雷火灸大椎、肾俞结合认知训练治疗缺血性脑卒中后轻度认知功能障碍疗效观察
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摘要
目的观察雷火灸大椎、肾俞结合认知训练治疗缺血性脑卒中后轻度认知功能障碍的临床疗效。方法将60例缺血性脑卒中后轻度认知功能障碍患者随机分为治疗组和对照组,每组30例。对照组采用基础治疗+认知训练,治疗组在对照组治疗基础上采用雷火灸治疗。两组治疗前后分别采用蒙特利尔认知量表、简易精神状态检查表、日常生活能力评定和韦氏记忆量表评定,观察患者主要临床症状,比较两组临床疗效,每组疗程8星期。结果雷火灸结合认知训练治疗总有效率为80.0%,单纯认知训练治疗总有效率为70.0%。两组总体疗效上的差异有统计学意义(P<0.05)。结论说明所选穴位有改善轻度认知功能障碍患者的认知及日常生活能力的效果,雷火灸大椎、肾俞结合认知训练临床疗效优于单纯认知训练,所以在临床预防和治疗轻度认知功能障碍中,我们可以将雷火灸同现代康复医学相结合,以提高疗效。
Objective To observe the clinical efficacy of thunder-fire moxibustion at Dazhui(GV14) and Shenshu(BL23) in treating mild cognitive impairment(MCI) due to ischemic cerebral stroke. Method Sixty patients with MCI due to ischemic cerebral stroke were randomized into a treatment group and a control group, 30 cases each. The control group was intervened by joint treatment plus cognitive training, while the treatment group was by thunder-fire moxibustion in addition to that given to the control group. The two groups were evaluated by the Montreal Cognitive Assessment(Mo CA), Mini-Mental State Examination(MMSE) and Wechsler Memory Scale(WMS), the major symptoms were observed, and the clinical efficacies were compared between the two groups. The two groups were both treated for 8 weeks. Result The total effective rate was 80.0% in the treatment group, versus 70.0% in the control group, and the difference was statistically significant(P<0.05). Conclusion The selected acupoints can improve the cognition and activities of daily living(ADL) in MCI patients; thunder-fire moxibustion at Dazhui and Shenshu plus cognitive training can produce a better clinical efficacy than dry cognitive training. Therefore, we can combine thunder-fire moxibustion with modern rehabilitation to enhance the therapeutic efficacy in preventing and treating MCI.
Objective To observe the clinical efficacy of thunder-fire moxibustion at Dazhui(GV14) and Shenshu(BL23) in treating mild cognitive impairment(MCI) due to ischemic cerebral stroke. Method Sixty patients with MCI due to ischemic cerebral stroke were randomized into a treatment group and a control group, 30 cases each. The control group was intervened by joint treatment plus cognitive training, while the treatment group was by thunder-fire moxibustion in addition to that given to the control group. The two groups were evaluated by the Montreal Cognitive Assessment(Mo CA), Mini-Mental State Examination(MMSE) and Wechsler Memory Scale(WMS), the major symptoms were observed, and the clinical efficacies were compared between the two groups. The two groups were both treated for 8 weeks. Result The total effective rate was 80.0% in the treatment group, versus 70.0% in the control group, and the difference was statistically significant(P<0.05). Conclusion The selected acupoints can improve the cognition and activities of daily living(ADL) in MCI patients; thunder-fire moxibustion at Dazhui and Shenshu plus cognitive training can produce a better clinical efficacy than dry cognitive training. Therefore, we can combine thunder-fire moxibustion with modern rehabilitation to enhance the therapeutic efficacy in preventing and treating MCI.
引文
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[3]中华神经科学会,中华神经科外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-381.
[4]中华医学会神经病学分会脑血管病学组缺血性脑卒中二级预防指南撰写组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2010[J].中国医学前沿杂志(电子版),2011,3(3):84-93.
[5]中华人民共和国国家质量监督检疫检验总局,中国国家标准化管理委员会.腧穴名称与定位:中华人民共和国国家标准[S].北京:中国标准出版社,2006:27.
[6]王新志,韩群英,郭学芳.中风脑病诊疗全书[M].北京:中国医药科技出版社,2000:272-273.
[7]Cherbuin N,Kumar R,Sachdev PS,et al.Dietary Mineral Intake and Risk of Mild Cognitive Impairment:The PATH through Life Project[J].Front Aging Neurosci,2013,6(3):4.
[8]关绍晨,汤哲,吴晓光.北京老年人群轻度认知障碍患病情况及危险因素的抽样调查[J].中国脑血管病杂志,2008,5(9):395-398.
