电针百会、四神聪穴治疗全脑放疗认知功能障碍的临床观察

Clinical Observation of Electroacupuncture at Baihui(GV20)and Sishencong(EX-HN1)for CognitiveImpairment Associated with Whole Brain Radiotherapy

目的观察电针百会、四神聪穴治疗转移性脑肿瘤全脑放疗认知功能障碍的临床疗效。方法80例多发转移性脑肿瘤全脑放疗患者随机分为研究组和对照组,每组40例。对照组于全脑放疗当天给予甘露醇、地塞米松脱水治疗。研究组在对照组基础上采用电针百会、四神聪穴治疗。两组放疗前1周及放疗后1个月、3个月、6个月,采用简易精神量表(MMSE)、蒙特利尔认知评估量表(MoCA)评价认知功能,颅脑磁共振灌注成像了解平均脑血容量(CBV值)及平均脑血流量(CBF值)情况。结果两组放疗后1个月、3个月、6个月MMSE评分、MoCA评分、平均CBV值、平均CBF值均较放疗前1周下降(P<0.05);对照组放疗后1个月、3个月、6个月MMSE评分、Mo CA评分、平均CBV值、平均CBF值低于研究组,差异均有统计学意义(P<0.05)。结论全脑放疗对认知功能的损害是缓慢的不可逆的病理过程,可能与脑血容量、脑血流量下降有关,在常规药物治疗基础上电针百会、四神聪穴对放疗后出现的认知功能障碍有防护作用。

Objective To observe the clinical efficacy of electroacupuncture at Baihui(GV20)and Sishencong(EX-HN1)in treating cognitive impairment associated with whole brain radiotherapy for metastatic brain tumor.Method Eighty patients who underwent whole brain radiotherapy for metastatic brain tumor were randomized into a research group and a control group,with 40 cases in each group.The control group was given Mannitol and Dexamethasone for dehydration treatment on the same day of receiving whole brain radiotherapy.The research group was intervened by electroacupuncture at Baihui(GV20)and Sishencong(EX-HN1)in addition to the intervention given to the control group.One week before treatment,and 1 month,3 months and 6 months after radiotherapy,the cognitive function was evaluated using the Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA),and the mean cerebral blood volume(CBV)and mean cerebral blood flow(CBF)were measured using cerebral MR perfusion imaging.Result The MMSE score,MoCA score,and mean CBV and CBF values all declined 1 month,3 months and 6 months after radiotherapy compared with those at 1 week before radiotherapy in both groups(P<0.05);the MMSE score,MoCA score,and mean CBV and CBF values were lower in the control group than in the research group 1 month,3 months and 6 months after radiotherapy,and the differences were statistically significant(P<0.05).Conclusion The cognitive impairment caused by whole brain radiotherapy is a slow and irreversible pathological process,and may be associated with the decline of CBV and CBF.On the basis of conventional medication treatment,electroacupuncture at Baihui(GV20)and Sishencong(EX-HN1)can produce certain protect effect in preventing cognitive impairment after radiotherapy.