温针灸百会穴为主治疗缺血性脑卒中后MCI的临床研究

发布时间：2018-02-02 06:46

  本文关键词： 缺血性脑卒中后轻度认知障碍 温针灸百会穴 电针智三针　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景缺血性脑卒中后轻度认知障碍是指由脑血管性病变所致的早期或轻度认知功能损害,且认知障碍程度尚未达到痴呆标准的一类综合征,是近年来才提出的新的疾病概念。据统计,脑卒中患者半数以上有认知功能障碍。[1]认知活动参与患者康复的全过程,认知障碍不仅对功能康复有一定影响,而且与患者卒中后的生活质量密切相关。目前现代医学尚未发现对认知功能有明显疗效的药物,且大多数药物具有毒副作用大、禁忌症多、容易复发等不良特点。因此,探讨副作用小、经济实用、疗效确切的治疗方法,以改善患者的认知功能障碍及提供患者的生活质量,具有一定的社会意义和经济效益。目的观察和综合评估温针灸百会穴为主治疗缺血性脑卒中后轻度认知障碍的临床疗效,从而为临床提供一种起效快、疗效确切、操作简便的治疗方法。方法本研究采用随机分组方法,将64例符合纳入标准的患者随机分为治疗组和对照组各32例。治疗组采用温针灸百会穴配合电针治疗,具体如下：温针灸取穴：百会穴；电针组：智三针,神庭穴、本神穴(左右各一)；体针取穴：印堂、人中、风池、太冲、太溪、内关、丰隆、三阴交；随症取穴：口角歪斜加患侧地仓；偏瘫加患侧曲池、足三里、三阴交、对侧合谷；失语加廉泉。辨证取穴：肾精亏虚证配太溪、悬钟；痰浊阻窍证配丰隆、中脘；瘀血阻络证配膈俞、血海；肝阳上亢证配太冲、肝俞；火热内盛证配内庭、曲池；腑滞浊留证配中脘、天枢；气血亏虚证配足三里、气海。常规消毒后,针尖与穴位成15°～30°角,沿皮下平刺1.5寸左右百会穴平刺0.8～1.2寸,深度达到帽状腱膜,以60次／min速度均匀捻转,力度以局部有麻胀或向各部放散感为宜,时间1 min。在留针过程中,取约2 cm长之艾条一段,套在针柄之上,距皮肤2～3cm,再从其下端点燃施灸。在燃烧过程中,如患者觉灼烫难忍,可在该穴区置一硬纸片,以稍减火力。共取艾条2壮。电针组选用G6805-1型多功能电针治疗仪,接入电极后,输出波型为疏密波,输出强度以患者能够耐受为度,通电30min。对照组不采用温针灸百会穴,其余同治疗组。每日1次,每周5次,6周为一个疗程。1个疗程后评定疗效,智力状况的疗效评估采用简易精神状态检查量表(MMSE)评价,认知功能的疗效评估采用蒙特利尔认知评估量表(MoCA)评价,日常生活能力的疗效评估采用日常生活能力量表(ADL)评价,中医症候的疗效评估采用血管性痴呆辩证量表(SDSVD)评价。结果将两组患者年龄、性别、病程等一般资料及两组治疗前MMSE、MoCA、ADL、SDSVD积分指标进行对比,经统计学分析无显著性差异(P＞0.05),说明两组具有可比性。1.总体疗效上：治疗结束后,治疗组显效12例,有效17例,无效3例,恶化0例,总有效率为90.625%；而对照组显效4例,有效17例,无效11例,恶化0例,总有效率为65.625%。治疗组总体疗效优于对照组,其差异具有统计学意义(P＜0.05)2.自身前后对照：两组治疗后MMSE、MoCA、ADL、SDSVD积分指标与治疗前比较均有所改善,差异均有统计学意义(P＜0.05),显示两种疗法均对缺血性脑卒中后轻度认知障碍有较好的治疗作用。3.治疗后组间对照：治疗组与对照组相比,其MMSE、MoCA、ADL、SDSVD (p0.05),显示治疗组疗效优于对照组。结论以上的结果提示两种治疗方法对缺血性脑卒中后轻度认知障碍均有较好的疗效,但在对照组的基础上加上温针灸百会穴能更好地改善缺血性脑卒中后轻度认知障碍患者的认知功能,对患者的症状、体征也有较大的改善。
[Abstract]:Background ischemic stroke refers to mild cognitive impairment caused by cerebral vascular disease early or mild cognitive impairment, cognitive impairment and dementia has not yet reached the standard of a kind of syndrome is a new disease concept proposed in recent years. According to statistics, more than half of the patients with cerebral stroke were involved in the whole process of cognitive rehabilitation of patients dysfunction of.[1] cognitive activity, cognitive impairment not only has a certain effect on the functional rehabilitation, but also closely related to the quality of life of patients after stroke. The modern medicine has not yet found the drug has obvious curative effect on cognitive function, and most of the drugs have side effects, contraindications, easy to relapse and other adverse features. Therefore, to investigate the side effect a small, economical and practical, effective therapeutic methods, to improve the quality of life of patients with cognitive dysfunction and has certain social significance and economic Objective To observe the efficiency. And comprehensive assessment of acupuncture and moxibustion at Baihui acupoint clinical curative effect in the treatment of mild cognitive impairment after ischemic stroke, so as to provide a clinical curative effect, the treatment effect is fast, simple method. Based on the method of random grouping method, 64 patients were randomly divided into the treatment group and the the control group with 32 cases in each group. The treatment group was treated by warm acupuncture Baihui acupuncture treatment, specifically as follows: the acupuncture and moxibustion acupoints: Baihui; Electroacupuncture group: zhisanzheng, shenting, Benshen (about each point); acupuncture points: Yintang, people, Fengchi, Taichong, Taixi, Neiguan. Fenglong, Sanyinjiao acupoints; with the disease: mouth askew plus ipsilateral Dicang plus ipsilateral hemiplegia; Quchi, Zusanli, Sanyinjiao and Hegu plus contralateral aphasia; Lian Quan. Differentiation acupoints: syndrome of deficiency of kidney essence with Taixi, Xuanzhong; phlegm blockage with Fenglong, Zhongwan; blood stasis 琛，

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