【作者】 许倩；

【导师】 江钢辉；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2011， 博士

【摘要】 背景血管性痴呆(Vascular Dementia, VD)是最常见的老年期痴呆之一,是指一组由缺血性和/或出血性脑血管疾病引起的脑功能损害所致的痴呆,其患病率大约占脑卒中幸存者中的1/3。随着人们寿命的延长以及脑血管病发病率逐年增高,血管性痴呆的发病率呈明显上升趋势,己成为人类衰老过程中常见的难治性疾病,目前国内外尚无有效地治疗本病或控制本病病程进展的方法和药物。该病不仅给患者带来了长期痛苦,严重影响患者的生存质量,成为威胁老年人身体健康和生活质量的重要疾病之一,也给病员家庭、社会及国家增添了沉重的负荷。因此积极开展对本病的研究具有非常重要的社会意义和现实意义。目的本课题针对血管性痴呆发病率高、复发率高、治疗难度大这些特点,采用修订Folstein简易精神状态检查(MMSE)量表、修订长谷川智力量表(HDS)、日常生活能力(ADL)量表、血管性痴呆的中医辨证量表(SDSVD、临床神经功能缺损量表(NFDS)、生存质量量表-36题健康调查问卷(SF-36),观察头颅计算机体层扫描成像(Computerized tomography, CT)定位围针法(简称“CT定位围针法”)治疗血管性痴呆前后各量表积分的变化,并进行比较,从而了解CT定位围针法治疗血管性痴呆的临床效果,并对CT定位围针法与传统头针法的疗效进行比较研究,旨在为临床提供一种简便易行、疗效确切的方法,为CT定位围针法的推广应用提供实践依据。治疗组与对照组在治疗前后行血清内皮素(ET)及一氧化氮(NO)检测,观测其变化情况,以期为CT定位围针法治疗血管性痴呆提供科学的理论依据。方法采用随机数字表简单随机化分组方法将符合纳入标准、经排除标准筛选的81例血管性痴呆患者分到CT定位围针组(治疗组)41例和传统头针组(对照组)40例。采用分析者(即第三者)盲法。所有患者均来自于广州中医药大学第一、第三附属医院。在对基础疾病行药物治疗前提下,CT定位围针组以头颅CT定位所示病灶在同侧头皮的最近距离的投射区周边为针刺部位行围针治疗,传统头针组则交替取顶中线、额中线、颞前线、颞后线针刺。两组均以苏州华佗牌一次性30号1.5寸不锈钢针灸针平刺,得气后以180-200次/分的频率捻转2分钟,留针30分钟,中间行针1次,约1分钟。每天治疗1次,每周连续治疗5天,休息2天,共治疗4周。治疗前、后分别进行修订Folstein简易精神状态检查(MMSE)量表、修订长谷川智力量表(HDS)、日常生活能力(ADL)量表、血管性痴呆的中医辨证量表(SDSVD)、临床神经功能缺损量表(NFDS)、生存质量量表-36题健康调查问卷(SF-36)的疗效及积分评估；在治疗前后行血清内皮素(ET)及一氧化氮(NO)检测。所有结果均用SPSS13.0分析。结果1在认知能力方面,治疗组总有效率为82.5%,对照组为56.41%,两组有显著性差异(P<0.05)；同时治疗组的显效率为25%,明显优于对照组的7.69%。在积分方面,治疗组较对照组有明显改善,两者有显著性差异(P<0.05),表明CT定位围针法对患者认知能力有较好的改善作用,优于传统头针法。2在痴呆程度改善方面,治疗组总有效率为85%,对照组为61.54%,两组有显著性差异(P<0.05)；同时治疗组的显效率30%,明显优于对照组的10.3%。在积分方面,治疗组较对照组有明显改善,有显著性差异(P<0.05),表明CT定位围针法对患者痴呆程度有较好的改善作用,优于传统头针法。3在日常生活能力方面,治疗组总有效率为85%,对照组为69.2%,两组有显著性差异(P<0.05)；同时治疗组的显效率为37.5%,明显优于对照组的15.4%。在积分方面,治疗组IADL(工具性日常生活能力量表)积分及ADL总积分均较对照组改善明显(P<0.05),表明CT定位围针法对患者日常生活能力有较好的改善作用,优于传统头针法,且在改善患者工具性日常生活能力方面较传统头针法有优势。4在中医证候方面,治疗组总有效率为72.5%,对照组为66.67%,两组无显著性差异(P>0.05)。在积分方面,治疗组与对照组均较治疗前明显改善,统计有显著性差异(P<0.05),但两组间比较,差别不明显(P>0.05),表明CT定位围针法与传统头针法对患者中医证候均有较好的改善作用,两者差别不明显。5在神经功能缺损积分方面,治疗组较对照组有明显改善,有显著性差异(P<0.05),表明CT定位围针法对神经功能缺损积分改善有较好作用,优于传统头针法。6在生存质量量表-36题健康调查问卷积分方面,治疗组在社会功能(SF)、情感角色(RE)、心理健康(MH)三个维度的积分及总积分上均较对照组有明显改善(P<0.05),表明CT定位围针法对患者生存质量量表积分改善有较好作用,优于传统头针法,且在患者心理因素影响的维度上较传统头针法有优势。7在患者血清内皮素(ET)值和血清一氧化氮(NO)值的测定方面,结果显示,两组均能显著降低患者血清内皮素(ET)值,升高血清一氧化氮(NO)值(P<0.01),且治疗组较对照组明显(P<0.05)。表明CT定位围针法在扩张脑血管、调节患者脑血流量方面较传统头针法更具有显著性。结论1两种方法对血管性痴呆均有较好的临床效果。2 CT定位围针法对血管性痴呆患者的治疗效果优于传统头针法。3 CT定位围针法在患者心理因素影响的领域效果较明显,对患者生存质量的改善优于传统头针法。4 CT定位围针法能显著降低患者血清内皮素(ET)值,升高血清一氧化氮(NO)值,在改善患者血管舒缩功能及调节脑血流量方面较传统头针法更具有显著性。5CT定位围针法操作简单方便,疗效确切,易于推广应用,具有较广阔的应用前景。更多还原

【Abstract】 BackgroundVascular Dementia (VD) is the most common form of the old age dementias. The dementia is always caused by brain function damage, which is the result of the ischemic and hemorrhagic cerebrovascular diseases. Its incidence rate in stroke survivors is about 1/3. With the prolonging of people’s lives and growing incidence of cerebro-vascular diseases year by year, the incidence rate of the Vascular Dementia rises obviously. Vascular Dementia has become a common and difficult disease in the aged. And nowadays, there is no effective treatment and medicine to alleviate or cure the disease. The disease has not only brought seriously suffering to the patients, but also reduced the quality of lives. Meanwhile, it is aslo a heavy burden on families and the society. Therefor, the research on this subject really has an important social and realistic significance.ObjectiveVascular Dementia has characteristics of high incidence and recurrence rate, which is difficult to treat. This subject is aiming to observe the clinical curative effect of the Surrounding Needling Based on CT (computerized tomography) Location treatment, The efficacy was judged by the Mini-Mental State Examination (MMSE), Hasegawa Dementia Scale (HDS), Ability of