针刺通里和大钟穴为主治疗血管性痴呆的临床研究  

Clinical Study on the Treatment of Vascular Dementia by Acupuncture Mainly at Tongli(HT5)and Dazhong(KI4)Acupoints

作　　者：杨海波 徐朝辉[1] 甄玉婷 陈颖 王琳 YANG Haibo;XU Zhaohui;ZHEN Yuting;CHEN Ying;WANG Lin(Baoding No.1 Central Hospital,Hebei,Baoding 071000,China)

机构地区：[1]河北省保定市第一中心医院,保定071000

出　　处：《上海针灸杂志》2022年第12期1166-1170,共5页Shanghai Journal of Acupuncture and Moxibustion

基　　金：保定市卫健委项目(2141ZF262)。

摘　　要：目的观察针刺通里和大钟穴为主治疗血管性痴呆(VD)的临床疗效及其对患者血清胆碱能神经递质水平、认知功能和日常生活能力的影响。方法将70例VD患者分为治疗组和对照组,每组35例。对照组予常规治疗,治疗组在对照组常规治疗基础上予针刺通里、大钟等穴治疗。观察两组治疗前后中医血管性痴呆辨证量表(SDSVD)、临床痴呆评定表(CDR)、简易精神状态量表(MMSE)和日常生活能力量表(ADL)评分的变化,评价患者痴呆水平、认知功能和日常活动能力。比较两组治疗前后血清胆碱能神经递质[乙酰胆碱(Ach)、乙酰胆碱酯酶(Ach E)和胆碱乙酰转移酶(ChAT)]的水平。采用经颅多普勒超声检测两组患者大脑中动脉收缩期峰流速(Vs)、平均血流速度(Vm)和搏动指数(PI)并观察治疗前后的变化。结果治疗后,两组SDSVD、CDR、MMSE和ADL评分均较同组治疗前改善,且治疗组上述评分均优于对照组(P<0.05)。治疗后,两组患者大脑中动脉Vs、Vm和PI均较同组治疗前降低(P<0.05),且治疗组均低于对照组(P<0.05)。治疗后,治疗组血清Ach和Ch AT水平均高于对照组(P<0.05),血清AchE水平低于对照组(P<0.05)。结论在常规治疗基础上,以通里和大钟穴为主的针刺治疗可改善VD患者的痴呆症状、认知功能及日常生活能力,促进大脑微循环,调节胆碱能神经递质的水平。Objective To observe the clinical efficacy of the treatment by acupuncture mainly at Tongli(HT5)and Dazhong(KI4)acupoints for vascular dementia(VD)and its influence on the level of serum cholinergic neurotransmitter,cognitive function,and ability of daily living in patients.Method Seventy VD patients were divided into a treatment group and a control group,with 35 cases in each group.The control group received routine treatment,and the treatment group received acupuncture treatment at Tongli(HT5)and Dazhong(KI4)acupoints in addition to the routine treatment.The dementia level,cognitive function and daily activity ability of the patients were evaluated by observing the score changes of the scale for the differentiation of syndromes of vascular dementia(SDSVD),clinical dementia rating scale(CDR),mini-mental state examination(MMSE)and activities of daily living(ADL)before and after treatment in both groups.The serum levels of cholinergic neurotransmitters[acetylcholine(Ach),acetylcholinesterase(AchE)and choline acetyltransferase(ChAT)]were compared between the two groups before and after treatment.Transcranial Doppler ultrasound was used to detect the systolic velocity(Vs),mean velocity(Vm)and pulsatility index(PI)of the middle cerebral artery in the two groups,and to observe the changes before and after treatment.Result After treatment,the scores of the SDSVD,CDR,MMSE and ADL in both groups were improved compared with those before treatment,and the scores in the treatment group were better than those in the control group(P<0.05).After treatment,the middle cerebral artery Vs,Vm and PI in both groups were lower than before treatment(P<0.05),and they were lower in the treatment group than in the control group(P<0.05).After treatment,the serum Ach and ChAT levels were higher in the treatment group than in the control group(P<0.05),and the serum AchE level was lower in the treatment group than in the control group(P<0.05).Conclusion In addition to conventional treatment,acupuncture treatment mainly at Tongli and Dazhong

关 键 词：针刺疗法 针药并用 血管性痴呆 认知障碍 胆碱能神经递质 血流动力学 

分 类 号：R246.6[医药卫生—针灸推拿学]