本文關(guān)鍵詞： 缺血性腦卒中后輕度認(rèn)知障礙 溫針灸百會(huì)穴 電針智三針　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：背景缺血性腦卒中后輕度認(rèn)知障礙是指由腦血管性病變所致的早期或輕度認(rèn)知功能損害,且認(rèn)知障礙程度尚未達(dá)到癡呆標(biāo)準(zhǔn)的一類綜合征,是近年來(lái)才提出的新的疾病概念。據(jù)統(tǒng)計(jì),腦卒中患者半數(shù)以上有認(rèn)知功能障礙。[1]認(rèn)知活動(dòng)參與患者康復(fù)的全過(guò)程,認(rèn)知障礙不僅對(duì)功能康復(fù)有一定影響,而且與患者卒中后的生活質(zhì)量密切相關(guān)。目前現(xiàn)代醫(yī)學(xué)尚未發(fā)現(xiàn)對(duì)認(rèn)知功能有明顯療效的藥物,且大多數(shù)藥物具有毒副作用大、禁忌癥多、容易復(fù)發(fā)等不良特點(diǎn)。因此,探討副作用小、經(jīng)濟(jì)實(shí)用、療效確切的治療方法,以改善患者的認(rèn)知功能障礙及提供患者的生活質(zhì)量,具有一定的社會(huì)意義和經(jīng)濟(jì)效益。目的觀察和綜合評(píng)估溫針灸百會(huì)穴為主治療缺血性腦卒中后輕度認(rèn)知障礙的臨床療效,從而為臨床提供一種起效快、療效確切、操作簡(jiǎn)便的治療方法。方法本研究采用隨機(jī)分組方法,將64例符合納入標(biāo)準(zhǔn)的患者隨機(jī)分為治療組和對(duì)照組各32例。治療組采用溫針灸百會(huì)穴配合電針治療,具體如下：溫針灸取穴：百會(huì)穴；電針組：智三針,神庭穴、本神穴(左右各一)；體針取穴：印堂、人中、風(fēng)池、太沖、太溪、內(nèi)關(guān)、豐隆、三陰交；隨癥取穴：口角歪斜加患側(cè)地倉(cāng)；偏癱加患側(cè)曲池、足三里、三陰交、對(duì)側(cè)合谷；失語(yǔ)加廉泉。辨證取穴：腎精虧虛證配太溪、懸鐘；痰濁阻竅證配豐隆、中脘；瘀血阻絡(luò)證配膈俞、血海；肝陽(yáng)上亢證配太沖、肝俞；火熱內(nèi)盛證配內(nèi)庭、曲池；腑滯濁留證配中脘、天樞；氣血虧虛證配足三里、氣海。常規(guī)消毒后,針尖與穴位成15°～30°角,沿皮下平刺1.5寸左右百會(huì)穴平刺0.8～1.2寸,深度達(dá)到帽狀腱膜,以60次／min速度均勻捻轉(zhuǎn),力度以局部有麻脹或向各部放散感為宜,時(shí)間1 min。在留針過(guò)程中,取約2 cm長(zhǎng)之艾條一段,套在針柄之上,距皮膚2～3cm,再?gòu)钠湎露它c(diǎn)燃施灸。在燃燒過(guò)程中,如患者覺(jué)灼燙難忍,可在該穴區(qū)置一硬紙片,以稍減火力。共取艾條2壯。電針組選用G6805-1型多功能電針治療儀,接入電極后,輸出波型為疏密波,輸出強(qiáng)度以患者能夠耐受為度,通電30min。對(duì)照組不采用溫針灸百會(huì)穴,其余同治療組。每日1次,每周5次,6周為一個(gè)療程。1個(gè)療程后評(píng)定療效,智力狀況的療效評(píng)估采用簡(jiǎn)易精神狀態(tài)檢查量表(MMSE)評(píng)價(jià),認(rèn)知功能的療效評(píng)估采用蒙特利爾認(rèn)知評(píng)估量表(MoCA)評(píng)價(jià),日常生活能力的療效評(píng)估采用日常生活能力量表(ADL)評(píng)價(jià),中醫(yī)癥候的療效評(píng)估采用血管性癡呆辯證量表(SDSVD)評(píng)價(jià)。結(jié)果將兩組患者年齡、性別、病程等一般資料及兩組治療前MMSE、MoCA、ADL、SDSVD積分指標(biāo)進(jìn)行對(duì)比,經(jīng)統(tǒng)計(jì)學(xué)分析無(wú)顯著性差異(P＞0.05),說(shuō)明兩組具有可比性。1.總體療效上：治療結(jié)束后,治療組顯效12例,有效17例,無(wú)效3例,惡化0例,總有效率為90.625%；而對(duì)照組顯效4例,有效17例,無(wú)效11例,惡化0例,總有效率為65.625%。治療組總體療效優(yōu)于對(duì)照組,其差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)2.自身前后對(duì)照：兩組治療后MMSE、MoCA、ADL、SDSVD積分指標(biāo)與治療前比較均有所改善,差異均有統(tǒng)計(jì)學(xué)意義(P＜0.05),顯示兩種療法均對(duì)缺血性腦卒中后輕度認(rèn)知障礙有較好的治療作用。3.治療后組間對(duì)照：治療組與對(duì)照組相比,其MMSE、MoCA、ADL、SDSVD (p0.05),顯示治療組療效優(yōu)于對(duì)照組。結(jié)論以上的結(jié)果提示兩種治療方法對(duì)缺血性腦卒中后輕度認(rèn)知障礙均有較好的療效,但在對(duì)照組的基礎(chǔ)上加上溫針灸百會(huì)穴能更好地改善缺血性腦卒中后輕度認(rèn)知障礙患者的認(rèn)知功能,對(duì)患者的癥狀、體征也有較大的改善。
