针刺结合督灸联合安理申治疗血管性痴呆的临床观察

Clinical observation on treating vascular dementia by acupuncture plus Du moxibustion and Anlishen

目的:观察针刺结合督灸联合盐酸多奈哌齐(安理申)治疗血管性痴呆的临床疗效。方法:将符合血管性痴呆诊断标准的60名患者采用随机对照法分为对照组和观察组各30例。对照组治疗方法为:每日1次睡前口服安理申5 mg,4周后药量增至10 mg,共8周。观察组采用针刺结合督灸联合安理申治疗,针刺治疗主要选取神庭、百会、大椎、神道及膈俞、绝骨等俞穴,行捻转手法,直至局部有酸麻胀感为止,针刺治疗每次30 min,隔日1次,每周3次;督灸治疗是在督脉及膀胱经左右第一侧线上方施行隔姜灸,连续灸治3壮,以患者微微汗出、皮肤潮红为度,督灸治疗每次1.5~2 h,每周1次。对照组与观察组均以2周为一个疗程,共4个疗程。观察两组患者治疗前后简明精神状态检查量表(Mini-mental State Examination,MMSE)评分、日常生活能力(Activities of Daily Living,ADL)评分、血管性痴呆评估量表-认知分量表(Vascular Dementia Assessment Scale-cog,VADAS-cog)评分变化情况。结果:观察组总有效率为86.67%(26/30),对照组总有效率为63.33%(19/30),两组差异具有统计学意义(P<0.05)。治疗后两组患者认知功能与行为能力较治疗前均有提高(均P<0.05),且观察组疗效优于对照组(P<0.05)。结论:针刺结合督灸联合安理申治疗血管性痴呆疗效优于单独行安理申药物治疗,且安全有效,可在临床中推广应用。

Objective:To observe the clinical efficacy of acupuncture plus Du moxibustion and donepezil hydrochloride(Anlishen)on vascular dementia.Methods:60 patients with vascular dementia were randomly divided into the control group and the observation group,with 30 cases in each group.The control group was given Anlishen 5mg once a day before going to bed,and the dosage was increased to 10 mg after 4 weeks,the treatment lasted for 8 weeks.The observation group was treated by acupuncture plus Du moxibustion and Anlishen.Acupoints such as Shenting,Baihui,Dazhui,Shendao,Geshu and Juegu were selected for acupuncture treatment,and twirling manipulation was performed until the local pain,numbness and distention.Acupuncture treatment was 30 minutes each time,once every other day,3 times a week.Du moxibustion was performed on Du meridian and the left and right first lateral lines of bladder meridian for 3 continuous moxibustion treatment,after which the patients were with slight sweating and skin flushing,Du moxibustion treatment was for 1.5-2 hours each time,once a week.The control group and the observation group were treated for 2 weeks as a course of treatment,the treatment lasted for a total of 4 courses.The changes of MMSE,ADL and VADAS-cog scores were observed before and after treatment.Results:The total effective rate in the observation group was 86.67%(26/30),and that in the control group was 63.33%(19/30),the difference between the two groups was statistically significant(P<0.05).After treatment,the cognitive function and behavioral ability in the two groups were improved compared with those before treatment(all P<0.05),and the curative effect in the observation group was better than the control group(P<0.05).Conclusion:The curative effect of acupuncture plus Du moxibustion and Anlishen is better than that of Anlishen alone on vascular dementia,it is safe and effective,and can be widely used in clinical practice.