针药结合对气血亏虚型血管性痴呆治疗方案的优化研究
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摘要
目的：探索“益气调血、扶本培元”针法结合“黄地散”方药治疗气血亏虚型血管性痴呆的临床疗效,并形成优化治疗方案,为临床进一步应用提供科学依据。
方法：将57例符合诊断标准及纳入标准的气血亏虚型血管性痴呆患者按中央随机系统随机分为综合治疗组19例、针刺组19例、西药组19例,纳入统计的病例每组各19例。综合治疗组为“益气调血、扶本培元”针法结合“黄地散”,针刺主穴为：膻中、中脘、气海、血海(双)、足三里(双)、外关(双)、四神聪、百会；针刺组针刺方法同治疗组；西药组予以盐酸多奈哌齐(安理申)；三组均予以临床常规的脑血管病治疗方案进行治疗。研究中运用阿尔茨海默病评定量表一认知部分(ADAS-cog)观察治疗后12周、治疗后6个月(随访研究)三组之间的认知功能差异,简易智能量表(MMSE)变化,评估三组之间的认知功能差异,日常生活能力量表(ADL)评估三组之间的日常生活能力差异。
结果：(1)ADAS-cog评分：综合治疗组、针刺组及西药组改善认知功能的总有效率分别为82.21%、78.94%、73.68%,其总有效率无显著性差异(P>0.05)；三组患者治疗前后ADAS-cog勺总评分均有改善(P<0.05),三组患者治疗后综合治疗组、针刺组的ADAS-cog总评分与西药组比较均有显著性差异(P<0.05),综合治疗组与针刺组之间无显著性差异(P>0.05)。三组内治疗后12周与6个月随访研究比较：综合治疗组P>0.05,针刺组、西药组P<0.05,说明综合治疗组的疗效持续性高于针刺组和西药组。
(2)MMSE评分：综合治疗组、针刺组及西药组改善认知功能的总有效率分别为84%、78%、73%,其总有效率无显著性差异(P>0.05)；三组患者治疗前后ADAS-cog的总评分均有改善(P<0.05),三组患者治疗后综合治疗组、针刺组的ADAS-cog.总评分与西药组比较均有显著性差异(P<0.05),综合治疗组与针刺组之间无显著性差异(P>0.05)。三组内治疗后12周与6个月随访研究比较：综合治疗组P>0.05,针刺组、西药组P<0.05,说明综合治疗组的疗效持续性高于针刺组和西药组。
(3)ADL评分：综合治疗组、针刺组及西药组提高同常生活能力的总有效率分别为78.94%、73.68%、68.42%,其总有效率无显著性差异(P>0.05)：三组患者治疗前后ADL总评分均有降低,有显著性差异(P<0.05)。三组患者治疗后综合治疗组、针刺组的ADL总评分与西药组比较均有显著性差异(P<0.05),综合治疗组与针刺组之间无显著性差异(P>0.05)。三组内治疗后12周与6个月随访研究比较：综合治疗组P>0.05,针刺组、西药组P<0.05,说明综合治疗组的疗效持续性高于针刺组和西药组。
结论：综合治疗组、针刺组、西药组对于气血亏虚型血管性痴呆的治疗均具有肯定的临床效果,均能显著改善患者的认知功能,尤其是记忆力、定向力；提高患者行的日常生活能力。综合治疗组、针刺组在躯体性日常生活能力方面的临床效果显著。而“益气调血、扶本培元”综合治疗组、针刺组对认知功能和同常生活能力的改善收作用相近。综合治疗组(“益气调血、扶本培元”针法结合“黄地散”)对于疗效持续性方面优于针刺组、西药组。
Objective:Evaluate the effectiveness of using the acupuncture method of "Yi qi tiao xue, fu ben pei yuan" combine with the Chinese herbal medicine "huang di san"to treat vascular dementia, and to form a better treatment scheme, as well as provide further scientific evidences for clinical studies.
Method:There are57people who have been officially match the standard and diagnosed as having vascular dementia have chosen, and it is randomly selected by central computer system into three different groups:combine treatment, acupuncture and western medicine with each of19people. These selected group cases will bring into clinical statistics studies. Combine treatment group are using the acupuncture method of "Yi qi tiao xue, fu ben pei yuan"and combine with the Chinese medicine "huang di san ". The main acupuncture points are Tanzhong, Zhongwan, Qihai, Xuehai (both), Zusanli (both), Waiguan (both), Sishengcong, Baihui; the therapy method for acupuncture group is same with combine group; western medicine group is given Donepezil hydrochloride (Aricept); three groups are treated as usual cerebrovascular disease. After twelve and six months treatment (randomly chosen for test), Alzheimer disease rating scale-Cognitive section (ADAS-cog) and Mini-mental state examination (MMSE) have been used to observe the differences of the cognitive ability between these three groups. Activities daily living scale (ADL) is used to observe the differences of the daily living skills between the three selected groups.
