中药健脑愈痴汤治疗老年血管性痴呆35例临床研究

【作者】 费建平；

【导师】 冯辉；

【作者基本信息】 湖北中医学院 ， 中西医结合临床， 2007， 硕士

【摘要】 老年血管性痴呆是指由缺血性、或出血性中风、或缺血缺氧性脑损害导致的智能低下，记忆能力、理解能力、判断能力明显减退，接触和参与社会工作、生活能力下降，精神呆滞，反应迟钝，寡言善忘，甚至生活不能自理等为主要临床表现的疾病。西医学认为，痴呆为一综合症，可由60多种疾病所致。其中最常见的是老年性痴呆，约占60％左右；其次为血管性痴呆，约占10-20％左右，脑部占位性病变，尤其是额颞肿瘤占4-5％。痴呆的患病率各家报道不一。欧美国家为2-8％，国内为1.8-4.6％。痴呆的危险因素主要为：如年龄(高龄)，年龄每增加5岁，其发病率增加一倍；性别，如女性；低教育水平等。近年还提出老年人的孤独感，缺乏工作与参加集体活动亦为引起痴呆危险因素。此外，一些躯体疾病和家族史也为痴呆的危险因素。老年性血管痴呆既可是一个独立的病，又可继发于其它疾病。随着社会的发展，生活水平的提高，心脑血管疾病的发病率逐年升高，故该病的发病率亦有上升的趋势，引起广大医务工作者的重视。祖国医学认为本病的发生与人的体质密切相关，总体是以正气不足为主，肝肾二脏之虚是本病发生的根本。因肾主骨生髓，肝藏血生精。另外，肝主疏泄，肝气郁滞可致血瘀络阻、脑神失养或逆乱；心脾不足可致聚湿生痰，影响心神；或久生它病，如癫痫、狂证致正气大虚，痰浊阻窍；或中毒、感受疫疠之邪，邪热久羁，劫伤肝肾，热伤血络，瘀浊败血阻窍；或因外伤致血脉瘀阻，忧郁思虑伤心脾，痰浊不行，上蒙清窍。诸种病因均可致痴呆，唯正气不足为根本。本病的发生可急可缓，其病位在脑，与心肾肝脾均有关系。古代医学认为本病的发病机制主要为心肝脾肾俱虚，精血亏虚，或痰浊瘀血上犯，脑髓失养，元神失调。中药健脑理愈痴汤系我院名老中医经验方。目的：观察中药健脑理呆汤治疗老年血管性痴呆的临床疗效。探索一种治疗老年性血管性痴呆患者的新的治疗方法。方法：将68例老年血管性痴呆患者随机分为治疗组35例和对照组33例，治疗组口服中药健脑愈痴汤(组成：红参、天麻、紫河车、当归、葛根、川芎、石菖蒲、胆南星、熟地黄、水蛭、桃仁、红花、丹参等)，随症加减。对照组口服西药喜得镇，每次10mg，每天3次。2组均用药治疗观察60天为一个疗程。结果：2组总有效率比较，治疗组的总有效率为68.57％，对照组的总有效率为51.52％，对中度患者，2组的总效率分别为75％和66.67％；对轻度患者的总有效率分别为54.55％和25％，组间及病情程度的疗效比较差异均无显著性意义(P＞0.05)。对老年性血管性痴呆的临床主要症状，如健忘、反应迟钝、言语不利、头晕眼花、失眠多梦、烦躁易怒、倦怠乏力、腰膝酸软、舌质暗淡、舌边有齿痕等疗效观察，治疗组的总有效为80％，对照组的总有效率为54.55％，中药健脑愈痴汤在改善临床症状方面明显优于对照组，差异有显著性意义(P＜0.05)。两组治疗前MMSE积分无统计学差异(P＞0.05)，治疗后两组患者MMSE积分均有提高。中药健脑愈痴汤可以降低不同切速下的全血粘度及血浆粘度，自身对照差异有显著性(P＜0.05)，并能显著降低红细胞聚集指数(P＜0.01)。对照组仅表现为全血低切以及红细胞聚集指数的改善(P均＜0.05)。表明在改善患者血液流变学状态上，中药健脑愈痴汤要优于喜得镇。对两组患者ADL积分观察表明，治疗组总有效率为67.74％；对照组总有效率为48.15％，组间比较差异无显著性(P＞0.05)，表明健脑愈痴汤与喜得镇对血管性痴呆患者日常生活能力均有一定的改善作用。总之，中药健脑愈痴汤可以明显改善临床症状，提高智能量表积分，改善患者记忆认知功能，恢复患者神经功能缺损，改善日常生活能力、血液流变学指标及脑部功能活动状态。其中在改善临床症状方面治疗组明显优于对照组。结论：血管性痴呆病机复杂，临床表现多样，适合以中医辨证为基础结合辨病用药进行整体治疗。如果能够切中病机，正确立法，合理组方，对本病的临床症状有减轻和控制作用，对患者的记忆、认知等功能有明显改善作用。本临床研究说明中药健脑理愈痴汤治疗老年血管性痴呆疗效肯定，在观察中未发现有任何毒副作用。值得进一步深入研究和推广。更多还原

【Abstract】 Gerontic Vascular Dementia(GVD) refers to cognitive impairment, charactered with impairment of the faculty of memory, understanding and judgement, sluggishness of spirit, clumsy respondence, untalkativeness and forgetfulness. GVD may be an independent disease or a secondary disease. With the development of the society and living standard, incidence of cardiovascular diseases is increasing. The incidence of GVD is rising, which has brought a lot of attention. The pathogenesy of GVD in traditional Chinese medicine theory is deficiency of essence and blood, turbid sputum and blood-stasis invading the brain and impairment of the brain. Yinaozengzhi Decoction(YD) is a empirical formula of famous TCM expert in Xiangfan Hospital of TCM.Objective: To observe the effect of Yinaozengzhi Decoction(YD) on Gerontic Vascular Dementia(GVD) and search for a new therapy for GVD. Methods: Sixty-eight GVD patients were divided into treatment group(35 cases) and control group(33 cases). The treatment group was given YD, and the control group given.hydergine, 10mg three times a day. A treatment course lasted for sixty days. Results: Total effective rate of the treatment group was 68.57%, and that of control group was 51.52%For the accumulated patients, total effective rate of the two groups was 75% and 66.67% respectively. For midrange patients, total effective rate of the two groups, was 54.55% and 25% respectively. There was no significant difference between the effects of the two groups as far as the pathogenetic condition was concerned(P＞0.05). Observation on the clinical symptoms, such as insomnia and dreaminess, morbid forgetfulness, clumsy respondence, dizziness and dim eyesight, restlessness and irritability, lassitude and debility, feeble and sore knees and waist showed that the effect of YD was better than hydergine in improving the symptoms for the total effective rate of the two groups was 80% and 54.55% respectively. YD could improve the clinical symptoms, increase the integral calculus of the intelligence measuring scale, ameliorate the function of memory and cognition, recover the impairment of the injured nerve function and the indexes of the hemorrheology.Conclusion: YD has positive effect on GVD. There was no side-effect during the treatment. The therapy was worth for further research and wide-spread.更多还原