卒中后认知功能减退的相关临床研究

【作者】 杜延军；

【导师】 谢颖桢；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2009， 硕士

【摘要】 目的:全国每年新发的脑卒中患者人数约两百万,认知功能减退是急性脑卒中患者最常见的表现之一。认知功能减退不但影响患者的社会适应能力与日常生活,而且影响脑卒中的全面康复、治疗与二级预防。本项研究旨在对卒中后认知功能减退的特点、其相关影响因素以及中医证候特征进行研究,对早期诊断、预防和临床治疗卒中后认知功能减退具有重要指导意义。方法:对50例新发脑梗死非痴呆患者应用简易智能状态检查量表(MMSE)和蒙特利尔认知评估量表(北京版)、DS量表在发病14天、1月、3月定期评定认知功能,完善相关辅助检查,包括头颅核磁共振(MRI)检查,多时点采集中医四诊信息,并对血压、血糖、血脂等进行检测和相关病历资料分析。MoCA量表子项目交替连线试验、视空间试验、画钟试验的组合是最佳分析方法,把发病3月时点交替连线试验＜1分、视空间试验＜1分、画钟试验＜3分的并集结合MoCA量表推荐分值(减退值〈26分)作为卒中后认知功能减退的评判标准,当中患者归属于卒中后认知功能减退组,其余属于卒中后认知功能无减退组。结果:①发病前3月总体MMSE量表与MoCA量表、DS量表分值逐渐升高。MMSE量表时空定向力、计算力,MoCA量表命名、计算力、延迟回忆、定向力快速恢复,书写、绘画能力、连线试验、视空间试验、画钟试验、抽象力、语言重复力减退缺损人数持续高水平且减少缓慢;②卒中后认知功能减退组双侧、多发病灶、皮层、基底节、侧脑室扩大梗塞患者比例明显高于无认知功能减退组,卒中后认知功能减退组高龄段人数所占比例明显高于无认知功能减退组,卒中后认知功能减退组饮酒、嗜荤的患者比例远低于卒中后认知功能无减退组。认知功能减退组的阳虚体质的人所占比例明显高于认知功能无减退组。③认知功能减退组痰证、阴虚证分值均值在发病1月、3月高于认知功能无减退组,有统计学差异。认知功能减退组气虚证分值均值在发病14天、1月、3月均高于认知功能无减退,有统计学差异。结论:①脑梗死患者存在一定程度的早期认知功能损害,以书写、绘画能力、连线试验、视空间试验、画钟试验、抽象力、语言重复力受损为主要特征,发病前3月认知功能总体趋势好转;②本项研究提示头颅核磁共振(MRI)检查双侧、多发病灶、皮层、基底节、侧脑室扩大、年龄、饮酒、嗜荤、阳虚体质很可能与卒中后认知功能减退有关系。③本项研究提示中医的痰证、气虚证、阴虚证可能是卒中后认知功能减退的主要证候。更多还原

【Abstract】 Objective:Every year the number of stroke patients is about 2 million and cognitive dysfunction in patients with acute stroke are the most common manifestations.The impact of cognitive decline in patients with not only the ability to adapt to everyday life and society and the impact of a comprehensive stroke rehabilitation,treatment and secondary prevention after cerebral infarction.This study aimed at the characteristics of cognitive decline and its related factors,as well as to study the characteristics of syndromes for early diagnosis,prevention and provide a basis for clinical treatment.Methods:50 cases of non-demented patients with new cerebral infarction are assessed with mini-mental state examination(MMSE) and Montreal Cognitive Assessment Scale(Beijing edition),DS Scale at 14 days,1 month,3 month of onset to assess cognitive function in a regular basis,at the same time using the Ranking Scale,I ADL Scale, BI Scale,NIHSS Scale,as well as other areas to assess and improve the relevant examinations,including cranial magnetic resonance imaging(MRI)examination,collection of Chinese medicine for some time points four patient information and blood pressure,blood glucose, blood lipids,such as testing and related medical data analysis.Scale MoCA connection sub-turn test,depending on space experiments,a combination of draw bell test is the best analytical methods,the incidence of 3 month pilot to connect the turn point in time＜1 point, depending on the space test＜1 point,draw bell test＜3 points combining recommend MoCA scores(reduced value of＜26 points)as a post-stroke cognitive decline of the evaluation criteria,which attributed to post-stroke patients with cognitive decline group,and the rest belong to non-cognitive function after stroke reduced group.Results:①After 3 months,MMSE Scale and MoCA Scale,DS Scale score increased gradually.Spatial orientation when the MMSE scale,and calculating the force,MoCA named scale,computing power,memory delay,express recovery orientation,writing,painting,capacity,the connection test,depending on space experiments,draw bell test, abstract,and duplicate language ability reduced defects come back to the number of high-level slowly;②Cognitive decline after stroke group with bilateral,multiple lesions,the cortex,basal ganglia, lateral expansion of infarction was significantly higher than the proportion of patients without cognitive decline groups,the cognitive decline group average age was significantly higher than the non-cognitive decline group;post-stroke cognitive decline group′drinking,meatting anopheles rate is much lower than that of non-cognitive decline group.Group cognitive decline of people Yangxu constitution was significantly higher than normal cognitive function.③In Cognitive decline group,Tan,yin deficiency′mean score is higher than the non-cognitive decline group at 1 month,3 month,and there is significant difference between the differences.In Cognitive decline group qi deficiency′mean scores at 14 days,1 month,3 month were higher than normal cognitive function group,and there is significant difference between the differences.Conclusion:①There is a certain degree of cerebral infarction in patients with early cognitive impairment to writing and painting capacity,the connection test,depending on space experiments,draw bell test,abstract,and language impaired to duplicate and this is the main features of cognitive dysfunction;In March prior to the onset,improvement is in the overall trend;②NMR study prompted the head(MRI)examination of bilateral,multiple lesions,the cortex, basal ganglia,lateral expansion of,age,alcohol,meat Anopheles, yangxu constitution may be related to cognitive function.③Tan,Qi deficiency,Yin deficiency are the major syndromes of post-stroke cognitive decline.更多还原