功能训练并用复方阿米三嗪改善重型颅脑损伤患者的认知功能

背景重型颅脑损伤患者的认知功能障碍给康复治疗带来困难,如何改善患者的认知功能是临床康复工作中的一项重要内容.目的探讨功能训练结合复方阿米三嗪对重型颅脑损伤恢复期患者认知功能障碍的治疗作用.设计非随机化同期对照观察.单位南方医科大学附属南方医院康复医学科病房.对象选择2000-02/2002-05在南方医科大学附属南方医院收治的48例重型颅脑损伤恢复期患者(创伤后昏迷时间≥6 h,格拉斯哥昏迷量表评分≤8分),按家属意愿分为分复方阿米三嗪组和常规组两组各24例.方法常规组在给予神经营养、改善血循环、脱水治疗及防治并发症的同时行康复功能训练,主要是运动治疗和作业治疗;复方阿米三嗪组在此基础上给予复方阿米三嗪片,1片/次,2次/d.观察疗程为1个月.主要观察指标①治疗前后检测单光子发射计算机断层扫描以了解缺血灶数目(局限性脑血流量减低区).②治疗前后应用简明精神状态检查(满分30分,其中定向力及记忆力占16分,评分越高提示认知功能越好)评估认知功能.结果按意向处理分析,48例全部进入结果分析.①缺血灶数目治疗后复方阿米三嗪组与常规组均较治疗前有明显减少,但两者比较无差异[(2.00±0.68),(2.20±0.85)个].②简明精神状态检查评分治疗后两组总分比较无差异(P＞0.05),定向力及记忆力得分均较治疗前显著升高,且复方阿米三嗪组得分显著高于常规组(8.70±2.23,5.60±1.77,P＜0.05).结论复方阿米三嗪对改善重型颅脑损伤后患者认知功能有帮助,尤其是对定向力及记忆力的改善作用更加显著.

Functional training combined with almitrine-raubasine treatment for improving cognitive function of patients with severe craniocerebral injury

BACKGROUND: Cognitive dysfunction brings difficulty for the rehabilitation treatment of patients with severe craniocerebral injury, and improving their cognitive function is the important task in clinical rehabilitative practice.OBJECTIVE: To observe the therapeutic effect of functional training in combination with almitrine-raubasine compound treatment for improving the cognitive function of patients with severe craniocerebral injury during recovery.DESIGN: Non-randomized concomitant controlled observation.SETTING: Department of Rehabilitation, Nanfang Hospital of Nanfang Medical University.PARTICIPANTS: Totally 48 patients with severe craniocerebral injury in recovery stage were admitted in Nanfang Hospital of Nanfang Medical University (coma time ≥ 6 hours after injury with Glasgow coma scores ≤ 8)between February and May 2000 and divided into Duxil (commercial name for almitrine-raubasine compound) group and conventional treatment group according to the willingness of the family members, with 24 cases in each group.METHODS: Patients in the conventional treatment group received treatment for neurotrophic support, improving blood circulation, correcting dehydration, and preventing and treating complications in addition to rehabilitative functional training that mainly consisted of motor function and performance training. On the basis of the above treatments, the patients in Duxil group were given additional Duxil, 1 tablet a time and twice a day,for an observation course of 1 month.tomography (SPECT) was performed before and after treatment to identify mental state examination (MMSE) was carried out before and after treatment to assess the patients' cognition function (totally 30 scores with orientation ability and memory of 15 scores respectively, higher grades suggests better cognitive function).RESULTS: According to intention-to-treat analysis, 48 cases all entered the result analysis. The number of ischemic foci was obviously reduced after treatment in both Duxil group and conventional treatment group, but the number was comparable between the two groups (2.00±0.68 vs 2.20±0.85).After treatment, the MMSE total scores showed no statistical difference between the two groups (P ＞ 0.05), but the scores for orientation and memory abilities increased remarkably after treatment, with the scores of Duxil group significantly higher than that of the conventional group (8.70±2.23 vs 5.60±1.77, P ＜ 0.05).CONCLUSION: Duxil can improve the cognitive function of patients with severe craniocerebral injury, with especially obvious effect on orientation and memory abilities.