麻将训练联合多奈哌齐对缺血性卒中后认知障碍患者的疗效观察

Effect of Mahjong Training Combined with Donepezil on Patients with Cognitive Impairment after Ischemic Stroke

摘要: 目的：分析麻将训练对缺血性卒中后认知障碍患者的认知改善情况，为PSCI (卒中后认知障碍)患者提供有效的康复治疗手段。方法：2022年9月至2022年12月在海垦社区对缺血性脑卒中后认知障碍的患者进行认知功能评估，根据纳入和排除标准共入组40例患者。并将所入组的40例患者随机分为干预组和非干预组，即干预组20例，非干预组20例。非干预组患者每日常规予以脑梗死二级预防药物和多奈哌齐药物口服治疗。而干预组患者在日常脑梗死二级预防药物和多奈哌齐药物口服治疗基础上，对患者进行麻将训练。干预组共分5组，以4人为一组，每周一次对干预组的患者进行麻将训练，训练时长共4个月。在干预前、4个月时，运用MMSE (简易精神状态量表)、MoCA (蒙特利尔认知评估量表)及临床痴呆评分量表(CDR评分量表)进行评估。最后运用相应的统计学方法对两组患者的疗效进行比较分析。结果：1) 两组患者性别、梗死部位、高血压、糖尿病、高脂血症等，经两组患者年龄经独立样本t检验结果显示，差异无统计学意义(P > 0.05)。两组患者性别、梗死部位、高血压、糖尿病、高脂血症人数所占比例经χ2检验结果显示，差异均无统计学意义(P > 0.05)。两组患者文化程度经Mann-Whitney U检验结果显示，差异无统计学意义(P > 0.05)；2) 两组患者干预前、4个月时的MMSE评分经独立样本t检验结果显示，两组患者干预前MMSE评分差异无统计学意义(P > 0.05)，干预组干预4个月时的MMSE评分明显高于非干预组，差异有统计学意义(P < 0.05)。两组患者干预前与干预后的MMSE评分经配对样本t检验结果显示，干预组干预4个月时的MMSE评分均明显高于干预前，差异有统计学意义(P < 0.05)，非干预组干预前与4个月时的MMSE评分差异无统计学意义(P > 0.05)。3) 两组患者干预前、干预4个月时的MoCA评分经独立样本t检验结果显示，两组患者干预前MoCA评分差异无统计学意义(P > 0.05)；干预组干预后4个月MoCA评分明高于非干预组，差异有统计学意义(P < 0.05)；两组患者干预前与干预后的MoCA评分经配对样本t检验结果显示，干预组4个月时的MoCA评分均明显高于干预前，差异有统计学意义(P < 0.05)，非干预组干预前与4个月时的MoCA评分差异无统计学意义(P > 0.05)；4) 两组患者干预前、干预4个月时的痴呆评分经Mann-Whitney U检验结果显示，两组患者干预前痴呆评分差异无统计学意义(P > 0.05)，干预组干预后4个月的痴呆评分明显低于非干预组，差异有统计学意义(P < 0.05)；两组患者干预前与干预后4个月的痴呆评分经Wilcoxon符号秩检验结果显示，两组患者干预后4个月痴呆评分均明显低于干预前，差异有统计学意义(P < 0.05)。结论：干预组患者在麻将训练4个月后的综合认知评分较干预前要明显提高；干预组在干预4个月时的临床痴呆评分要明显低于干预前；同样非干预组患者在4个月时的临床痴呆评分要低于干预前；而干预组患者4个月时的综合认知评分要高于非干预组患者；干预组患者4个月时的临床痴呆评分要明显低于非干预组患者。

Abstract: Objective: To analyze the cognitive improvement of mahjong training on patients with cognitive impairment after ischemic stroke, and to provide effective rehabilitation treatment for patients with PSCI (cognitive impairment after stroke). Methods: PSCI patients in Haiken community from September 2022 to December 2022 were selected for cognitive function assessment. A total of 40 patients were selected according to inclusion and exclusion criteria, and the 40 patients were ran-domly divided into intervention group and non-intervention group, namely 20 patients in interven-tion group and 20 patients in non-intervention group. Patients in the non-intervention group were routinely given secondary prevention drugs for cerebral infarction and oral treatment with Donepezil. The patients in the intervention group received mahjong training on the basis of daily secondary prevention drugs for cerebral infarction and oral treatment with Donepezil. The inter-vention group was divided into 5 groups, and the patients in the intervention group received mah-jong training once a week for a total of 4 months. Before the intervention, at 4 months, the MMSE (Simple Mental State Scale), MoCA (Montreal cognitive Assessment Scale) and Clinical Dementia score scale were used to evaluate. Finally, corresponding statistical methods were used to compare the efficacy of the two groups of patients. Results: 1) Gender, infarct site, hypertension, diabetes, hyperlipemia and age of patients in the two groups by independent sample t-test showed no statis-tical significance (P > 0.05). χ2 test results showed no significant differences in gender, infarct site, hypertension, diabetes and hyperlipemia in 2 groups (P > 0.05). The results of Mann-Whitney U test showed no statistical significance in education level between the two groups (P > 0.05). 2) The in-dependent sample t-test results showed that the MMSE scores before intervention and at 4 months between the two groups had no statistical significance (P > 0.05), and the MMSE scores in the inter-vention group at 4 months were significantly higher than those in the non-intervention group, with statistical (P < 0.05). The results of paired sample t-test showed that the MMSE scores of the two groups before and after intervention were significantly higher in the intervention groups at 4 months, with statistical significance (P < 0.05), while the MMSE scores of the non-intervention group at 4 months and before intervention had no statistical significance (P > 0.05). 3) The results of in-dependent sample t-test showed that there was no significant difference in MoCA scores between the two groups before intervention and 4 months after intervention (P > 0.05). The MoCA score of the intervention group was significantly higher than that of the non-intervention group at 4 months after intervention, and the difference was statistically significant (P < 0.05). The results of paired sample t-test showed that the MoCA score of the two groups before and after intervention was sig-nificantly higher at 4 months in the intervention group than before intervention, the difference was statistically significant (P < 0.05), while the MoCA scores of the non-intervention group were not statistically significant between before intervention and 4 months (P > 0.05). 4) The results of Mann-Whitney U test showed that the dementia scores of 40 patients in the two groups before in-tervention and 4 months after intervention showed no significant difference between the two groups before intervention (P > 0.05), and dementia at 4 months after intervention in the interven-tion group, the score was significantly lower than that of the non-intervention group, the difference was statistically significant (P < 0.05). Wilcoxon signed rank test showed that dementia scores of patients in both groups were significantly lower at 4 months after intervention than before inter-vention, and the difference was statistically significant (P < 0.05). Conclusion: The overall cognitive score of patients in the intervention group was significantly improved after 4 months of mahjong training. The clinical dementia score of the intervention group at 4 months was significantly lower than that before intervention; similarly, patients in the non-intervention group had lower clinical dementia scores at 4 months than before the intervention. In addition, overall cognitive scores at 4 months were higher in the intervention group than in the non-intervention group, and clinical de-mentia scores at 4 months were significantly lower in the intervention group than in the non-intervention group.