Daily Living scale (ADL), the Scale for the Differentiation of Syndromes of Vascular Dementia (SDSVD), Neurological Function Deficit Score (NFDS), Short Form 36 Health Survey Questionnaire (SF-36). Both of the two groups were tested the Serum Endothelin (ET)and Nitric Oxide (NO) before and after the treatment to investigate changes of them. In this way, providing scientific theory basis to the Surrounding Needling based on CT location treatment. Method81 patients who with the inclusion criteria and the exclusion standard were alloted by simple randomization into two groups:the Surrounding Needling based on CT location group (41 cases) and the Traditional Scalp Acupuncture group (40 cases). Extramural judgement was used to observe the results. All the 81 patients of Vascular Dementia were came from the Clinic of The First and Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. The areas of the Surrounding Needling based on CT location group (the treatment group) for acupuncture were selected according to the location by CT scan result and needles were inserted in the galea aponeurotics around the selected areas, while the Traditional Scalp Acupuncture group(the matched group) selected the top midline, frontal midline, temporal front and Linear temporal line as the area for acupuncture. Both of the two groups used the 1.5 inches of stainless needles inserted in the galea aponeurotics, then twisted the needles with 180～200 times per minute of frequency for two minutes. After having the sense of acupuncture, needles retain stay in the galea aponeurotics for 30 minutes, during this time, twisted 1 minute for once. One treatment each day, five days is a course, between courses of treatment for 2 days off. All the treatment lasted for 4 weeks. Before and after the treatment, the efficacy was judged by the Mini-Mental State Examination (MMSE), Hasegawa Dementia Scale (HDS), Ability of Daily Living scale (ADL), the Scale for the Differentiation of Syndromes of Vascular Dementia (SDSVD), Neurological Function Deficit Score (NFDS), Short Form 36 Health Survey Questionnaire (SF-36). Both of the two groups were tested the serum Endothelin (ET) and Nitric Oxide (NO) before and after the treatment. All results were analyzed by the software SPSS 13.0. Results1 The result showed that the total effective rate of cognitive ability in Surrounding Needling Based on CT Location group (the treatment group) was 82.5%, while the traditional scalp acupuncture group (the matched group) was 56.41%, two groups on the clinical curative effect showed significant difference (P<0.05). Meanwhile, the significant efficiency in treatment group was 25%, which was better than the 7.69% in the matched one. Compared to the matched group, the cognitive abilities score in the treatment group was significantly improved, which had the statistical significant difference (P<0.05). The result showed that the Surrounding Needling based on CT location method had better effect to the VD patients than the Traditional Scalp Acupuncture group on cognitive ability improvement.2 The result showed that the total effective rate of dementia symptoms improvement in treatment group was 85%, while the rate in the matched one was 61.54%, two groups on the clinical curative effect showed significant difference (P<0.05).Meanwhile, the significant efficiency in the treatment group was 30%, which was obviously higher than the 10.3% in the matched one. Compared to the matched group, the total score of Hasegawa dementia scale (HDS) in the treatment group was significantly improved, which had the statistical significant difference (P<0.05). The result showed that the Surrounding Needling Based on CT Location method