首页|针刺治疗卒中后痴呆的疗效观察及对氧化应激激素水平和血流变学的影响

针刺治疗卒中后痴呆的疗效观察及对氧化应激激素水平和血流变学的影响

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目的 观察调神益智针刺治疗痰瘀闭阻型卒中后痴呆(post-stroke dementia,PSD)的临床疗效及对氧化应激激素水平和血流变的影响.方法 将 94 例痰瘀闭阻型PSD患者随机分为基础治疗组(31 例)、对照组(32例)和观察组(31 例).基础治疗组给予内科常规治疗,对照组在基础治疗组的基础上采用常规针刺治疗,观察组在基础治疗组的基础上采用调神益智针法治疗.观察 3 组治疗前后蒙特利尔认知评估(Montreal cognitive assessment,MoCA)和简易精神状态检查(mini-mental state examination,MMSE)评分、中医证候积分、日常生活活动(activities of daily living,ADL)量表评分、氧化应激水平[超氧化物歧化酶(superoxide dismutase,SOD)和丙二醛(malondialdehyde,MDA)]、血脂水平[甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)和低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)]、血流变学指标[全血高切黏度、全血低切黏度和血浆黏度]变化,并比较3 组临床疗效.结果 观察组总有效率优于其余两组,差异有统计学意义(P<0.05).3 组治疗后 MoCA 和 MMSE 评分较治疗前提高(P<0.05),且观察组高于其余两组(P<0.05).观察组和对照组治疗后中医证候各项积分较治疗前显著降低(P<0.05);基础治疗组除体态臃肿外,中医证候各项积分均较前显著降低(P<0.05).3 组治疗后中医证候各项积分除体态臃肿外,中医证候各项积分低于其余两组(P<0.05).3组治疗后ADL评分较治疗前均升高,差异具有统计学意义(P<0.05);3组治疗后ADL评分比较,差异无统计学意义(P>0.05).3 组治疗后血清SOD水平较治疗前均升高(P<0.05),且观察组SOD水平高于其余两组(P<0.05);3 组治疗后 MDA 水平较治疗前均降低(P<0.05),且观察组 MDA 水平低于其余两组(P<0.05).3 组治疗后血清TG、TC、LDL-C水平较治疗前均降低(P<0.05),且观察组低于其余两组(P<0.05).3 组治疗后全血高切黏度、全血低切黏度、血浆黏度均低于治疗前(P<0.05),且观察组低于其余两组(P<0.05).结论 在内科常规治疗的基础上,调神益智针法治疗痰瘀闭阻型PSD可改善患者MoCA和MMSE评分、中医证候积分、氧化应激激素水平、血脂水平以及血流变学指标.
Observation on the efficacy of acupuncture in treating post-stroke dementia and its effect on oxidative stress hormone level and blood rheology
Objective To observe the clinical efficacy of Tianshen-Yizhi acupuncture in treating post-stroke dementia(PSD)with phlegm and blood stasis obstruction pattern and its effects on oxidative stress hormone levels and blood rheology.Method Ninety-four patients with phlegm and blood stasis obstruction pattern PSD were randomly divided into the basic treatment group(31 cases),the control group(32 cases)and the observation group(31 cases).The basic treatment group was given conventional internal medicine treatment,the control group was treated with conventional acupuncture on the basis of the basic treatment group,and the observation group was treated with the Tiaoshen-Yizhi acupuncture on the basis of the basic treatment group.The Montreal cognitive assessment(MoCA),mini-mental state examination(MMSE)scores,Chinese medicine syndrome scores,activities of daily living(ADL)scale scores,oxidative stress level[superoxide dismutase(SOD)and malondialdehyde(MDA)],lipid level[triglyceride(TG),total cholesterol(TC),and low density lipoprotein cholesterol(LDL-C)],blood rheological indexes(whole blood high viscosity,whole blood low viscosity,plasma viscosity)were observed before and after the treatment in the three groups,and the clinical efficacy of the three groups were compared.Result The total effective rate of the observation group was better than that of the remaining two groups,and the difference was statistically significant(P<0.05).The MoCA and MMSE scores of the three groups were higher than those before treatment(P<0.05),and the observation group was higher than that of the remaining two groups(P<0.05).In the observation and control groups,the Chinese medicine syndrome scores were significantly lower than those before treatment(P<0.05);in the basic treatment group,except for bloatedness,the TCM scores were significantly lower than those before treatment(P<0.05);the Chinese medicine syndrome scores of the observation group were lower than those of the remaining two groups except for bloatedness(P<0.05).The ADL scores of the 3 groups were higher than those before treatment,and the difference was statistically significant(P<0.05);the difference was not statistically significant(P>0.05)when comparing the ADL scores of the 3 groups after treatment.The serum SOD levels of the three groups after treatment increased compared with that before treatment(P<0.05),and the SOD level of the observation group was higher than that of the remaining two groups(P<0.05);the MDA levels of the three groups after treatment decreased compared with that before treatment(P<0.05),and the MDA level of the observation group was lower than that of the remaining two groups(P<0.05).The serum TG,TC and LDL-C levels of the three groups were lower than those before treatment(P<0.05),and those of the observation group was lower than those of the remaining two groups(P<0.05).The whole blood high viscosity,whole blood low viscosity and plasma viscosity of the three groups were lower than those before treatment(P<0.05),and the observation group was lower than the remaining two groups(P<0.05).Conclusion On the basis of conventional internal medicine treatment,the treatment of phlegm and blood stasis obstruction pattern PSD by Tiaoshen-Yizhi acupuncture can improve the patients'MoCA and MMSE scores,Chinese medicine syndrome scores,oxidative stress hormone levels,blood lipid levels and blood rheology indexes.

Acupuncture therapyAcupuncture-medication combinedTiaoshen-Yizhi(Regulating the spirit and improve the wisdom)DementiaPost-stroke sequelae

李洁、陈云飞、王栩、刘臻、张智龙

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上海中医药大学附属岳阳中西医结合医院,上海 200437

上海中医药大学岳阳临床医学院,上海 200080

天津市中医药研究院附属医院,天津 300120

针刺疗法 针药并用 调神益智 痴呆 中风后遗症

2025

上海针灸杂志
福建省水利学会

上海针灸杂志

影响因子:1.273
ISSN:1005-0957
年,卷(期):2025.44(1)