摘要目的:评价不同非药物干预方法对脑卒中后认知障碍（PSCI）患者认知功能及日常生活活动能力的影响。方法:基于Cochrane Library、PubMed、Web of Science、Embase、中国知网、万方及维普数据库，检索建库至2021年12月31日公开发表的PSCI患者康复治疗的随机对照研究，并进行文献筛选、资料提取、质量评价和数据分析。结果:纳入的26项研究涉及12种干预方法和2 007例PSCI患者，网状Meta分析结果显示，相比常规康复训练和/或常规康复护理，认知训练（ SMD=-1.30，95% CI -2.09~-0.52）、重复经颅磁刺激（ SMD=-1.67，95% CI -2.54~-0.81； SMD=-2.34，95% CI -3.71~-0.97）、重复经颅磁刺激联合认知训练（ SMD=-1.56，95% CI -2.76~-0.36； SMD=-2.23，95% CI -3.39~-1.07）、针刺联合认知训练（ SMD=-2.31，95% CI -3.51~-1.12； SMD=-2.98，95% CI -4.13~-1.84）、虚拟现实技术（ SMD=-1.01，95% CI -1.98~-0.04； SMD=-1.68，95% CI -2.98~-0.38）、计算机辅助认知训练联合认知训练（ SMD=-2.50，95% CI -4.35~-0.65； SMD=-3.17，95% CI -4.99~-1.35）、音乐疗法（ SMD=-1.47，95% CI -2.61~-0.33）、音乐疗法联合认知训练（ SMD=-2.35，95% CI -4.04~-0.67）、工娱疗法（ SMD=-2.11，95% CI -3.93~-0.30）、引导想象训练（ SMD=-2.48，95% CI -4.00~-0.96）在改善PSCI患者认知功能方面差异均有统计学意义（均 P<0.05）；工娱疗法（ SMD=-3.57，95% CI -6.09~-1.04； SMD=-3.70，95% CI -7.22~-0.18）在改善PSCI患者日常生活活动能力方面差异有统计学意义（ P<0.05）。根据累积排序概率图下面积排序结果，针刺联合认知训练（89.2%）和工娱疗法（85.1%）分别在改善认知功能和日常生活活动能力方面居首位。 结论:针刺联合认知训练、工娱疗法分别对改善PSCI患者认知功能、日常生活活动能力效果最佳，但考虑纳入原始文献质量不高，尚需要更多大样本、高质量随机对照研究来进一步验证。

abstractsTo evaluate the effects of non-pharmacological interventions on cognitive function and activities of daily living in patients with post-stroke cognitive impairment (PSCI).Methods:Based on Cochrane Library, PubMed, Web of Science, Embase, CNKI, WanFang, and VIP databases, randomized controlled studies on rehabilitation therapy for PSCI patients were retrieved. And the retrieval date was from the establishment of the databases to 31 December 2021. Literature screening, data extraction, quality evaluation and data analysis were carried out.Results:A total of 26 studies were included, involving 12 interventions and 2007 patients with PSCI. The results of network Meta-analysis showed that compared with routine rehabilitation and/or routine rehabilitation care, cognitive therapy ( SMD=-1.30, 95% CI -2.09 - -0.52)、repetitive transcranial magnetic stimulation ( SMD=-1.67, 95% CI -2.54 - -0.81; SMD=-2.34, 95% CI -3.71 - -0.97), repetitive transcranial magnetic stimulation combined with cognitive therapy ( SMD=-1.56, 95% CI -2.76 - -0.36; SMD=-2.23, 95% CI -3.39 - -1.07), acupuncture combined with cognitive therapy ( SMD=-2.31, 95% CI -3.51 - -1.12; SMD=-2.98, 95% CI -4.13 - -1.84), virtual reality ( SMD=-1.01, 95% CI -1.98 - -0.04; SMD=-1.68, 95% CI -2.98 - -0.38), computer-assisted cognitive training combined with cognitive therapy ( SMD=-2.50, 95% CI -4.35 - -0.65; SMD=-3.17, 95% CI -4.99 - -1.35), music therapy ( SMD=-1.47, 95% CI -2.61 - -0.33), music therapy combined with cognitive therapy ( SMD=-2.35, 95% CI -4.04 - -0.67), recreational therapy ( SMD=-2.11, 95% CI -3.93 - -0.30), guided imagination therapy ( SMD=-2.48, 95% CI -4.00 - -0.96) had statistical significance in improving the cognitive function of PSCI patients ( P<0.05); recreational therapy ( SMD=-3.57, 95% CI -6.09 - -1.04; SMD=-3.70, 95% CI -7.22 - -0.18) had statistical significance in improving the ability of daily living activities of PSCI patients ( P<0.05). According to the area ranking results under the cumulative ranking probability graph, acupuncture combined with cognitive therapy (89.2%) and recreational therapy (85.1%) ranked first in improving cognitive function and activities of daily living, respectively. Conclusions:Acupuncture combined with cognitive therapy and recreational therapy have the best effect on improving cognitive function and activities of daily living in PSCI patients, respectively. However, considering the poor quality of the original literature included, more large samples and high-quality RCTs are needed for further verification.