【摘要】：癡呆是由于腦功能障礙而產(chǎn)生的獲得性智能損害綜合癥。隨著我國人口的老齡化,老年期癡呆的發(fā)病率有升高趨勢,已成為一個日益突出的社會及醫(yī)學(xué)問題,為此,尋求癡呆的治療,對改善老年人的生活質(zhì)量尤為重要,在治療方面,由于癡呆是器質(zhì)性病變,絕大多數(shù)是不可逆的,所以目前尚無滿意的療效,針對癡呆本質(zhì)上的治療仍在努力的探索之中,有些原因所致的癡呆試驗性藥物治療取得了一些可喜的進(jìn)展,藥物治療有改善部分癥狀的作用。與此同時,中醫(yī)藥治療癡呆具有巨大的潛力,總結(jié)和發(fā)掘中藥的有效成分,建立統(tǒng)一的療效觀察指標(biāo)和定量療效評定的藥理模型,在攻克癡呆中為人類提供新的希望。因此,進(jìn)行中西醫(yī)結(jié)合治療癡呆是迫切需要研究的課題,我們探討了中西醫(yī)結(jié)合治療老年性癡呆的臨床療效。中醫(yī)藥是我國的瑰寶,在目前老年期癡呆的治療尚未有特異療效的情況下,相比之下,中醫(yī)藥在延緩衰老以及衰老相關(guān)疾病的防治方面有著豐富的理論和實踐經(jīng)驗,具有潛在的優(yōu)勢和廣闊的開發(fā)前景。研究發(fā)現(xiàn)雌激素對女性認(rèn)知功能有保護(hù)作用,設(shè)計了雌激素對女性阿爾茨海默病患者的對照觀察的研究,提出了雌激素配合膽堿酯酶抑制劑治療女性阿爾茨海默病患者的可能性,也取得了理想的效果,達(dá)到了改善老年期癡呆認(rèn)知功能的預(yù)期目的,為女性阿爾茨海默病患者的治療帶了了福音。本文通過對癡呆的中西醫(yī)結(jié)合治療與康復(fù)觀察研究,發(fā)現(xiàn)其有較好的療效�？傊畬ふ掖_切有效的防治方法,改善和提高患者的生存質(zhì)量和對社會的適應(yīng)能力,以最大程度減少癡呆類疾病所帶來的不良后果,都有十分重要的意義。本文在認(rèn)真研究國內(nèi)外近期對癡呆的發(fā)病機(jī)制與治療研究的基礎(chǔ)上,以中西醫(yī)結(jié)合施治與康復(fù)為主導(dǎo)思想,運(yùn)用中醫(yī)的特點(diǎn),結(jié)合西醫(yī)的作用,配合康復(fù)治療,對癡呆,尤其是阿爾茨海默病和血管性癡呆進(jìn)行預(yù)防、控制與治療,取得了明顯的療效。 首先提出并開展了中藥提純針劑(絡(luò)泰)治療老年期癡呆(本文主要指血管性癡呆和阿爾茨海默病癡呆)的療效研究。不管血管性癡呆還是老年性癡呆(阿爾茨海默病),腦血流量的減少可能是共同的病理改變,而絡(luò)泰的有效成分人參皂苷R1,且其是無菌凍干粉劑,有較高的穩(wěn)定性。本課題的動物實驗表明人參總皂甙對大鼠腦缺血再灌注損傷有明顯的保護(hù)作用,表現(xiàn)在它可擴(kuò)張血管,增加腦血流量,減輕腦水腫超微結(jié)構(gòu)損傷和降低死亡率。其保護(hù)作用與抑制鈣積累密切相關(guān)。臨床應(yīng)用證明它具有 WP=4 擴(kuò)張心腦血管,增加心腦血管流量,改善心腦微循環(huán),并對腦缺血后海馬CAI區(qū)(與學(xué)習(xí)和記憶有關(guān))的遲發(fā)性神經(jīng)元損傷有明顯的保護(hù)作用,且又抗炎作用和雌激素樣作用, 臨床實踐證明,人參皂苷具有與雌激素相似的改善記憶和神經(jīng)保護(hù)作用。雌激素參與中樞神經(jīng)系統(tǒng)功能的調(diào)節(jié),內(nèi)源性雌激素是Alzheimer Disease(AD), 的保護(hù)因素,雌激素替代治療對AD的預(yù)防和治療有益。因此,人參皂苷作為具有雌激素樣作用的中藥,可以作為雌激素的替代品,對于AD的防治具有重 要意義。在動物衰老過程中,鈣代謝平衡失調(diào)造成神經(jīng)元中游離鈣超負(fù)荷,使神經(jīng)元可塑性減低,從而發(fā)生記憶障礙。李麟仙研究表明,同樣人參皂苷的益智作用機(jī)制之一即它的有效成分中的Rb1能夠降低細(xì)胞內(nèi)鈣的濃度及鈣蛋白的活性�？s小腦梗死范圍,從而有抗AD和Vascular Dementia(VD)作用。 其次,研究了中草藥治療血管性癡呆的效果,方藥組成為:黃芪、紅花、枸杞子、五味子、赤芍、川芎、紅花、當(dāng)歸、地龍。方中黃芪、紅花、枸杞子、五味子可益氣補(bǔ)腎,填精生髓;赤芍、川芎、紅花、當(dāng)歸活血化瘀,地龍疏通經(jīng)絡(luò)�，F(xiàn)代藥理研究證明,黃芪、五味子、枸杞子對神經(jīng)系統(tǒng)有興奮作用,能改善人的智能活動;當(dāng)歸、川芎、赤芍、紅花、五味子、黃柏均有不同程度的鈣通道阻滯作用,可明顯增加腦血流量,改善腦循環(huán),清除自由基。地龍,赤芍含有纖維蛋白溶解酶激活物,有溶栓作用,絞股藍(lán)抗衰老。所以以上諸藥配伍可以提高患者血中超氧化物歧化酶的活性,降低過氧化脂質(zhì),抗自由基損傷,改善腦微循環(huán),促進(jìn)神經(jīng)細(xì)胞功能恢復(fù),并對腦缺血后海馬CAI區(qū)(與學(xué)習(xí)和記憶有關(guān))的遲發(fā)性神經(jīng)元損傷有明顯的保護(hù)作用,進(jìn)一步延緩了癡呆的發(fā)生,為眾多的血管性癡呆患者提供了價廉的治療渠道。 第三,提出并開展了從中草藥千層塔中的提取物—石杉堿甲(膽堿酯酶抑制劑)配合雌激素治療阿爾茨海默病的可行性,這和美國Research Nurse Coordinator Alzheimer's Disease Research Center(Houston Baylor College of Medicine)目前幾個重點(diǎn)研究阿爾茨海默病的研究機(jī)構(gòu),觀察雌激素治療阿爾茨海默病的研究幾乎同步進(jìn)行。流行病學(xué)證明,女性阿爾茨海默病的發(fā)病率遠(yuǎn)遠(yuǎn)高于男性,其可能的原因之一是因為雌激素水平的下降有關(guān)。雌激素對認(rèn)知等有保護(hù)作用已達(dá)共識,本課題的研究表明:雌激素配合石杉堿甲治療阿爾茨海默病對其認(rèn)知功能等有保護(hù)作用,并且可加強(qiáng)石杉堿甲的療效,為女性阿爾茨海默病的預(yù)防及治療帶來了希望。同時還小樣本的采用了安理申配合雌激素治療阿爾茨海默病的試驗,取得了和國外同類研究的一致性。 康復(fù)研究在老年期癡呆的治療中起著舉足輕重的作用。由于癡呆是一種慢性疾病 WP=5 且社會生活功能缺損日益加重,需要對其進(jìn)行照料,而我國的國情決定了多數(shù)患者是在家庭內(nèi)被照料,照料負(fù)擔(dān)極
