血管性痴呆的证候分析及针刺与穴位注射的疗效观察

Vascular dementia syndromes analysis and clinical observation on acupuncture and acupoint injection treatment

目的 对血管性痴呆（VD）患者进行中医证候学分析,并观察针刺与穴位注射对认知功能及日常生活能力的影响.方法 2014年1—12月对首都医科大学附属北京康复医院中医康复中心门诊及病房90例VD患者随机分为两组,穴位注射组和针刺对照组,应用证候量表进行分析,采用穴位注射或针刺治疗血管性痴呆,连续治疗4周,比较两组治疗前后简易精神状态检查（MMSE）、蒙特利尔认知评估量表（MoCA）、日常生活能力量表（ADL）评分.结果 血管性痴呆证候有瘀血阻络、痰浊内阻、肝肾亏虚、肝气郁滞和气血不足,本次观察中瘀血阻络占首位（40％）.治疗后MoCA、MMSE及ADL量表评分与治疗前相比均提高,差异有统计学意义（P〈0.05）,但是穴位注射组与针刺对照组相比差异无统计学意义（P〉0.05）.结论 血管性痴呆证候表现机制为正虚邪凑,针刺及穴位注射对血管性痴呆有较好的治疗作用.

Objective To analyze the syndromes of vascular dementia （VD） patients, and to observe the acupuncture effect on cognitive function and life skills. Methods From January to December 2014, a total of 90 inpatients and outpatients from TCM Rehabilitation Center of Beijing Rehabilitation Hospital of Capital Medical University were selected, and divided into acupuncture group and acupoint injection group. The patients of the two groups were treated with acupuncture and acupoint injection respectively for 4 continuous weeks. Traditional Chinese Medicine Syndrome Score Scale （TCMSSS） was applied to analyze. Mini-mental State Examination （MMSE）, Montreal Cognitive Assessment （MoCA） and Activity of Daily Living Scale （ADL） were compared between the two groups before and after treatment. Results Vascular dementia syndrome has blood stasis blocking collaterals, internal obstruction of phlegm turbidity, deficiency of liver and kidney, stagnation of liver-qi and insufficiency of Qi and blood. Blood stasis blocking collaterals occupies the first place in this observation （40%）. The differences in the scores of MoCA, MMSE and ADL before and after treatment were statistically significant （P 〈 0.05）. However, there was no statistical significance between the acupoint injection group and the acupuncture group （P 〉 0.05）. Conclusions The mechanism of vascular dementia syndrome is toxic pathogen obstruction when deficiency. Acupuncture and acupoint injection have good effect VD.