中医综合治疗方案配合治疗血管性痴呆110例临床观察

Clinical Observation on Comprehensive Treatment of Basic Western Medicine and Traditional Chinese Medicine in Treating 110 Cases of Vascular Dementia

目的观察西医基础治疗联合中医综合治疗方案治疗血管性痴呆(VD)的临床疗效,并探讨其作用机制。方法将218例患者随机分为治疗组(110例)和对照组(108例)。治疗组给予西医基础治疗+中医辨证论治+针刺+康复训练和护理,对照组给予西医基础治疗+多奈哌齐片+康复训练和护理。两组均治疗2个月后观察临床疗效,于治疗前后观察两组患者认知功能(ADAS-Cog量表)、日常生活能力(ADL量表)、血清氧自由基[超氧化物歧化酶(SOD)、丙二醛(MDA)]和血管内皮活性物质[内皮素(ET)、一氧化氮(NO)]水平的变化。结果治疗组临床疗效总有效率为66.99%,对照组为57.00%,治疗组优于对照组(P<0.05)。两组患者治疗后ADL、ADAS-Cog评分均降低(P<0.05或P<0.01),治疗组治疗后ADL和ADAS-Cog评分低于对照组(P<0.05)。两组患者治疗后血清SOD水平上升,MDA、ET、NO水平均明显下降(P<0.05或P<0.01);治疗后治疗组血清SOD水平高于对照组,MDA及ET、NO水平均低于对照组(P<0.05)。结论西医基础治疗联合中医综合治疗方案能显著提高临床疗效,改善患者认知功能和日常生活能力,可能与其降低患者血清ET和NO含量、调节SOD、MDA的水平有关。

Objective To observe the clinical efficacy of comprehensive treatment of basic western medicine and traditional Chinese medicine（ TCM） in the treatment of vascular dementia（ VD） and to discuss its possible mechanism. Methods In total 208 VD patients were randomly assigned to the treatment group（ 110 cases） and control group（ 108 cases）. The treatment group was given basic western medicine,TCM syndrome differentiation treatment,acupuncture,rehabilitation training and nursing,while the control group were given basic western medicine,donepezil,rehabilitation training and nursing. The observation time was for 2 months. The cognitive function（ ADAS-Cog scale）and activity of daily living（ ADL） were evaluated. The serum levels of superoxide dismutase（ SOD）,malondialdehyde（ MDA）,endothelin（ ET） and nitric oxide（ NO） were detected before and after treatment. Results The total effective rate in treatment group（ 66. 99%） was higher than that in the control group（ 57. 00%,P〈0. 05）.After treatment,the ADL and ADAS-Cog scores were significantly improved in both groups（ P〈0. 05 or P〈0. 01）,and the improvement in the treatment group was superior to that in the control group（ P〈0. 05）. The level of SOD increased,while the levels of MDA,ET and NO decreased significantly after treatment in both groups（ P〈0. 05 or P〈0. 01）,and the improvements in the treatment group were superior to that in the control group（ P〈0. 05）.Conclusion Comprehensive treatment of basic western medicine and TCM could notably improve clinical efficacy and better the cognitive function and activity of daily living of VD patients,which is possibly related to the decreasing of serum level of ET and the regulation of SOD and MDA levels.