[Abstract]:Dementia is an acquired intelligence impairment syndrome caused by brain dysfunction. With the aging of the population in China, the incidence of senile dementia has an increasing trend, and has become an increasingly prominent social and medical problem. Therefore, seeking treatment for dementia is particularly important to improve the quality of life of the elderly, in the treatment, because of dementia. Dementia is an organic disease, most of which are irreversible, so there is no satisfactory effect at present. Essential treatment for dementia is still under exploration. Experimental drug therapy for dementia caused by some reasons has made some gratifying progress. Drug therapy can improve some symptoms. It has great potential to summarize and explore the effective ingredients of traditional Chinese medicine, establish a unified efficacy observation index and quantitative efficacy evaluation of the pharmacological model, in order to provide new hope for human beings to conquer dementia. Traditional Chinese medicine is a treasure of our country. At present, the treatment of senile dementia has no specific effect. In contrast, traditional Chinese medicine has rich theoretical and practical experience in delaying senility and preventing and treating senility-related diseases. It has potential advantages and broad prospects for development. Sexual cognitive function has a protective effect. A comparative study of estrogen on female patients with Alzheimer's disease was designed. The possibility of estrogen combined with cholinesterase inhibitor in the treatment of female patients with Alzheimer's disease was put forward. The ideal effect was achieved. The anticipated purpose of improving cognitive function of senile dementia was achieved. The treatment of patients with Alzheimer's disease has brought the gospel.Through the observation and Study on the treatment and rehabilitation of dementia with the combination of traditional Chinese medicine and Western medicine, we found that it has a better effect.In a word, we should find a precise and effective prevention and treatment method to improve the quality of life and social adaptability of patients, so as to minimize the adverse effects caused by dementia-like diseases. On the basis of studying the pathogenesis and treatment of dementia at home and abroad in recent years, this paper takes the treatment and rehabilitation of integrated traditional Chinese and Western medicine as the leading ideology, applies the characteristics of traditional Chinese medicine, combines the role of Western medicine, and cooperates with rehabilitation therapy to predict dementia, especially Alzheimer's disease and vascular dementia. Prevention, control and treatment have achieved obvious curative effects.