[Abstract]:Background ischemic stroke refers to mild cognitive impairment caused by cerebral vascular disease early or mild cognitive impairment, cognitive impairment and dementia has not yet reached the standard of a kind of syndrome is a new disease concept proposed in recent years. According to statistics, more than half of the patients with cerebral stroke were involved in the whole process of cognitive rehabilitation of patients dysfunction of.[1] cognitive activity, cognitive impairment not only has a certain effect on the functional rehabilitation, but also closely related to the quality of life of patients after stroke. The modern medicine has not yet found the drug has obvious curative effect on cognitive function, and most of the drugs have side effects, contraindications, easy to relapse and other adverse features. Therefore, to investigate the side effect a small, economical and practical, effective therapeutic methods, to improve the quality of life of patients with cognitive dysfunction and has certain social significance and economic Objective To observe the efficiency. And comprehensive assessment of acupuncture and moxibustion at Baihui acupoint clinical curative effect in the treatment of mild cognitive impairment after ischemic stroke, so as to provide a clinical curative effect, the treatment effect is fast, simple method. Based on the method of random grouping method, 64 patients were randomly divided into the treatment group and the the control group with 32 cases in each group. The treatment group was treated by warm acupuncture Baihui acupuncture treatment, specifically as follows: the acupuncture and moxibustion acupoints: Baihui; Electroacupuncture group: zhisanzheng, shenting, Benshen (about each point); acupuncture points: Yintang, people, Fengchi, Taichong, Taixi, Neiguan. Fenglong, Sanyinjiao acupoints; with the disease: mouth askew plus ipsilateral Dicang plus ipsilateral hemiplegia; Quchi, Zusanli, Sanyinjiao and Hegu plus contralateral aphasia; Lian Quan. Differentiation acupoints: syndrome of deficiency of kidney essence with Taixi, Xuanzhong; phlegm blockage with Fenglong, Zhongwan; blood stasis 琛，

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