[9]刘爽,张玉莲,周震.老年性痴呆流行病学研究现况[J].中国老年学杂志,2010,30(10):1455-1457.
[10]Huckans M,Hutson L,Twamley E,et al.Efficacy of cognitive rehabilitation therapies for mild cognitive impairment(MCI)in older adults:working toward a theoretical model and evidence-based interventions[J].Neuropsychol Rev,2013,23(1):63-80.
[11]江钢辉,陈振虎,赖新生.针刺智三针和四神聪穴治疗血管性痴呆的临床研究[J].广州中医药大学学报,2003,20(4):271-273.
[12]赖新生.针刺治疗老年性血管性痴呆的疗效观察[J].中国针灸,1997,17(4):201-202.
[13]蒋垂刚,崔韶阳,聂彬彬,等.捻针刺激太溪穴对MCI功能性磁共振成像影响的研究[J].中国中医基础医学杂志,2011,17(12):1365-1367.
[14]孙平.针刺并药物治疗对老年血管性痴呆认知功能的影响[J].中国临床康复,2004,8(7):1234.
[15]田福玲,李旗,刘国荣,等.阴-阳对刺呼吸补泻法对中风偏瘫患者步态周期的影响[J].上海针灸杂志,2015,34(1):11-13.
[16]申斌,于川.针刺治疗中风后肢体运动功能障碍临床研究概述[J].中国中医药图书情报杂志,2015,39(2):60-63.
[17]张勇,傅立新,薛平聚,等.针刺治疗中风后运动性失语的临床研究进展[J].中华针灸电子杂志,2014,3(6):19-21.
[18]王招玲,王黎玲,蒋永萍,等.热敏灸结合针刺治疗中风后抑郁症的临床疗效观察[J].实用中西医结合临床,2014,14(10):72-73.
[19]王频,汤敬一,杨骏,等.艾灸对血管性痴呆大鼠海马内VEGF、flt-1、b FGF及b FGF-r表达的影响[J].中国中西医结合杂志,2012,32(1):97-101.
[20]郑洪华,付天明.辨证分型针刺、雷火灸联合中药内服及外用治疗慢性湿疹随机平行对照研究[J].实用中医内科杂志,2016,30(4):92-95.
[21]粟顺美,林俏丽,陈璇如,等.赵氏雷火灸治疗上呼吸道感染的应用体会[J].按摩与康复医学,2016,7(22):20-21.
[22]陈春海,刘春禹,许广里,等.雷火灸治疗尿道综合征45例[J].长春中医药大学学报,2013,29(4):684.
[23]郭强中,汪蓉,陈敏军,等.药灸结合治疗阳虚型过敏性鼻炎[J].光明中医,2011,26(8):1649.
[24]张小芹,付玲.雷火灸大椎治疗颈性眩晕60例临床观察[J].中外女性健康研究,2015,(18):191.
[25]李扬帆.督灸合雷火灸治疗放化疗后白细胞减少症81例[J].中医外治杂志,2013,22(2):40-41.
[26]朱才丰,杨骏,费爱华,等.艾灸督脉组穴治疗轻度认知功能障碍疗效观察[J].上海针灸杂志,2010,29(11):695-697.
[27]沈洁,艾炳蔚,沈梅红,等.温和灸肾俞穴对绝经前后女性亚健康状态的干预[J].南京中医药大学学报,2015,31(6):532-535.
[28]赵琛,施茵,崔云华,等.温和灸肾俞穴、关元穴对肾阳虚老年人衰老症状及外周血Rb蛋白表达的影响[J].环球中医药,2012,5(5):350-353.
[29]钟峰,胡玲,罗磊,等.不同疗程温和灸对活动期类风湿关节炎患者临床疗效的的影响[J].中国中医药咨讯,2011,3(3):167-169.
[30]Sargeant R,Webster G,Salzman T,et al.Enriching the environment of patients undergoing long term rehabilitation through group discussion of the news[J].Cognitive Re-habilitation,2000,18(1):20-23.
[2]Ganguli M,Dodge HH,Shen C,et al.Mild cognitive impairment,amnestic type:an epidemiologic study[J].Neurol,2004,63(1):115-121.
[3]中华神经科学会,中华神经科外科学会.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-381.
[4]中华医学会神经病学分会脑血管病学组缺血性脑卒中二级预防指南撰写组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2010[J].中国医学前沿杂志(电子版),2011,3(3):84-93.
[5]中华人民共和国国家质量监督检疫检验总局,中国国家标准化管理委员会.腧穴名称与定位:中华人民共和国国家标准[S].北京:中国标准出版社,2006:27.
