作者：陈炜，贾伟华，蔺芳菊，杨宝玲，陈英，冯建荣

单位：

首都医科大学石景山教学医院北京市石景山医院神经内一科

Units：

Department of Neurology, Shijingshan Teaching Hospital, Capital Medical University/Beijing Shijingshan Hospital, Beijing 100043, China

关键词：

脑梗死; 认知功能障碍; 焦虑; 认知功能障碍康复诊疗系统;

Keywords：

Brain infarction; Cognitive dysfunction; Anxiety; Cognitive dysfunction rehabilitation diagnosis and treatment system

CLC：

R 743.33 R 741 R 749.72

DOI：

10.12114/j.issn.1008-5971.2022.00.329

Funds：

摘要：

目的 探讨认知功能障碍康复诊疗系统对脑梗死后认知功能障碍伴焦虑患者的干预效果。方法 选取2018年6月至2020年5月在北京市石景山医院神经内科门诊就诊的脑梗死后认知功能障碍伴焦虑患者116例，按照随机数字表法分为观察组和对照组，每组58例。所有患者干预期间控制血压、血糖、血脂，给予营养神经、抗血小板类药物治疗，在此基础上对照组进行传统康复训练。观察组在对照组基础上联合认知功能障碍康复诊疗系统进行康复训练。比较两组干预前、干预3个月后认知功能[洛文斯顿作业疗法认知评定量表(LOTCA)评分、蒙特利尔认知评估量表(MoCA)评分]、焦虑程度[汉密尔顿焦虑量表(HAMA)评分]、日常生活活动能力[改良Barthel指数(MBI)]、神经递质[血清多巴胺(DA)、5-羟色胺(5-HT)]及训练依从性、随访结果。结果 两组干预3个月后LOTCA评分、MoCA评分分别高于本组干预前，且观察组LOTCA评分、MoCA评分高于对照组(P<0.05)。两组干预3个月后HAMA评分分别低于本组干预前，MBI分别高于本组干预前，且观察组HAMA评分低于对照组，MBI高于对照组(P<0.05)。两组干预3个月后DA、5-HT分别高于本组干预前，且观察组DA、5-HT高于对照组(P<0.05)。观察组训练依从性优于对照组(Z=2.656,P=0.008)。随访1年后，观察组HAMA评分<7分者占比为65.5%(38/58)，高于对照组的44.8%(26/58)(χ2=5.019,P=0.025)。结论 认知功能障碍康复诊疗系统可有效改善脑梗死后认知功能障碍伴焦虑患者认知功能，减轻焦虑程度，提高患者日常生活活动能力、训练依从性，进而促进焦虑症状完全消失。

Abstract：

　Objective To explore the intervention effect of cognitive dysfunction rehabilitation diagnosis and treatment system on patients with cognitive dysfunction and anxiety after cerebral infarction. Methods A total of 116 patients with cognitive dysfunction and anxiety after cerebral infarction who were admitted to Department of Neurology of Beijing Shijingshan Hospital from June 2018 to May 2020 were selected. According to the random number table method, they were divided into observation group and control group, 58 cases in each group. During the intervention period, blood pressure, blood glucose and blood lipid were controlled, and neuronutrition and antiplatelet drugs were given to the patients. On this basis, traditional rehabilitation training was performed in the control group. The observation group was treated with cognitive dysfunction rehabilitation treatment system on the basis of the control group. The cognitive function [Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) scores, Montreal Cognitive Assessment (MoCA) scores] , anxiety degree [Hamilton Anxiety Scale (HAMA) scores] , daily living ability [modified Barthel index (MBI) ] , neurotransmitters [dopamine (DA) , 5-hydroxytryp tamine (5-HT) ] before intervention and after 3 months of intervention, training compliance, and follow-up results were compared between the two groups. Results The LOTCA score and MoCA score of the two groups after 3 months of intervention were higher than those before intervention respectively, and the LOTCA score and MoCA score of the observation group were higher than those of the control group (P < 0.05) . After 3 months of intervention, HAMA score of the two groups was lower than that before intervention, MBI was higher than that before intervention respectively, and HAMA score of the observation group was lower than that of the control group, MBI was higher than that of the control group (P < 0.05) . After 3 months of intervention, DA and 5-HT in the two groups were higher than those before intervention respectively, and DA and 5-HT in the observation group were higher than those in the control group (P < 0.05) . The training training compliance of the observation group was better than that of the control group (Z=2.656, P=0.008) . After one year of follow-up, the proportion of patients with HAMA score < 7 in the observation group was 65.5% (38/58) , which was higher than 44.8% (26/58) in the control group (χ2 =5.019, P=0.025) . Conclusion The cognitive dysfunction rehabilitation diagnosis and treatment system can effectively improve the cognitive function of patients with cognitive dysfunction and anxiety after cerebral infarction, reduce the degree of anxiety, improve the daily living ability and training compliance, and then promote the complete disappearance of anxiety symptoms.

ReferenceList：