 405-407, 403.
[3]	汪凯, 董强, 郁金泰, 等. 卒中后认知障碍管理专家共识2021[J]. 中国卒中杂志, 2021, 16(4): 376-389. WANG K, DONG Q, YU J T, et al. Experts Consensus on Post-stroke Cognitive Impairment Management 2021 Chinese Society of Vascular Cognitive Impairment[J]. Chinese Journal of Stroke, 2021, 16(4): 376-389.
[4]	王永炎. 中风病中医诊断、疗效评定标准[J]. 中国医药学报, 1986(2): 56-57. WANG Y Y. Traditional Chinese Medicine Diagnosis and Efficacy Evaluation Criteria for Stroke[J]. Chinese Medical Journal, 1986(2): 56-57.
[5]	武杰, 王玉, 刘建, 等. 涤痰汤加减联合表面肌电生物反馈对脑梗死后吞咽障碍患者吞咽功能的效应观察[J]. 世界中医药, 2019, 14(12): 3338-3342, 3348. WU J, WANG Y, LIU J, et al. Effect of Modified Ditan Decoction Combined with Surface Electromyography Biofeedback on Swallowing Function in Patients with Dysphagia after Cerebral Infarction[J]. World Chinese Medicine, 2019, 14(12): 3338-3342, 3348.
[6]	杨珊莉, 蔡素芳, 吴静怡, 等. 中西医结合康复临床实践指南·认知障碍[J]. 康复学报, 2020, 30(5): 343-348. YANG S L, CAI S F, WU J Y, et al. Clinical practice guidelines in integrated traditional Chinese and western medicine rehabilitation: cognitive impairment[J]. Rehabilitation Medicine, 2020, 30(5): 343-348.
[7]	王拥军, 李子孝, 谷鸿秋, 等. 中国卒中报告2019(中文版)(3)[J]. 中国卒中杂志, 2020, 15(12): 1251-1263. WANG Y J, LI Z X, GU H Q, et al. China Stroke Statistics 2019(3)[J]. Chinese Journal of Stroke, 2020, 15(12): 1251-1263.
[8]	HACKETT M L, PICKLES K. Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies[J]. Int J Stroke, 2019, 9(8): 1017-1025.
[9]	中国医师协会神经内科分会认知障碍专业委员会, 《中国血管性认知障碍诊治指南》编写组. 2019年中国血管性认知障碍诊治指南[J]. 中华医学杂志, 2019, 99(35): 2737-2744. The Cognitive Impairment Professional Committee of the Neurology Branch of the Chinese Medical Association, and the drafting group of the Chinese Guidelines for the Diagnosis and Treatment of Vascular Cognitive Impairment 2019 Chinese Guidelines for the Diagnosis and Treatment of Vascular Cognitive Impairment[J]. National Medical Journal of China, 2019, 99(35): 2737-2744.
[10]	中国卒中学会卒中后认知障碍研究圆桌会议专家组. 中国卒中后认知障碍防治研究专家共识[J]. 中国卒中杂志, 2020, 15(2): 158-166. Expert Group of the Round Table Conference on Poststroke Cognitive Impairment Research of the Chinese Stroke Society. Experts consensus on research on prevention and treatment of poststroke cognitive impairment in China[J]. Chinese Journal of Stroke, 2020, 15(2): 158-166.
[11]	ROHDE D, GAYNOR E, LARGE M, et al. The impact of cognitive impairment on poststroke outcomes: a 5-year follow-up[J]. J Geriatr Psychiatry Neurol, 2019, 32(5): 275-281. doi: 10.1177/0891988719853044
[12]	徐玉婷, 李若照, 陈刚. 自拟柴牡醒脑汤结合康复训练治疗脑卒中后认知功能障碍临床研究[J]. 国际中医中药杂志, 2020, 42(9): 852-855. XU Y T, LI R Z, CHEN G. Clinical study of self-made Chaimu-Xingnao Decoction combined with rehabilitation training in the treatment of cognitive dysfunction after stroke[J]. International Journal of Traditional Chinese Medicine, 2020, 42(9): 852-855.
[13]	高庆元, 陈晓城, 邹卫兵, 等. 益肾活血中药联合电针穴位刺激治疗脑梗死后记忆功能障碍的疗效[J]. 中华全科医学, 2019, 17(7): 1194-1197. doi: 10.16766/j.cnki.issn.1674-4152.000899 GAO Q Y, CHEN X C, ZOU W B, et al. Efficacy of Yishen Huoxue decoction combined with electroacupuncture on memory dysfunction after cerebral infarction[J]. Chinese Journal of General Practice, 2019, 17(7): 1194-1197. doi: 10.16766/j.cnki.issn.1674-4152.000899
[14]	刘晓锐. 补阳还五汤联合多奈哌齐治疗轻度认知功能障碍临床观察[J]. 实用中医药杂志, 2020, 36(3): 359-360. LIU X R. Clinical observation on the combination of Buyang Huanwu Tang and Donepezil in the treatment of mild cognitive impairment[J]. Journal of Practical Traditional Chinese Medicine, 2020, 36(3): 359-360.
[15]	向宪文, 刘西建. 补阳还五汤联合经颅磁刺激治疗脑卒中后认知功能障碍临床研究[J]. 陕西中医, 2020, 41(7): 885-887. XIANG X W, LIU X J. A clinical study on the combination of Buyang Huanwu Tang and transcranial magnetic stimulation in the treatment of cognitive impairment after stroke[J]. Shaanxi Journal of Traditional Chinese Medicine, 2020, 41(7): 885-887.
[16]	陈克龙, 宋成城, 陈凌. 益气活血法在脑小血管病认知障碍患者中的临床应用[J]. 中华全科医学, 2023, 21(10): 1767-1769. doi: 10.16766/j.cnki.issn.1674-4152.003220 CHEN K L, SONG C C, CHEN L. Clinical application of supplementing Qi and activating blood in patients with cognitive impairment due to cerebral small vessel disease[J]. Chinese Journal of General Practice, 2023, 21(10): 1767-1769. doi: 10.16766/j.cnki.issn.1674-4152.003220
[17]	雷海军, 贺中正, 王国军. 补阳还五汤加减方联合多奈哌齐及个体化认知训练对脑卒中后认知功能障碍患者康复的影响观察[J]. 药物流行病学杂志, 2023, 32(2): 158-165. LEI H J, HE Z Z, WANG G J. Effect of Buyang Huanwu decoction plus donepezil and individualized cognitive training on rehabilitation of patients with cognitive dysfunction after stroke[J]. Chinese Journal of Pharmacoepidemiology, 2023, 32(2): 158-165.