[6]王新志,韩群英,郭学芳.中风脑病诊疗全书[M].北京:中国医药科技出版社,2000:272-273.
[7]Cherbuin N,Kumar R,Sachdev PS,et al.Dietary Mineral Intake and Risk of Mild Cognitive Impairment:The PATH through Life Project[J].Front Aging Neurosci,2013,6(3):4.
[8]关绍晨,汤哲,吴晓光.北京老年人群轻度认知障碍患病情况及危险因素的抽样调查[J].中国脑血管病杂志,2008,5(9):395-398.
[9]刘爽,张玉莲,周震.老年性痴呆流行病学研究现况[J].中国老年学杂志,2010,30(10):1455-1457.
[10]Huckans M,Hutson L,Twamley E,et al.Efficacy of cognitive rehabilitation therapies for mild cognitive impairment(MCI)in older adults:working toward a theoretical model and evidence-based interventions[J].Neuropsychol Rev,2013,23(1):63-80.
[11]江钢辉,陈振虎,赖新生.针刺智三针和四神聪穴治疗血管性痴呆的临床研究[J].广州中医药大学学报,2003,20(4):271-273.
[12]赖新生.针刺治疗老年性血管性痴呆的疗效观察[J].中国针灸,1997,17(4):201-202.
[13]蒋垂刚,崔韶阳,聂彬彬,等.捻针刺激太溪穴对MCI功能性磁共振成像影响的研究[J].中国中医基础医学杂志,2011,17(12):1365-1367.
[14]孙平.针刺并药物治疗对老年血管性痴呆认知功能的影响[J].中国临床康复,2004,8(7):1234.
[15]田福玲,李旗,刘国荣,等.阴-阳对刺呼吸补泻法对中风偏瘫患者步态周期的影响[J].上海针灸杂志,2015,34(1):11-13.
[16]申斌,于川.针刺治疗中风后肢体运动功能障碍临床研究概述[J].中国中医药图书情报杂志,2015,39(2):60-63.
[17]张勇,傅立新,薛平聚,等.针刺治疗中风后运动性失语的临床研究进展[J].中华针灸电子杂志,2014,3(6):19-21.
[18]王招玲,王黎玲,蒋永萍,等.热敏灸结合针刺治疗中风后抑郁症的临床疗效观察[J].实用中西医结合临床,2014,14(10):72-73.
[19]王频,汤敬一,杨骏,等.艾灸对血管性痴呆大鼠海马内VEGF、flt-1、b FGF及b FGF-r表达的影响[J].中国中西医结合杂志,2012,32(1):97-101.
[20]郑洪华,付天明.辨证分型针刺、雷火灸联合中药内服及外用治疗慢性湿疹随机平行对照研究[J].实用中医内科杂志,2016,30(4):92-95.
[21]粟顺美,林俏丽,陈璇如,等.赵氏雷火灸治疗上呼吸道感染的应用体会[J].按摩与康复医学,2016,7(22):20-21.
[22]陈春海,刘春禹,许广里,等.雷火灸治疗尿道综合征45例[J].长春中医药大学学报,2013,29(4):684.
[23]郭强中,汪蓉,陈敏军,等.药灸结合治疗阳虚型过敏性鼻炎[J].光明中医,2011,26(8):1649.
[24]张小芹,付玲.雷火灸大椎治疗颈性眩晕60例临床观察[J].中外女性健康研究,2015,(18):191.
[25]李扬帆.督灸合雷火灸治疗放化疗后白细胞减少症81例[J].中医外治杂志,2013,22(2):40-41.
[26]朱才丰,杨骏,费爱华,等.艾灸督脉组穴治疗轻度认知功能障碍疗效观察[J].上海针灸杂志,2010,29(11):695-697.
[27]沈洁,艾炳蔚,沈梅红,等.温和灸肾俞穴对绝经前后女性亚健康状态的干预[J].南京中医药大学学报,2015,31(6):532-535.
[28]赵琛,施茵,崔云华,等.温和灸肾俞穴、关元穴对肾阳虚老年人衰老症状及外周血Rb蛋白表达的影响[J].环球中医药,2012,5(5):350-353.
[29]钟峰,胡玲,罗磊,等.不同疗程温和灸对活动期类风湿关节炎患者临床疗效的的影响[J].中国中医药咨讯,2011,3(3):167-169.
[30]Sargeant R,Webster G,Salzman T,et al.Enriching the environment of patients undergoing long term rehabilitation through group discussion of the news[J].Cognitive Re-habilitation,2000,18(1):20-23.