Result:(1) ADAS-cog assessment score:The cognitive ability percentages for combine treatment, acupuncture and western medicine groups have improved about82.21%,78.94%,73.68%respectively. The effective percentage of difference with no significance is (P>0.05). These three groups have shown improvement in ADAS-cog before and after treatment, about (P<0.05). Furthermore, the ADAS cog assessment score for combine and acupuncture groups have notable different from western medicine group, is (P<0.05).However, there are no significant differences between combine and acupuncture groups, which is (P>0.05). The comparison after twelve weeks treatment and six months for those three groups'assessment score are:combine treatment group is P>0.05, acupuncture and western medicine are P<0.05, it has proved that the therapy of combine treatment group is effective than acupuncture and western medicine groups.
(2) MMSE assessment score:The cognitive ability percentages for combine treatment, acupuncture and western medicine groups have improved about84%,78%,73%respectively. The effective percentage of difference with no significance is (P>0.05). These three groups have shown improvement in MMSE before and after treatment, about (P<0.05). Besides that, the MMSE assessment score for combine and acupuncture groups have notable different from western medicine group, is (P<0.05). It is noticeable that there is no significant difference between combine treatment and acupuncture groups are (P>0.05). The comparison after twelve weeks treatment and six months for those three groups'assessment score are:combine treatment group is P>0.05, acupuncture and western medicine are P<0.05, it has proved that the therapy of combine treatment group is effective than acupuncture and western medicine groups.(3)ADL assessment score:The daily living skills percentages for combine treatment, acupuncture and western medicine groups have improved about78.94%,73.68%and68.42%respectively. The effective percentage of difference with no significance is (P>0.05). The total score for these three groups have decreased in ADL assessment after and before therapy, it has significant difference which is (P<0.05). The comparison between combine treatment and acupuncture groups with western medicine group of ADL total assessment scores are noticeably different (P<0.05). Furthermore, there is no significant percentage difference between combine treatment and acupuncture groups (P>0.05). The comparison after twelve weeks treatment and six months for those three groups' assessment score are:combine treatment group is P>0.05, acupuncture and western medicine are P<0.05, it has proved that the therapy of combine treatment group is effective than acupuncture and western medicine groups.
Conclusion:The research indicates combine treatment; acupuncture and western medicine groups have affirmative and effective results to treat vascular dementia in clinical studies. It helps to improve patients' cognitive abilities, particularly memories, stabilities; increase patient's activities daily living skills. On the other hand, combine treatment and acupuncture groups have significant improvement for physical daily living skills in clinical studies. Also,'Yi qi tiao xue, fu ben pei yuan" combine treatment and acupuncture groups have the same therapies to improve patients'cognitive abilities and normal daily living skills. It is remarkable that combine treatment group ("Yi qi tiao xue, fu ben pei yuan" combine with the Chinese herbal medicine "huang di san") is continuously effective way than acupuncture and western medicine groups.
方法：将57例符合诊断标准及纳入标准的气血亏虚型血管性痴呆患者按中央随机系统随机分为综合治疗组19例、针刺组19例、西药组19例,纳入统计的病例每组各19例。综合治疗组为“益气调血、扶本培元”针法结合“黄地散”,针刺主穴为：膻中、中脘、气海、血海(双)、足三里(双)、外关(双)、四神聪、百会；针刺组针刺方法同治疗组；西药组予以盐酸多奈哌齐(安理申)；三组均予以临床常规的脑血管病治疗方案进行治疗。研究中运用阿尔茨海默病评定量表一认知部分(ADAS-cog)观察治疗后12周、治疗后6个月(随访研究)三组之间的认知功能差异,简易智能量表(MMSE)变化,评估三组之间的认知功能差异,日常生活能力量表(ADL)评估三组之间的日常生活能力差异。
结果：(1)ADAS-cog评分：综合治疗组、针刺组及西药组改善认知功能的总有效率分别为82.21%、78.94%、73.68%,其总有效率无显著性差异(P>0.05)；三组患者治疗前后ADAS-cog勺总评分均有改善(P<0.05),三组患者治疗后综合治疗组、针刺组的ADAS-cog总评分与西药组比较均有显著性差异(P<0.05),综合治疗组与针刺组之间无显著性差异(P>0.05)。三组内治疗后12周与6个月随访研究比较：综合治疗组P>0.05,针刺组、西药组P<0.05,说明综合治疗组的疗效持续性高于针刺组和西药组。
(2)MMSE评分：综合治疗组、针刺组及西药组改善认知功能的总有效率分别为84%、78%、73%,其总有效率无显著性差异(P>0.05)；三组患者治疗前后ADAS-cog的总评分均有改善(P<0.05),三组患者治疗后综合治疗组、针刺组的ADAS-cog.总评分与西药组比较均有显著性差异(P<0.05),综合治疗组与针刺组之间无显著性差异(P>0.05)。三组内治疗后12周与6个月随访研究比较：综合治疗组P>0.05,针刺组、西药组P<0.05,说明综合治疗组的疗效持续性高于针刺组和西药组。
(3)ADL评分：综合治疗组、针刺组及西药组提高同常生活能力的总有效率分别为78.94%、73.68%、68.42%,其总有效率无显著性差异(P>0.05)：三组患者治疗前后ADL总评分均有降低,有显著性差异(P<0.05)。三组患者治疗后综合治疗组、针刺组的ADL总评分与西药组比较均有显著性差异(P<0.05),综合治疗组与针刺组之间无显著性差异(P>0.05)。三组内治疗后12周与6个月随访研究比较：综合治疗组P>0.05,针刺组、西药组P<0.05,说明综合治疗组的疗效持续性高于针刺组和西药组。
结论：综合治疗组、针刺组、西药组对于气血亏虚型血管性痴呆的治疗均具有肯定的临床效果,均能显著改善患者的认知功能,尤其是记忆力、定向力；提高患者行的日常生活能力。综合治疗组、针刺组在躯体性日常生活能力方面的临床效果显著。而“益气调血、扶本培元”综合治疗组、针刺组对认知功能和同常生活能力的改善收作用相近。综合治疗组(“益气调血、扶本培元”针法结合“黄地散”)对于疗效持续性方面优于针刺组、西药组。
Objective:Evaluate the effectiveness of using the acupuncture method of "Yi qi tiao xue, fu ben pei yuan" combine with the Chinese herbal medicine "huang di san"to treat vascular dementia, and to form a better treatment scheme, as well as provide further scientific evidences for clinical studies.
