认知训练改善卒中后认知功能障碍系统评价.docVIP

认知训练改善卒中后认知功能障碍系统评价 　　【摘要】目的：系统评价认知训练对卒中后认知功能障碍的疗效。方法：严格按照循证医学系统评价方法，收集所有认知训练对卒中后认知功能障碍的临床随机对照试验研究文献，并对纳入的研究逐个进行质量评价，而后采用RevMan50软件进行Meta分析。结果：7个研究共368例患者符合纳入标准。Meta分析结果显示：PSCI患者的MMSE评分（MD）=542，95%CI=（316，768），差异有统计学意义（P005）；BI评分（MD）=1117，95%CI=（440，1794），差异有统计学意义（P005）。结论：认知训练可有效改善卒中后认知功能障碍患者的认知功能和日常生活能力。 　　【关键词】认知训练；脑卒中；认知功能障碍；系统评价 　　【中图分类号】R493【文献标志码】 A【文章编号】1007-8517（2017）08-0078-05 　　Abstract：Objective We conducted a meta-analysis to evaluate the efficacy of cognitive training on post-stroke cognitive impairment.Methods Randomized controlled trials （RCTs） comparing cognitive training with no cognitive training in addition to either medicine or rehabilitation were identified from Database. Meta-analyses were conducted for the eligible RCTs.Results Seven trials with a total of 368 patients met inclusion criteria. Pooled random-effects estimates of the change in the Mini-Mental State Examination were calculated for the comparison of cognitive training with no cognitive training in addition to medicine or rehabilitation. Following intervention with cognitive training， the merged mean difference （MD） was 5.42 （95% CI [3.16，7.68]，P0005）. For the comparison of cognitive training with no cognitive training in addition to medicine or rehabilitation groups， the Barthel Index MD was 1117，95% CI=（440，17.94），（P005）. Overall， the study quality was rated as moderate based on the Cochrane Handbook for Systematic Reviews of Intervention：Part 2：8.5.Conclusion This meta-analysis suggests that cognitive training had positive effects on cognitive function and Activities of daily living of post-stroke cognitive impairment patient. 　　Keywords：Cognitive Function； Meta-Analysis； Cognitive Function； Stroke 　　?X卒中后导致一系列躯体、认知、行为和情感等障碍，其中卒中后认知功能障碍（post-stroke cognitive impairment， PSCI）的发生率很高，卒中后3个月认知功能障碍的发生率为218%～500%[1-2]。Sundar等报道卒中后3个月认知功能损害的发病率为317%[3-4]。认知障碍不但影响病人的社会适应能力，而且影响脑卒中患者的全面康复。国内外对认知障碍的治疗主要有药物、高压氧、康复训练等。康复训练是根据患者脑部病变部位，评估存在障碍的认知功能域及严重程度，制定针对性康复干预方案，以达到再次学习、提高应用水平等目的。认