【作者】 胡晶晶；

【导师】 张唐法；

【作者基本信息】 湖北中医学院 ， 针灸推拿学， 2009， 硕士

【摘要】 目的:探讨头针对脑梗死(cerebral infarction,CI)所致血管性痴呆(vascular dementia,VaD)患者颅脑MRI及临床症状的影响。为脑梗死所致血管性痴呆治疗方法的优选提供临床根据。方法:108例确诊的CI所致VaD患者均为2005年9月～2007年6月就诊于武汉市中西医结合医院针灸科、神经内科以及武汉市中心医院康复科的住院及门诊病例。92例患者最终完成观察,按随机数字表法随机分为头针治疗组(47例)和西药治疗组(45例)。头针治疗组取穴:根据中国针灸学会制订的《头皮针穴名国际标准化方案》取顶颞前斜线(前神聪至悬厘)、顶颞后斜线(百会至曲鬓),均为双侧取穴。局部常规消毒,选用华佗牌30号1.5寸毫针进行针刺。针尖与头皮呈15°左右夹角,沿顶颞前斜线、顶颞后斜线快速刺入头皮下,当针尖抵达帽状腱膜下层时,指下感到阻力减小,然后使针与头皮平行,沿刺激线刺入1.0～1.5寸,再快速连续捻转,速度应保持在220次/min左右,每次捻转2～3min,留针30min,每15min重复捻转1次,1次/d,6d为1个疗程,疗程间隔1d,连续治疗5个疗程,共30d。西药治疗组:尼莫地平片,口服,每次40mg,3次/d,6d为1个疗程,疗程间隔1d,连续治疗5个疗程,共30d。各组分别于治疗30d后、治疗结束后1个月、治疗结束后2个月统一评定疗效。观察治疗前后患者颅脑MRI片下的外侧裂宽度、第三脑室宽度、平均脑室宽度、额角指数、尾状核指数、侧脑室体积指数,并运用简易智力状态检查(MMSE)、Blesse痴呆量表(BBS)、长谷川痴呆量表(HDS)、日常生活能力量表(ADL)进行智能评分。结果:经过30d的治疗后,两组HDS、BBS和MMSE得分上升,ADL得分下降,与治疗前比较,差异有统计学意义(P＜0.05);治疗后两组HDS、ADL、BBS和MMSE分值的差异无统计学意义(P＞0.05),提示头针与西药疗效相当。治疗后两组患者颅脑MRI各指标变化均不明显(P＞0.05),说明头针治疗和西药治疗对颅脑MRI各指标的影响不大。结论:头针治疗不能改善患者颅脑形态指标,但可以改善脑梗死所致血管性痴呆患者的临床症状。更多还原

【Abstract】 Objective:To explore the effects of Scalp-acupuncture on encephalic MRI and clinical symptoms in vascular dementia (VaD) and the clinical evidence for vascular dementia (VaD) treatment optimization.Methods:108 patients suffered from VaD were from department of acupuncture and neurology, integration of traditional and western medicine hospital of Wuhan and department of rehabilitation medicine, central hospital of Wuhan, including inpatients and outpatients, from September 2005 to June 2007. 92 patients finished the observation finally, they were randomly divided into two groups: Scalp-acupuncture group (47 patients) and drug group (45 patients). The patients of Scalp-acupuncture group were hibaterally punctured top temple linea oblique anterior (Qian Shen Cong to Xuan Li)、top temple linea obliqe posterior ( Bai Hui to Qu Bin )according to China association of acupuncture-moxibustionformulated "China scalp point programme of the international standardization". After conventional disinfection, 0. 25 mm×40 mm filiform needles were selected to acupuncture. Along the top temple linea oblique anterior and top temple linea obliqe posterior prick into scalp quickly by 15 degrees angle. When the needle tip reached the aponeurosis of occipitofron talis muscle underlayer, resistance decreasion could be felt . The needle was put at equal pace with scalp, and punctured follow the line prick into 1 to 1. 5 cun, rotated rapidly and continuously. The speed was kept by 220 times per minute. The needles were kept for 30 min, one time per day, one course of treatment contains 6 times, 5 continuous courses of treatment consisted 30 days. The patients of the drug group taken Nimodipine Tablets orally 40mg, three times daily, one course of treatment contains 6 times, 5 continuous courses of treatment consisted 30 days. The therapeutic effect was evaluated 30 days, 60 days and 90 days after the treatment. The changes of Lateral cerebral fissure width, Third ventricle sulcus, Cerebral sulcus average width, Frontal horn index, Caudate nudeus index, Lateral ventrie body index, scoring value of HDS (Hasegawa dementia scale), ADL (ability of daily life), MMSE (mini-mental state examination) and BBS (Blesse dementia scale) were measured pre and post treatment.Results:After 30 days treatment, two groups’ scores of HDS, BDS, MMSE increased, while the score of ADL decreased. Compared with pre-treatment,The difference had statistical significance ( P< 0. 05 ) . After the treatment, the score difference of HDS, BBS, MMSE and ADL of two groups didn’t have statistical significance ( P> 0. 05 ) , it suggested that the therapeutic effect of the Scalp-acupuncture and drug were similar. There were no significant changes in encephalic MRI (P> 0.05 ) . The influence to MRI by Scalp-acupuncture and drug were all no obvious.Conclusions:Scalp-acupuncture therapy can’ t ameliorate encephalic MRI, but can improve the symptoms of patients suffered from VaD.更多还原