Method:There are57people who have been officially match the standard and diagnosed as having vascular dementia have chosen, and it is randomly selected by central computer system into three different groups:combine treatment, acupuncture and western medicine with each of19people. These selected group cases will bring into clinical statistics studies. Combine treatment group are using the acupuncture method of "Yi qi tiao xue, fu ben pei yuan"and combine with the Chinese medicine "huang di san ". The main acupuncture points are Tanzhong, Zhongwan, Qihai, Xuehai (both), Zusanli (both), Waiguan (both), Sishengcong, Baihui; the therapy method for acupuncture group is same with combine group; western medicine group is given Donepezil hydrochloride (Aricept); three groups are treated as usual cerebrovascular disease. After twelve and six months treatment (randomly chosen for test), Alzheimer disease rating scale-Cognitive section (ADAS-cog) and Mini-mental state examination (MMSE) have been used to observe the differences of the cognitive ability between these three groups. Activities daily living scale (ADL) is used to observe the differences of the daily living skills between the three selected groups.
Result:(1) ADAS-cog assessment score:The cognitive ability percentages for combine treatment, acupuncture and western medicine groups have improved about82.21%,78.94%,73.68%respectively. The effective percentage of difference with no significance is (P>0.05). These three groups have shown improvement in ADAS-cog before and after treatment, about (P<0.05). Furthermore, the ADAS cog assessment score for combine and acupuncture groups have notable different from western medicine group, is (P<0.05).However, there are no significant differences between combine and acupuncture groups, which is (P>0.05). The comparison after twelve weeks treatment and six months for those three groups'assessment score are:combine treatment group is P>0.05, acupuncture and western medicine are P<0.05, it has proved that the therapy of combine treatment group is effective than acupuncture and western medicine groups.
(2) MMSE assessment score:The cognitive ability percentages for combine treatment, acupuncture and western medicine groups have improved about84%,78%,73%respectively. The effective percentage of difference with no significance is (P>0.05). These three groups have shown improvement in MMSE before and after treatment, about (P<0.05). Besides that, the MMSE assessment score for combine and acupuncture groups have notable different from western medicine group, is (P<0.05). It is noticeable that there is no significant difference between combine treatment and acupuncture groups are (P>0.05). The comparison after twelve weeks treatment and six months for those three groups'assessment score are:combine treatment group is P>0.05, acupuncture and western medicine are P<0.05, it has proved that the therapy of combine treatment group is effective than acupuncture and western medicine groups.(3)ADL assessment score:The daily living skills percentages for combine treatment, acupuncture and western medicine groups have improved about78.94%,73.68%and68.42%respectively. The effective percentage of difference with no significance is (P>0.05). The total score for these three groups have decreased in ADL assessment after and before therapy, it has significant difference which is (P<0.05). The comparison between combine treatment and acupuncture groups with western medicine group of ADL total assessment scores are noticeably different (P<0.05). Furthermore, there is no significant percentage difference between combine treatment and acupuncture groups (P>0.05). The comparison after twelve weeks treatment and six months for those three groups' assessment score are:combine treatment group is P>0.05, acupuncture and western medicine are P<0.05, it has proved that the therapy of combine treatment group is effective than acupuncture and western medicine groups.
Conclusion:The research indicates combine treatment; acupuncture and western medicine groups have affirmative and effective results to treat vascular dementia in clinical studies. It helps to improve patients' cognitive abilities, particularly memories, stabilities; increase patient's activities daily living skills. On the other hand, combine treatment and acupuncture groups have significant improvement for physical daily living skills in clinical studies. Also,'Yi qi tiao xue, fu ben pei yuan" combine treatment and acupuncture groups have the same therapies to improve patients'cognitive abilities and normal daily living skills. It is remarkable that combine treatment group ("Yi qi tiao xue, fu ben pei yuan" combine with the Chinese herbal medicine "huang di san") is continuously effective way than acupuncture and western medicine groups.
引文
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