临床误诊误治

目的 观察“通督醒神”式针刺联合治疗脑卒中后轻度认知障碍（PSMCI）的效果及对血清脑源性神经营养因子（BDNF）、神经元特异性烯醇化酶（NSE）的影响。方法 采用随机数字表法将2020年1月至2024年1月收治的124例PSMCI患者分为2组，对照组给予常规治疗联合认知训练，观察组在此基础上加用“通督醒神”式针刺治疗，均治疗4周。治疗后比较2组临床疗效和不良反应，以及治疗前后简易精神状态检查量表（MMSE）评分、蒙特利尔认知评估量表（MoCA）评分、改良Barthel指数评定量表（MBI）评分和血清BDNF、NSE水平。结果 观察组总有效率为91.94%(57/62)高于对照组的77.42%(48/62)，差异有统计学意义（P<0.05）。治疗后2组MMSE、MoCA及MBI评分均升高，且观察组上述评分更高（P<0.05,P<0.01）。治疗后2组BDNF水平均升高，且观察组高于对照组（P<0.05,P<0.01）；治疗后2组NSE水平均降低，且观察组低于对照组（P<0.05,P<0.01）。2组不良反应发生率比较无明显差异（P>0.05）。结论 “通督醒神”式针刺联合治疗PSMCI患者效果好，能有效减轻患者认知障碍，改善认知功能与生活自理能力，保护神经细胞，且安全性较高。

Objective To observe the effect of "Tongdu Xingshen" acupuncture combination treatment on post-stroke mild cognitive impairment(PSMCI) and its impact on serum brain-derived neurotrophic factor(BDNF) and neuron-specific enolase(NSE). Methods A total of 124 patients with PSMCI treated from January 2020 to January 2024 were divided into two groups by random number table method. The control group was given conventional treatment combined with cognitive training, and the observation group was treated with "Tongdu Xingshen" acupuncture therapy for 4 weeks. The clinical effect and adverse reactions of the two groups were compared after treatment, as well as the score of Mini-Mental State Examination(MMSE), Montreal Cognitive Assessment Scale(MoCA), modified Barthel Index Rating Scale(MBI) and BDNF and NSE levels before and after treatment.Results The total effective rate of observation group was 91.94%(57/62), which was higher than that of control group [77.42%(48/62)], showing significant difference(P<0.05). After treatment, the scores of MMSE, MoCA and MBI were increased in the two groups, and the above scores were higher in observation group(P<0.05, P<0.01). After treatment, the level of BDNF was increased in both groups, which was higher in the observation group than in the control group(P<0.05, P<0.01). After treatment, the level of NSE was decreased in both groups, which was lower in the observation group than in the control group(P<0.05, P<0.01). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion "Tongdu Xingshen" acupuncture combination treatment is more effective in the treatment of PSMCI patients, which can effectively reduce cognitive impairment, improve cognitive function and self-care ability, protect nerve cells, and has high safety