發(fā)布時間：2018-04-23 02:10

  本文選題：血管性癡呆 + 交通心腎法��； 參考：《廣西中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:通過觀察血管性癡呆(vascular dementia,簡稱VD)患者治療前后的簡易智能精神狀態(tài)檢查(MMSE)量表評分、日常生活活動能力(ADL)量表評分和中醫(yī)證候量表評分變化情況,評估交通心腎法治療腎陰虧虛型VD的臨床療效。方法:選取2014年09月至2015年11月期間,廣西中醫(yī)藥大學(xué)第一附屬醫(yī)院腦病科門診就診的VD患者60例,所有患者均符合VD的診斷標(biāo)準(zhǔn),且中醫(yī)辨證為腎陰虧虛的患者。按照患者門診就診的先后順序進(jìn)行編號,采用隨機(jī)數(shù)字表法的分組方法分為治療組與對照組各30例。對照組給予鹽酸多奈哌齊片5mg,每晚睡前口服,治療組則在對照組治療的基礎(chǔ)上,予加服交通心腎法中藥(藥物包括:黃連9g,肉桂3g,黃芩10g,阿膠6g,白芍10g,熟地黃24g,山藥10g,枸杞10g,鹿角膠6g,菟絲子10g,龜板膠10g,川牛膝10g,山茱萸12g,新鮮雞子黃1枚)治療,對兩組中合并有高血糖、高血壓、冠心病、高脂血癥等患者予控制血糖、控制血壓、調(diào)脂穩(wěn)斑、抗血小板聚集等基礎(chǔ)藥物治療。以1個月為1個療程,連服3個療程。記錄治療組和對照組患者治療前后的MMSE量表評分、ADL量表評分和中醫(yī)證候量表評分變化情況,使用SPSS 16.0軟件進(jìn)行統(tǒng)計學(xué)分析,對治療效果進(jìn)行評價。結(jié)果:(1)MMSE評分:與治療前比較,治療組分別在治療1個月后、2個月后、3個月后的MMSE評分均明顯升高(P0.01),對照組也在治療1個月后、2個月后、3個月后的MMSE評分均有升高(P0.05)。兩組各治療時間點(diǎn)的MMSE評分比較,差異具有統(tǒng)計學(xué)意義(P0.05)。(2)ADL評分:與治療前比較,治療組分別在治療1個月后、2個月后、3個月后的ADL評分均有明顯升高(P0.01),對照組在治療1個月后、2個月后、3個月后的ADL評分均有升高(P0.05)。兩組各治療時間點(diǎn)的ADL評分比較,差異具有統(tǒng)計學(xué)意義(P0.05)。(3)中醫(yī)證候評分:與治療前比較,治療組分別在治療1個月后、2個月后、3個月后的中醫(yī)證候評分均有明顯降低(P0.01),對照組在治療1個月后、2個月后、3個月后的中醫(yī)證候評分也均有降低(P0.05),兩組各治療時間點(diǎn)的中醫(yī)證候評分比較,差異均具有統(tǒng)計學(xué)意義(P0.05)。(4)中醫(yī)證候療效:治療組總有效率為90.00%,對照組總有效率為66.67%,治療組和對照組間的總有效率比較具有顯著性差異(P0.05)。(5)安全性評價:兩組治療前后的血、尿常規(guī)及肝、腎功能均無明顯改變,兩組治療前后比較差異均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:(1)交通心腎法治療腎陰虧虛型VD具有確切臨床療效;(2)本法在治療VD的臨床療效及改善VD患者的MMSE、ADL、中醫(yī)證候評分方面均優(yōu)于單用鹽酸多奈哌齊治療。
[Abstract]:Objective: to observe the changes of MMSE scale, ADL scale and TCM syndrome scale in patients with vascular dementia before and after treatment. To evaluate the clinical effect of the method of communicating heart and kidney in treating VD with deficiency of kidney yin. Methods: from September 2014 to November 2015, 60 VD patients in the Department of Encephalopathy of the first affiliated Hospital of Guangxi University of traditional Chinese Medicine were selected. All the patients met the diagnostic criteria of VD, and the TCM syndrome differentiation was the deficiency of kidney yin. According to the order of outpatient visits, the patients were divided into treatment group (n = 30) and control group (n = 30). The control group was given 5 mg of Donepezil hydrochloride and taken orally before bedtime every night, while the treatment group was treated on the basis of the control group. They were treated with Chinese medicine (including Huanglian 9g, cinnamon 3g, Scutellaria 10g, Ejiao 6g, Paeoniae Alba 10g, cooked Rehmannia 24g, yam 10g, Lycium barbarum 10g, antler gum 6g, dodder 10g, glans gel 10g, Achyranthes bidentata 10g, doggy 12g, fresh chicken yellow). Patients with hyperglycemia, hypertension, coronary heart disease and hyperlipidemia were treated with basic drugs such as controlling blood glucose, controlling blood pressure, regulating lipid and stabilizing plaque, and anti-platelet aggregation. Take 1 month as a course of treatment, and take 3 courses of treatment. The changes of MMSE scale and TCM syndrome scale were recorded before and after treatment in the treatment group and the control group. SPSS 16.0 software was used for statistical analysis to evaluate the therapeutic effect. Results: compared with before treatment, the MMSE scores of the treatment group increased significantly after 1 month, 2 months and 3 months respectively, while the MMSE scores of the control group also increased after 1 month, 2 months and 3 months respectively. There were significant differences in MMSE scores between the two groups at each time point of treatment. After 1 month, 2 months and 3 months after treatment, the ADL scores in the treatment group were significantly higher than those in the control group. The ADL scores in the control group were increased after 1 month, 2 months and 3 months, respectively. The difference of ADL score between the two groups at each treatment time point was statistically significant (P 0.05. 0. 0. 3) TCM syndromes score: compared with before treatment, After 1 month, 2 months and 3 months after treatment, the TCM syndrome scores in the treatment group were significantly lower than those in the control group after 1 month, 2 months and 3 months, respectively, and the scores of TCM syndromes in the control group were also decreased after 1 month, 2 months and 3 months, respectively. Comparison of TCM syndromes score at time points, The difference was statistically significant (P 0.05, P 0.05, P < 0.05).) the total effective rate of the treatment group was 90.00.The total effective rate of the control group was 66.67.The total effective rate between the treatment group and the control group was significantly different (P0.05. 5) the safety evaluation: the blood before and after treatment in the two groups, the total effective rate of the treatment group was 90.005, the total effective rate of the control group was 66.67, and the total effective rate was significantly different between the two groups. Urine routine and liver and renal function were not significantly changed, and there was no significant difference between the two groups before and after treatment (P 0.05). Conclusion (1) the method of communicating heart and kidney is effective in treating VD with deficiency of kidney yin. This method is superior to Donepezil hydrochloride in the treatment of VD and the improvement of MMSE ADL in VD patients.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R277.7

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