专方加减与辨证论治治疗轻、中度血管性痴呆阶段性结局效果对比研究

Comparative study of light and moderate vascular demention treatment by special decoction method and syndrome differentiation method

目的:比较分析专方加减与辨证论治两法治疗轻、中度血管性痴呆(VD)的阶段性结局效果,客观评价两法的优势与特色。方法:根据干预方案的不同将560例轻、中度VD患者随机分为专方加减组(280例)和辨证论治组(280例)。对比两组治疗90d后阶段性结局效果。结果:治疗90d后,两组轻、中度VD患者MMSE及CDT总分、MMSE定向力、即刻记忆、计算力及延迟记忆得分和轻度VD患者MMSE语言与视空间亚项得分均较治疗前显著提高(P<0.05,P<0.01),两组轻、中度VD患者NPI及ADL总分较治疗前显著下降,差异有统计学意义(P<0.05,P<0.01);其中,专方加减组MMSE总分、定向力及延迟记忆得分,尤其是轻度VD患者MMSE总分、定向力及延迟记忆得分治疗前后变化较辨证论治组更为显著,两组差异有统计学意义(P<0.05);而辨证论治组NPI总分,尤其是轻度VD患者NPI总分治疗前后变化较专方加减组更为显著,两组差异有统计学意义(P<0.05,P<0.01)。结论:两法对轻、中度VD患者认知功能、日常生活能力、精神症状等均有改善;其中,专方加减对VD患者认知功能,尤其是轻度VD患者定向力和延迟记忆的改善效果更明显;而辨证论治对VD患者精神症状,尤其是轻度VD患者的精神症状改善效果更为理想。

Objective： To Compare and analyze two methods of treatment-special decoction and syndrome differentiation, their stage treatment effects of different light and moderate vascular dementia （VD） patients and evaluate objectively the advantages and features of the two treatment methods. Methods： Divide case studies into special decoction group （280 cases） and syndrome differentiation group （280 cases） and compare stage treatment effects after 90 days. Results： After 90 days＇ treatment, MMSE and CDT score, sub-item score of MMSE, as well as MMSE language and vision-space sub-item score of light and moderate VD patients have been greatly improved in both groups （P〈0.05, P〈0.01）, while the NPI and ADL score have decreased, with a statistical difference （P〈0.05, P〈0.01）; In special decoction group, MMSE score, orientation and delayed memory score, especially those of light VD patients, have improved greatly than that in syndrome differentiation with a statistical difference （P〈0.05）; While in syndrome differentiation group, NPI score has changed more than that in special decoction group with a statistical difference （P〈0.05, P〈0.01）. Conclusion： Both groups have clinical efficacy for mild and moderate VD patients, and can improve the patients＇ cognitive function, daily living capacity and mental symptoms.The special decoction group has significant improvement effects on moderate VD patient＇s cognitive function, especially on disorientation and delayed memory; the syndrome differentiation group has better effects on the treatment of psychiatric symptoms, especially on the light VD patients＇ mental symptoms.