“益肾调督”针刺法治疗轻度认知功能障碍的临床观察

发布时间：2019-03-28 19:04

【摘要】：目的:以轻度认知功能障碍患者为研究对象,比较经针刺结合口服盐酸多奈哌齐与单纯口服盐酸多奈哌齐治疗后的临床疗效,观察针刺治疗轻度认知功能障碍的临床疗效,以此说明“益肾调督”针刺法治疗此病的有效性,为其在轻度认知障碍的治疗及对痴呆的防治提供临床依据。方法:采用随机对照、三分离的研究方法,将来自于武汉江南脑科医院针灸门诊及住院部符合纳入标准的62例患者,采用随机数字表的方法随机分为针药结合组及西药组,每组31例,各组脱落1人,最终有60人完成本实验。针药结合组采用“益肾调督”为法,以百会、四神聪、神庭、风池(双侧)、肾俞(双侧)、悬钟(双侧)、太溪(双侧)等穴位为主穴(头部穴位分两组,交替加用电针,频率2-5Hz,连续波,留针30min),经中医整体辨证后对不同的证型加以配穴(肾精亏耗证加志室,心脾不足证加心俞、脾俞,痰浊扰心证加丰隆,血瘀痹阻证加膈俞)进行针刺配合口服盐酸多奈哌齐治疗,每日1次,6次为1个疗程,每个疗程中间休息1天,持续治疗8个疗程。西药组采用盐酸多奈哌齐(安理申)口服,每日1片(5mg),于每晚睡前服用,持续口服8周。观察两组患者治疗前后简易精神状态量表(Mini-mental State Examination,MMSE)及蒙特利尔量表(Montreal Cognitive Assessment,MoCA)的评分变化,评估其临床疗效,运用SPASS17.0统计软件对相应数据进行对比分析。结果:1.两组治疗前与治疗后的MMSE评分和MoCA评分结果对比显示,差异均有显著性(P0.05),说明两组都能提高患者MMSE量表和MoCA量表的评分结果。2.针药结合组治疗后的MMSE量表和MoCA量表评分与西药组治疗后的MMSE量表和MoCA量表评分的对比显示,差异有统计学意义(P0.05)。说明针刺配合西药口服的治疗方法在改善MCI患者认知功能上优于单纯口服西药。3.针药结合组与西药组总体疗效相比较,针药结合组总有效率为83.33%,西药组总有效率为73.33%,两组都能改善MCI患者的临床症状,且两组疗效相比,有显著性差异(P0.05),具有统计学意义,说明针刺配合西药口服的方法的临床疗效优于单纯口服西药,“益肾调督”针刺法是可以在临床推广的一种治疗方法。结论:研究结果显示:针刺配合口服盐酸多奈哌齐的治疗方法与单纯口服盐酸多奈哌齐均可改善轻度认知障碍患者的病情,且针刺配合口服盐酸多奈哌齐的方法的疗效优于单纯口服盐酸多奈哌齐。
[Abstract]:Objective: to compare the clinical efficacy of acupuncture combined with oral Donepezil Hydrochloride and Donepezil Hydrochloride in the treatment of mild cognitive impairment, and to observe the clinical effect of acupuncture on mild cognitive dysfunction. In order to provide clinical basis for the treatment of mild cognitive impairment and the prevention and treatment of dementia, the acupuncture therapy of "tonifying the kidney and regulating the governor" is effective in the treatment of this disease. Methods: 62 patients from acupuncture outpatient department and inpatient department of Wuhan Jiangnan brain Hospital were randomly divided into acupuncture combined group and western medicine group by random numerical table, and 62 patients from Wuhan Jiangnan brain Hospital were randomly divided into two groups: acupuncture combined group and western medicine group by random numerical table, and 62 patients from Wuhan Jiangnan brain Hospital were randomly divided into acupuncture group and western medicine group. There were 31 cases in each group, 1 person fell off in each group, and 60 people completed the experiment. The acupuncture and medicine combination group adopted "tonifying the kidney and regulating the governor" as the method, with Baihui, Sishen Cong, Shenting, Fengchi (bilateral), Shenshu (bilateral), hanging bell (bilateral), Taixi (bilateral) as the main points (head acupoints divided into two groups, alternately using electroacupuncture, etc.). Frequency 2 ~ 5 Hz, continuous wave, needle retention 30min), after the whole syndrome differentiation of traditional Chinese medicine (TCM), the different syndrome types were combined with acupoints (kidney essence deficiency syndrome plus journal room, heart and spleen deficiency syndrome plus Xin Shu, spleen Shu syndrome, phlegm turbidity disturbing heart syndrome plus Fenglong), the syndrome of kidney deficiency and spleen deficiency syndrome plus Xin Shu, spleen Shu syndrome, phlegm turbidity disturbing heart syndrome plus Fenglong, The patients were treated with acupuncture combined with oral administration of Donepezil once a day, 6 times as a course of treatment, one day rest in the middle of each course, and 8 courses of continuous treatment. In the western medicine group, Donepezil Hydrochloride (Aristin) was given orally, one tablet per day (5mg), which was taken every night before bedtime, and was given orally for 8 weeks. To observe the changes of mini mental state scale (Mini-mental State Examination,MMSE) and Montreal scale (Montreal Cognitive Assessment,MoCA) before and after treatment in the two groups, to evaluate the clinical efficacy, and to compare and analyze the data with SPASS17.0 statistical software. Results: 1. The comparison of MMSE score and MoCA score between the two groups before and after treatment showed that the difference was significant (P0.05), indicating that the two groups could improve the scores of MMSE and MoCA scales. 2. The scores of MMSE and MoCA in acupuncture combined with medicine group were compared with those of MMSE and MoCA after treatment in western medicine group, and the difference was statistically significant (P0.05). It is indicated that acupuncture combined with oral western medicine is superior to oral western medicine in improving cognitive function in patients with MCI. 3. Compared with the western medicine group, the total effective rate was 83.33% in the acupuncture combined group and 73.33% in the western medicine group. Both groups could improve the clinical symptoms of MCI patients, and the curative effect of the two groups was better than that of the western medicine group, and the total effective rate of the combination group was 83.33%, and that of the western medicine group was 73.33%. There was significant difference (P0.05), with statistical significance, indicating that the clinical efficacy of acupuncture combined with oral western medicine was better than that of oral western medicine alone, and "tonifying the kidney and regulating the governor" acupuncture was a therapeutic method that could be popularized in clinical practice. Conclusion: acupuncture combined with oral Donepezil can improve the condition of patients with mild cognitive impairment. The therapeutic effect of acupuncture combined with oral Donepezil hydrochloride was better than that of oral Donepezil Hydrochloride alone.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

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