益肾化浊解毒汤联合针刺对肾精亏虚证血管性痴呆患者血液流变学及认知功能的影响

Effect of Yishen Huazhuo Jiedu Decoction Combined with Acupuncture on Hemorheology and Cognitive Function of Vascular Dementia Patients with Deficiency of Kidney Essence

目的探讨益肾化浊解毒汤联合针刺对肾精亏虚证血管性痴呆(VD)患者血液流变学及认知功能的影响。方法采用前瞻性研究,选取2017年10月—2019年10月期间河南省周口市中医院脑一科收治的84例VD患者作为研究对象,按随机数字表法分为对照组42例和研究组42例。两组均给予常规治疗,对照组加用针刺治疗,研究组采用益肾化浊解毒汤联合针刺治疗,每个疗程为4周,两组均连续治疗2个疗程。比较两组患者治疗总有效率、不良反应发生情况,同时对两组患者治疗前后血液流变学指标水平、中医症状评分、痴呆简易筛查量表(BSSD)评分及简易精神状态量表(MMSE)评分进行观察。结果治疗后研究组总有效率为92.86%(39/42),与对照组总有效率73.81%(31/42)比较,差异有统计学意义(χ2=5.48,P=0.02,P<0.05)。治疗2个月后两组患者失眠、善忘、头晕耳鸣及精神恍惚中医症状评分均低于治疗前,差异有统计学意义(P<0.05),且研究组失眠、善忘、头晕耳鸣及精神恍惚中医症状评分均明显低于对照组,两组比较,差异有统计学意义(P<0.05)。治疗2个月后两组患者血液流变学指标血浆黏度、红细胞压积、全血低切还原黏度、全血高切还原黏度水平均低于治疗前,差异有统计学意义(P<0.05),且研究组血液流变学指标血浆黏度、红细胞压积、全血低切还原黏度、全血高切还原黏度水平明显低于对照组,两组比较,差异有统计学意义(P<0.05)。治疗2个月后两组患者MMSE评分均高于治疗前,BSSD评分均低于治疗前,差异有统计学意义(P<0.05);且研究组MMSE评分明显高于对照组,BSSD评分明显低于对照组,两组比较,差异有统计学意义(P<0.05)。治疗期间,对照组不良反应发生率19.05%,研究组不良反应发生率11.90%,两组比较,差异无统计学意义(P>0.05)。结论益肾化浊解毒汤联合针刺对VD的治疗效果显著,可改善患者中医症状、认知功能及血液流变学,且安全性可靠,值得临床推广使用。

Objective To investigate the effect of Yishen Huazhuo Jiedu Decoction combined with acupuncture on hemorheology and cognitive function of patients with vascular dementia(VD)with deficiency of kidney essence.Methods A prospective study was used to select 84 patients with VD who were admitted to the First Department of Brain,Zhoukou City Hospital of Traditional Chinese Medicine,Henan Province from October 2017 to October 2019 as the research objects.They were divided into the control group and the study group by random number table method,42 cases each group.Both groups were given conventional treatment.The control group was treated with acupuncture,and the study group was treated with Yishen Huazhuo Jiedu Decoction combined with acupuncture.Each course was 4 weeks,and both groups were treated with 2 consecutive courses.The total effective rate of treatment and the occurrence of adverse reactions were compared between the two groups of patients.At the same time,the blood rheology index levels,TCM symptom scores,dementia simple screening scale(BSSD)scores and the simple mental state scale(MMSE)were evaluated before and after treatment.ResultsAfter treatment,the total effective rate of treatment in the study group was 92.86%(39/42),compared with the total effective rate of 73.81%(31/42)in the control group,the difference was statistically significant(χ2=5.48,P=0.02,P<0.05).After 2 months of treatment,the scores of insomnia,forgetfulness,dizziness,tinnitus,and trance of TCM symptoms in the two groups were lower than before treatment(P<0.05),and the scores of insomnia,forgetfulness,dizziness,tinnitus,and trance of TCM in the study group were all significant Lower than the control group(P<0.05).After 2 months of treatment,the blood rheology indexes of the two groups of patients were plasma viscosity,hematocrit,whole blood low-cut reduction viscosity,and whole blood high-cut reduction viscosity levels were lower than before treatment(P<0.05),and the blood flow of the study group The plasma viscosity,hematocrit,whole blood low-shear reduction viscosity,and whole blood high-shear reduction viscosity levels were significantly lower than those of the control group(P<0.05).After 2 months of treatment,the MMSE scores of the two groups of patients were higher than before treatment,and the BSSD scores were lower than before treatment(P<0.05);and the MMSE score of the study group was significantly higher than that of the control group,and the BSSD score was significantly lower than that of the control group(P<0.05).During the treatment period,the incidence of adverse reactions in the control group was 19.05%,and the incidence of adverse reactions in the study group was 11.90%.There was no statistically significant difference between the two groups(P>0.05).Conclusion Yishen Huazhuo Jiedu Decoction combined with acupuncture has a significant effect on the treatment of VD,which can improve patients′TCM symptoms,cognitive function and hemorheology,and is safe and worthy of clinical promotion.