In this paper, we first proposed and carried out a study on the curative effect of Chinese medicine (Luotai) on senile dementia (vascular dementia and Alzheimer's disease). The animal experiment showed that the total saponins of ginseng had obvious protective effect on cerebral ischemia-reperfusion injury in rats. It could dilate blood vessels, increase cerebral blood flow, alleviate ultrastructural damage of cerebral edema and reduce mortality. Its protective effect was closely related to inhibition of calcium accumulation. Clinical application proves that it has
WP=4
Expanding cardio-cerebrovascular, increasing cardio-cerebrovascular flow, improving cardio-cerebral microcirculation, and protecting delayed neuronal damage in hippocampal CAI area (related to learning and memory) after cerebral ischemia, and anti-inflammatory and estrogen-like effects, clinical practice has proved that ginsenoside can improve memory and neuroprotection similar to estrogen. Estrogen participates in the regulation of central nervous system function. Endogenous estrogen is the protective factor of Alzheimer Disease (AD). Estrogen replacement therapy is beneficial to the prevention and treatment of AD. Therefore, ginsenoside, as a traditional Chinese medicine with estrogen-like effect, can be used as an alternative to estrogen and has important significance for the prevention and treatment of AD. Li Linxian has shown that Rb1, an active component of ginsenoside, can reduce the concentration of intracellular calcium and the activity of calcium protein. The range of cerebral infarction has the effect of anti AD and Vascular Dementia (VD).
Secondly, the effects of Chinese herbal medicine on vascular dementia were studied. The prescriptions consisted of Astragalus membranaceus, Safflower, Lycium barbarum, Schisandra chinensis, Radix Paeoniae rubrae, Rhizoma Chuanxiong, Safflower, Angelica sinensis, Dilong. Fructus Schisandrae Chinensis and Fructus Lycium barbarum have exciting effects on nervous system and can improve people's intelligence activities; Angelica sinensis, Ligusticum chuanxiong, Radix Paeoniae rubra, Fructus Schisandrae chinensis, Fructus Phellodendrae chinensis and Fructus Phellodendrae phellodendrae chinensis all have different degrees of calcium channel blockade effect, which can obviously increase cerebral blood flow, improve cerebral circulation and scavenge free radi Blue anti-aging. Therefore, the combination of the above drugs can improve the activity of superoxide dismutase, reduce lipid peroxide, anti-free radical damage, improve cerebral microcirculation, promote the recovery of nerve cell function, and have a significant protective effect on delayed neuronal damage in hippocampal CAI area (related to learning and memory) after cerebral ischemia. The steps slow down the occurrence of dementia and provide a cheap treatment channel for many patients with vascular dementia.
Thirdly, the feasibility of huperzine A (cholinesterase inhibitor) in combination with estrogen in the treatment of Alzheimer's disease, an extract from the Chinese herbal medicinal Millennium tower, has been proposed and developed, which is currently the focus of several studies in the US Research Nurse Coordinator Alzheimer's Disease Research Center (Houston Baylor College of Medicine). Epidemiological studies have shown that the incidence of female Alzheimer's disease is much higher than that of male. One of the possible reasons for this is that estrogen levels have declined. Estrogen has a protective effect on cognition, and so on. It is concluded that estrogen combined with huperzine A has a protective effect on cognitive function of Alzheimer's disease and can enhance the efficacy of huperzine A, which brings hope for the prevention and treatment of female Alzheimer's disease. Consistency of class research.
Rehabilitation research plays an important role in the treatment of senile dementia, which is a chronic disease.
WP=5
And the social life function defect is getting worse and worse, which needs to be cared for. However, the situation of our country determines that most of the patients are cared for in the family, and the burden of care is extremely high.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2004
【分類號】：R749.16

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

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本文編號：2211691