| 杨健,梁桂生,邓嘉威,廖成钜,周光辉.基于脑神经代谢物变化研究经颅直流电刺激配合认知训练治疗卒中后认知功能障碍的疗效[J].中国康复,2023,38(1):20-25 |
| 基于脑神经代谢物变化研究经颅直流电刺激配合认知训练治疗卒中后认知功能障碍的疗效 |
| Curative effectiveness of transcranial direct current stimulation combined with cognitive training in the treatment of cognitive dysfunction after stroke based on the changes of cerebral nerve metabolites |
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| DOI： |
| 中文关键词: 经颅直流电刺激 认知训练 卒中后认知功能障碍 脑神经代谢物 随机行走模型 |
| 英文关键词: transcranial direct current stimulation cognitive training cognitive dysfunction after stroke brain neurometabolites random walk model |
| 基金项目:东莞市社会科技发展（一般）项目（201950715024924） |
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| 中文摘要: |
| 目的：观察经颅直流电刺激（tDCS）配合认知训练对卒中后认知功能障碍患者认知功能恢复的影响。方法：选取100例卒中后认知功能障碍患者，随机分为对照组和观察组，对照组给予认知训练，观察组在对照组治疗基础上给予tDCS。比较2组患者治疗前后的认知功能、日常生活活动能力及脑神经代谢物表达水平的变化；采用随机行走模型评价2组患者治疗后脑神经代谢物表达水平的改善情况。结果：观察组治疗总有效率明显高于对照组（84.00%、62.00%，P＜0.05）；2组患者治疗后的简易智力状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）、改良Barthel指数（MBI）、功能独立性评定量表（FIM）评分较治疗前均显著增加（均P＜0.05）；2组患者血清去甲肾上腺素（NE）、多巴胺（DA）水平、5-羟色胺（5-HT）/5-羟吲哚乙酸（5-HIAA）、3,4-二羟基苯乙酸（DOPAC）/高香草酸（HVA）比值、脑内氮-乙酰天门冬氨酸（rNAA）比值较治疗前显著升高（均P＜0.05），而脑内乳酸相对浓度Lac/Cr较治疗前显著下降（均P＜0.05）；随机行走模型显示，观察组治疗后NE、DA、5-HT/5-HIAA、DOPAC/HVA、rNAA、Lac/Cr的改善效果优于对照组（均P＜0.05）。结论：tDCS配合认知训练能够明显改善卒中后认知功能障碍患者的认知功能、日常行为活动能力，提高治疗效果，这可能与调节脑神经代谢物表达水平有关。 |
| 英文摘要: |
| Objective： To observe the effects of transcranial direct current stimulation (tDCS) combined with cognitive training on the expression of cerebral metabolites in patients with post-stroke cognitive dysfunction. Methods： A total of 100 patients with post-stroke cognitive dysfunction admitted to our hospital from October 2019 to February 2021 were selected as the research objects. They were divided into control group and observation group by the random number table method. The control group was given cognitive training, and the observation group was given tDCS in addition to the treatment of the control group. The clinical efficacy, cognitive function, ability of daily living and expression level of neurometabolites before and after treatment were compared between the two groups. A random walking model was used to evaluate the improvement of cerebral neurometabolite expression in 2 groups after treatment. Results：The total effective rate in observation group ［84.00% (42/50)］ was significantly higher than that in control group ［62.00% (31/50)］(P<0.05). After treatment, the scores of MMSE, Montreal Cognitive Assessment Scale (MoCA), Modified Barthel Index (MBI) and Functional Independence Rating Scale (FIM) were significantly increased in 2 groups as compared with those before treatment (all P<0.05). Serum norepinephrine (NE), dopamine (DA) levels, 5-hydroxytryptamine (5-HT)/5-hydroxyindoleacetic acid (5-HIAA), ratio of 3, 4-dihydroxyphenylacetic acid (DOPAC)/vanillic acid (HVA), and ratio of N-acetylaspartic acid (rNAA) in brain of 2 groups after treatment were significantly increased as compared with those before treatment. The concentration of Lac/Cr in the brain was significantly decreased as compared with that before treatment, and the concentration of LAC/Cr in the observation group was significantly decreased as compared with that in the control group (all P<0.05). The results of random walking model showed that NE, DA, 5-HT/5-HIAA, DOPAC/HVA, rNAA and Lac/Cr in the observation group were significantly increased as compared with those in the control group. Conclusion： TDCS combined with cognitive training can significantly improve the cognitive function, daily behavior ability and therapeutic effect of patients with cognitive impairment after stroke, which may be related to the regulation of the expression of neurometabolites in the brain. |
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