【作者】 周薇；

【导师】 周仲瑜；

【作者基本信息】 湖北中医学院 ， 针灸推拿学， 2009， 硕士

【摘要】 目的:血管性痴呆(vascular dementia,VD)是指各种脑血管疾病所致的智能及认知功能障碍的临床综合征,以遇事善忘、不能定向、理解错误、计算力差、情绪失控等认知、记忆、言语、情感、性格的精神减退或消失为特征,属祖国医学“痴证”、“呆病”范畴。本病病机是脏腑功能渐衰,肾精亏损,髓海失充,气血不足,痰浊内生,瘀血阻窍所致髓减脑消,神机逆乱,属本虚标实之证。血管性痴呆是脑血管病后产生的进行性智能障碍综合征.是世界范围内困扰老年人生活质量的常见病症,其发病率随人口老龄化而逐年上升。因此,加强对VD的研究,探求有效的治疗方法具有重要的现实意义。本研究基于导师多年临床经验,在系统回顾文献的基础上,制定治疗方案,采用头针加体针治疗为主,随证加减,在治疗前后均观察临床症状的变化,并运用修订长谷川痴呆量表、简易精神状态检查表、日常生活活动量表等量表及颅脑MRI各项指标进行测评,评分结果进行统计学处理,研究针刺治疗血管性痴呆的临床疗效,为针刺治疗本病的疗效判定探索量化指标。方法:60例研究对象均为湖北省中医院针灸科门诊或住院患者,根据症状、体征及相关检查确诊为血管性痴呆,按随机表法分成两组,治疗组及对照组,即治疗组为头针加体针组,对照组为单纯体针组。治疗组及对照组各30例。其中治疗组取穴:头针取穴:顶中线、额中线、颞前线、颞后线。体针取穴:肾俞、悬钟、太溪、足三里、水沟穴,并随证配穴。皮肤常规消毒后,针刺各穴,得气后,每10分钟用平补平泻手法行针1次,留针30分钟,每日针刺1次,6次为1个疗程,治疗1个疗程后休息一天,连续治疗6个疗程。针刺对照组30例,采用单纯体针针刺治疗,体针针刺取穴与操作方法同治疗组,每日针刺1次,6次为1个疗程,治疗1个疗程后休息一天,连续治疗6个疗程。分别观察临床症状、体征、认知功能、非认知功能、MRI的变化,比较两种治疗方法的临床疗效。结果:1.治疗组显效率和有效率分别为50.0%和83.3%,对照组显效率和有效率分别为40.0%和76.7%,经统计学处理(P＜0.05),两组的显效率和有效率之间有显著性差异,治疗组明显优于对照组。2.治疗组和对照组在治疗前、后认知功能和非认知功能方面都有显著性改善(P＜0.05)。3.治疗组和对照组在治疗结束后颅脑MRI的影像学指标无明显改变,说明VD患者智能改善并不是因为改善颅脑宏观结构,可能是通过其他正常脑组织的功能代偿而实现的。结论:头针加体针治疗血管性痴呆有很好的疗效,能显著改善患者的临床症状、体征及认知功能、非认知功能的各项指标,且避免了西药的毒副作用和潜在并发症的危险,此法经济、简便,患者容易接受,值得在临床上推广应用。更多还原

【Abstract】 Objective:Vascular Dementia(VD) is a kind of acquired intellectual impairment syndrome which produced by brain dysfunction that caused from varies of cerebrovascular diseases.The character show the disappearance or decline of cognitive memory,speaking,emotion and spirit such as often forgetting things,unable distinguishing direction,misunderstanding,poor calculation,uncontrolled emotion etc.It belongs to "Dai syndrome" field of Chinese medical science.The cause of disease is a proof of exterior excess and interior deficiency which appears gradually decline of organ functions;insufficiency of kidney essence,sea of marrow,Qi and blood;interior phlegm turbidity;static blood that invading the head that cause reducing sea of marrow,shrinking of brain and nerve confusion.VD is a common disease that disturbs the quality of life of older persons around the world and the disease incidence has been rising with the aging of the population.So reinforcing the study of VD and researching effective treatment has important practical significance.This research which based on my tutor’s clinical experience for years and the systematical review of all documents, then made the treatment plan,cured mainly by scalp acupuncture and increased or decreased points in the process of treatment,observed all changes of clinical symptoms before and after treatment.At the end,the results were evaluated by using Hasegawa dementia scale, activities of Daily Living scale,the social function of events scale and kinds of targets of brain MRI.All score results are treated with statistics.To study the physiological mechanism of VD treatment by acupuncture could explore effective quantitative targets of VD treatment by acupuncture well.Method:Sixty patients were selected from clinic or hospital of Hubei university of Chinese medicine.They were diagnosed VD with their symptoms,signs and relevant inspections and divided into two groups by random table.One group had 30 patients which treated with scalp acupuncture and acupuncture.They were acupunctured on top midline,forehead midline,temporal frontline and behind temporal line of scalp points and Shenshui,Xuanzhong,Taixi,Shuigou and Zu sanli points,and then mated with other points with symptoms as possible.After conventional cleansing skin,punctured shallowly on the skin of head by using 0.30×50mm needles,and punctured other points by perpendicular needling.After getting Qi,ran the needles every 10 Min,then retained the needles in the point for 30 Min. The patients were punctured with needles one time every day and six days as a period of treatment,after one period then rested one day. The continuous treatment was for six periods.Other 30 patients as puncture comparing group were punctured purely and the method as the same as the above group.These patients were punctured with needles one time every day and six days as a period of treatment,after one period then rested one day.The continuous treatment was for six periods. To observe respectively the changes of clinical symptoms,signs, cognitive function,non-cognitive function and MRI and compare the clinical effect of two kinds of treatmentsResult:1.The significant efficient rate and efficient rate of treatment group reached respectively 50.0%and 83.3%.Those rates of comparing group reached respectively 40.0%and 76.7%.The statistical data(P＜0.05) showed that there were significant difference between two groups and treatment group was better than comparing group.2.There were great improvements on cognitive function and non-cognitive function before and after treatment in these two groups.3.The target of brain MRI imaging study showed nothing obviously in these two groups after treatment.This result showed that the intelligent of VD patients could improve by functional metabolism of other good brain tissue rather than improving the macro-structure of brain.Conclusion:The method of scalp acupuncture and acupuncture has good effects on VD.It can improve the patients’ clinical symptoms,signs,all targets of cognitive function and non-cognitive function significantly.It can avoid the toxic and side effects of Western medicine and the danger of potential complications.This method is worth to promote and apply in clinic because it is a saving and easy way that could be accepted by patients easily.更多还原