had better effect to the VD patients than the Traditional Scalp Acupuncture group on dementia symptoms improvement.3 The result showed that the total effective rate of the activities of daily living in treatment group was 85%, while the rate in the matched group was 69.2%, two groups on the clinical curative effect showed significant difference (P<0.05). Meanwhile, the significant efficiency in treatment group was 37.5%, which was obviously higher than the 15.4% in matched one. Compared to the matched group, the score of Ability of Daily Living scale (ADL) and Instrumental Activities of Daily Living ability scale (IADL) in the treatment group was significantly improved, which had the statistical significant difference (P<0.05). The result showed that the Surrounding Needling Based on CT Location method had better effect than the Traditional Scalp Acupuncture group on the activities of daily living improvement, especially in the executive ability.4 The result showed that the total effective rate of the scale for the Differentiation of Syndromes of Vascular Dementia (SDSVD) in treatment group was 72.5%, and the matched group was 66.67%, both of the two groups on the clinical curative effect showed no significant difference (P>0.05). Meanwhile, the score of the Scale for the Differentiation of Syndromes of Vascular Dementia (SDSVD) was significantly improved in both two groups, while the scores between them showed no significant difference (P>0.05).5 The result showed that the score of Neurological Function Deficit Score (NFDS) in the treatment group was significantly improved, which had the statistical significant difference (P<0.05). The result showed that the Surrounding Needling Based on CT Location method had better effect to the VD patients than the Traditional Scalp Acupuncture group on the neurological deficit improvement.6 The result showed that the score of Short Form 36 Health Survey Questionnaire (SF-36) in the treatment group was significantly improved, which had the statistical significant difference (P<0.05). The result showed that the Surrounding Needling Based on CT Location method had better effect to the VD patients than the traditional scalp acupuncture group on the quality of living improvement, Especially in in Social Function(SF), Role of Emotional (RE)and Mental Health(MH) fields.7 The result showed that both groups can significantly reduce patients’serum endothelin (ET) and increase nitric oxide (NO), which had the statistical significant difference (P<0.01), and the treatment group had obvious effects than the matched one (P<0.05). The result showed that Surrounding Needling based on CT location method had better effect to the VD patients than the traditional scalp acupuncture method on regulating cerebral blood flow.Conclusion1 Both of the two methods for treating Vascular Dementia had favourable clinical results.2 The Surrounding Needling Based on CT Location method had better clinical effect than scalp acupuncture method.3 The Surrounding Needling based on CT location method had better effect in the field affected by the Psychological factors, and superior to the traditional scalp acupuncture method in quality improvement.4 The Surrounding Needling based on CT location method had better effect in reducing patients’serum endothelin (ET) and increasing nitric oxide (NO), showed that Surrounding Needling based on CT location group had better effect to the VD patients than the traditional scalp acupuncture group on regulating cerebral blood flow.5 The Surrounding Needling based on CT location method is simple, convenient and effective, and is easily for application. It will have a broad application prospect in the future.更多还原