摘要
脑梗死具有发病率高、致残率高及死亡率高的特点,脑梗死后不但运动功能、感觉及语言会受到影响,还常会伴有认知障碍,甚至是痴呆等神志不清的疾患,也是血管性痴呆最常见的引发因素。在我国,脑梗死后导致的血管性认知障碍的治疗,除了西医常规的治疗方法外,已有大量文献报道针灸、中药疗法在治疗本病上也具有明显的疗效。因此,本课题从临床实践出发,充分发挥针灸治疗脑血管病的优势,在单纯康复认知训练的基础上,结合电针疗法,增强疗效,提高患者的生存质量,为脑梗死后血管性认知障碍(痰浊阻窍型)的临床治疗探求更安全、更有效的治疗方案。
目的：
探讨电针结合认知训练治疗梗死后血管性认知障碍(痰浊阻窍证)的临床疗效性及优越性,为血管性认知障碍的治疗提供更有效、简便、安全的治疗方案。
方法：
从台湾的明医中医诊所收集符合观察条件的71例脑梗死后血管性认知障碍(痰浊阻窍证)的患者,随机分为对照组(单纯康复认知训练组)35例和治疗组(电针结合康复认知训练组)36例。每组按照既定的治疗方案连续治疗3个疗程,并随访1个月。通过比较两组患者不同时期中医证候积分、MMSE积分、ADL积分、NFDS积分及生存质量(SF-36)的变化,观察两组病例的近期和远期临床疗效。建立数据库,运用SPSS17.0进行统计分析。
结果：
1.在改善中医证候方面,两组治疗方案均有明显的临床疗效(P＜0.05)。其中对照组的总有效率为71.43%,临床治愈1例(2.86%),显效7例(20.00%),好转17例(48.57%),无效10例(28.57%)；治疗组的总有效率为83.33%,临床治愈6例(16.67%),显效16例(44.44%),好转8例(22.22%),无效6例(16.67%)治疗组的中医证候的改善情况远优于对照组,即在认知训练的基础上增加电针治疗,可以明显增加患者的中医证候的改善,从根本上改善患者的身体质量。且治疗组在改善中医证候上的疗效出现明显快于对照组。
2.在认知能力的改善方面,治疗前后两组MMSE积分均有显著差异(P＜0.05),说明两组治疗方案均能有效提高患者的认知能力。其中,对照组总有效率为77.14%,显效10例(28.57%),有效17例(48.57%),无效8例(22.86%),恶化0例；治疗组的总有效率为80.56%,显效12例(33.33%),有效17例(47.22%),无效7例(19.44%),恶化0例。可见整体比较而言,治疗组的疗效优于对照组。此外,经比较,治疗组在第1疗程便开始出现明显的疗效,对照组在第2疗程才开始出现明显的疗效,可见治疗组见效快而优。
3.在日常生活能力的改善上,治疗前后两组AD1积分均有显著差异(P<0.05)说明两组治疗方案均能有效提高患者的日常生活能力。其中,对照组总有效率为82.86%,显效12例(34.29%),有效17例(48.57%),无效6例(17.14%),恶化0例；治疗组的总有效率为86.11%,显效12例(33.33%),有效19例(52.78%),无效5例(13.89%),恶化0例。可见整体比较而言,治疗组的疗效优于对照组。此外,经比较,治疗组在第1疗程便开始出现明显的疗效,对照组在第2疗程才开始出现明显的疗效,可见治疗组在改善患者生活能力上见效快而优。
4.在恢复缺损的神经功能上,治疗前后两组的NFDS积分均有显著差异(P<0.05),说明两组治疗方案均能有效提高患者的日常生活能力。其中,对照组总有效率为77.14%,显效9例(25.71%),有效18例(51.43%),无效7例(20.00%),恶化1例(2.86%)；治疗组的总有效率为88.89%,显效13例(36.11%),有效19例(52.78%),无效4例(11.11%),恶化0例。可见整体比较而言,治疗组的疗效优于对照组。此外,经比较,治疗组在第1疗程便开始出现明显的疗效,对照组在第2疗程才开始出现明显的疗效,可见治疗组在改善患者缺损的神经功能上见效快而优。
5.在提高患者生存质量上,治疗组内患者的生存质量在治疗前后有了非常显著的改善(P=0.00<0.01),且八个维度在治疗前后均有非常显著的差异(P<0.01)。而对照组患者的生存质量也有了显著的改善(P=0.01<0.05),其中,在生理职能、身体疼痛、社会功能、情感职能四个维度上,对照组患者有了非常显著的改善(P=0.00<0.01)；而在生理功能、总体健康、活力、精神健康这四个维度上只有显著的改善(P<0.05)。治疗后两组患者的生存质量存在一定的差异(P=-0.03<0.05),主要体现在生理职能和社会功能两个维度上(P<0.05),而其余六个维度经组间比较则无明显差异(P>0.05)。由此可见,两组患者的生存质量在治疗后均有明显改善,治疗组优于对照组。
6.在远期疗效的观察上,治疗结束1个月后,对照组患者在的中医证候积分、MMSE积分及NFDS积分均有所反复,比较后均得P<0.05,存在显著差异,说明停止治疗1个月后,患者的中医证候、认知功能及神经功能缺损情况有所反复,只有日常生活能力暂无变化(P>0.05)。而治疗结束1个月后,治疗组患者在中医证候积分、MMSE积分、ADL积分及NFDS积分上均无明显变化(P>0.05),病情无反复,远期临床疗效显著。
结论：
电针配合认知训练的综合治疗方法及单纯认知训练均可改善患者的中医证候、认知功能、神经功能、日常生活能力及生存质量,但综合疗法见效更快,疗效更佳,且具有明显的远期临床疗效,复发率低,在改善患者体质上更是有明显的优势。可见,电针治疗配合认知训练可以起到疗效叠加的作用,强化疗效,同时电针治疗操作相对简便、安全、无毒副作用,容易被广大患者接受,应大力推广。
Objective
To evaluate the dominance and curative effect of galvano-acupuncture and cognitive training in post-stroke vascular cognitive impairment (turbid phlegm obstructing orifices type), and to provide a effective, convenient and safe treatment option on primary insomnia.
