益气聪明汤联合康复治疗对脑卒中后认知功能障碍患者认知及日常生活能力的影响

The Impact of Yiqi Congming Decoction Combined with Rehabilitation Therapy on Cognition and Activities of Daily Living in Patients with Cognitive Dysfunction after Stroke

摘要: 目的：探讨益气聪明汤加减联合常规康复治疗对气虚血瘀型脑卒中后认知功能障碍(PSCI)患者认知水平、日常生活活动能力及各血清学指标的临床疗效，为脑卒中后认知障碍的防治提供依据。方法：选取2024年1月~2025年12月黑龙江省哈尔滨市阿城区中医医院康复理疗科收治的86例气虚血瘀型PSCI患者为研究对象，采用随机数字表法分为对照组与观察组，各43例。对照组实施常规治疗，观察组在对照组基础上口服益气聪明汤加减治疗，两组均连续干预8周。比较干预前后两组简易精神状态检查表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分、Barthel日常生活能力指数(BI)及血清脑源性神经营养因子(BDNF)、同型半胱氨酸(Hcy)水平，同时监测干预期间不良事件发生情况。结果：干预前两组各项基线指标差异无统计学意义(P > 0.05)；干预8周后，观察组总有效率90.70%显著高于对照组72.09% (P < 0.05)；两组MMSE评分、MoCA评分、Barthel指数及血清BDNF水平均较干预前升高，血清Hcy水平较干预前降低，且观察组改善幅度显著优于对照组(P < 0.05)。两组均无严重不良事件发生。结论：益气聪明汤加减联合康复治疗具有益气活血、升阳通络、通窍益智的作用，有效改善气虚血瘀型PSCI患者的认知功能，提升日常生活活动能力，调节血清神经因子水平，安全性良好，值得临床推广应用。

Abstract: Objective: To investigate the clinical efficacy of Yiqi Congming Decoction (YCD) combined with conventional rehabilitation therapy on cognitive level, activities of daily living (ADL), and various serum markers in patients with post-stroke cognitive impairment (PSCI) of qi deficiency and blood stasis type, and to provide evidence for the prevention and treatment of post-stroke cognitive impairment. Methods: A total of 86 patients with PSCI of qi deficiency and blood stasis type admitted to the neurology department of a tertiary hospital from January 2024 to December 2025 were selected as the study subjects and divided into a control group and an observation group using a random number table method, with 43 cases in each group. The control group received conventional treatment, while the observation group received oral YCD treatment on the basis of the control group. Both groups underwent continuous intervention for 8 weeks. The scores of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Barthel Index (BI), as well as the levels of serum brain-derived neurotrophic factor (BDNF) and homocysteine (Hcy), were compared between the two groups before and after intervention. Additionally, the occurrence of adverse events during the intervention period was monitored. Results: There were no significant differences in baseline indicators between the two groups before intervention (P > 0.05). After 8 weeks of intervention, the total effective rate in the observation group was 90.70%, which was significantly higher than that in the control group (72.09%) (P < 0.05). Both MMSE scores, MoCA scores, Barthel index, and serum BDNF levels increased after intervention, while serum Hcy levels decreased, with significantly greater improvements in the observation group compared to the control group (P < 0.05). No serious adverse events occurred in either group. Conclusion: YCD combined with rehabilitation therapy has the effects of nourishing qi, promoting blood circulation, ascending yang, dredging meridians, and improving intelligence, effectively improving cognitive function in patients with PSCI of qi deficiency and blood stasis type, enhancing ADL, regulating serum neurofactor levels, and demonstrating good safety. It is worthy of clinical promotion and application.