Methods
Seventy-one cases of primary insomnia character as post-stroke vascular cognitive impairment (turbid phlegm obstructing orifices type), were chosen, and divided randomly into controlled group (treated with cognitive training), and treatment group(treated with galvano-acupuncture and cognitive training) averagely. All of them were treated for three courses and followed up after the treatment for one month. The symptoms of turbid phlegm obstructing orifices, the index of MMSE, the index of ADL, the index of NFDS, and the quality of life, were compared between the two groups. The short-term and long-term curative effect was observed. Establish a database and the experimental data is statistically analyzed by using the SPSS17.0
Results
1. Both the controlled group and the treatment group have remarkable effect on improving the symptoms of turbid phlegm obstructing orifices type. The total effectiveness of controlled group is71.43%, white the heal rate is2.86%, the significant efficiency rate is20.00%, the efficiency rate is48.57%, the inefficiency rate is28.57%. And the total effectiveness of treatment group is83.33%, white the heal rate is16.67%, the significant efficiency rate is44.44%, the efficiency rate is22.22%, the inefficiency rate is16.67%. It means the treatment group is better than the controlled group in improving the symptoms of turbid phlegm obstructing orifices type, by the galvano-acupuncture can make the body stronger. Except that, the treatment group is earlier in making effect.
2. Both the two groups have remarkable effect on improving the cognitive ability, by the analysis of the MMSE. The total effectiveness of controlled group is77.14%, white the significant efficiency rate is28.57%, the efficiency rate is48.57%, the inefficiency rate is22.86%, and no one is going worse. And the total effectiveness of treatment group is80.56%, white the significant efficiency rate is33.33%, the efficiency rate is47.22%, the inefficiency rate is19.44%, and no one is going worse. It means the treatment group is better than the controlled group in improving the cognitive ability, and in this research the treatment group is earlier in making effect.
3. Both the two groups have remarkable effect on improving the activities of daily living, by the analysis of the ADL. The total effectiveness of controlled group is82.86%, white the significant efficiency rate is34.29%, the efficiency rate is48.57%, the inefficiency rate is17.14%, and no one is going worse. And the total effectiveness of treatment group is86.11%, white the significant efficiency rate is33.33%, the efficiency rate is52.78%, the inefficiency rate is13.89%, and no one is going worse. It means the treatment group is better than the controlled group in improving the activities of daily living, and in this research the treatment group is earlier in making effect.
4. Both the two groups have remarkable effect on rehealing the neurological function, by the analysis of the NFDS. The total effectiveness of controlled group is77.14%, white the significant efficiency rate is25.71%, the efficiency rate is51.43%, the inefficiency rate is20.00%, and one person is going worse. And the total effectiveness of treatment group is88.89%, white the significant efficiency rate is36.11%, the efficiency rate is52.78%, the inefficiency rate is11.11%, and no one is going worse. It means the treatment group is better than the controlled group in improving the neurological function, and in this research the treatment group is earlier in making effect.
5. Both the two groups have remarkable effect on improving the quality of life, by the analysis of the Short Form36Health Survey Questionnaire (SF-36). And the result also shows that the score of in the treatment group is significantly improved, which has the statistical significant difference (P<0.05). The treatment group has the remarkable effect on all the eight sides of the SF-36, white the controlled group only has remarkable effect on the RP(Role Physical), the BP(Bodily Pain), the SF(Social Functioning), and the RE(Role Emotional).
6. One month later, we follow up the patients, and find that the treatment group has the low relapse rate.
Conclusion
Both the galvano-acupuncture and cognitive training have definite curative effect on post-stroke vascular cognitive impairment(turbid phlegm obstructing orifices type), by the analysis of the symptoms of turbid phlegm obstructing orifices type, the index of MMSE, the index of ADL, the index of NFDS, and the index of SF-36. And the galvano-acupuncture plus the cognitive training can inforce the effect, with low relapse rate. So we should extend the application of the combined treatment.
引文
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