本文選題：益氣聰明湯加味　切入點(diǎn)：血管性癡呆　出處：《廣西中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:家?guī)煾鶕?jù)自己多年臨床經(jīng)驗(yàn),以益氣聰明湯加味治療血管性癡呆。家?guī)熣J(rèn)為,血管性癡呆中醫(yī)的主要病機(jī)為氣虛為本,痰瘀為標(biāo),由痰致瘀,以痰為主,其病位雖在腦,而根本卻在脾,所以治療的關(guān)鍵在于益氣健脾,并主張?jiān)谔叼鐾蔚幕A(chǔ)上重在化痰。此次在整理古今中醫(yī)文獻(xiàn)的基礎(chǔ)上,擬中藥益氣聰明湯加味治療氣虛痰瘀型血管性癡呆患者,觀察其臨床療效和安全性。方法:根據(jù)西醫(yī)診斷標(biāo)準(zhǔn)和中醫(yī)診斷及中醫(yī)辨證分型標(biāo)準(zhǔn),采取隨機(jī)分組法,將所收集自2015年5月至2015年12月廣西中醫(yī)藥大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科二病區(qū)門診和住院62例血管性癡呆患者隨機(jī)分為2組,治療組32例,予益氣聰明湯加味治療,對(duì)照組30例,予鹽酸多奈哌齊片治療,4周為1療程,治療3個(gè)療程。采用簡(jiǎn)易智能精神狀態(tài)檢查量表(MMSE)評(píng)價(jià)患者的認(rèn)知功能及癡呆的嚴(yán)重程度,采用日常生活能力量表(ADL)評(píng)價(jià)患者的日常生活自理能力,采用AD評(píng)定量表的認(rèn)知次級(jí)量表(ADAS-cog)評(píng)價(jià)患者認(rèn)知功能及精神行為。治療前后分別由專業(yè)人員進(jìn)行簡(jiǎn)易智能量表(MMSE)、日常生活活動(dòng)量表(ADL)、ADAS-Cog量表積分評(píng)定,中醫(yī)證候和安全性積分分布評(píng)分標(biāo)準(zhǔn)進(jìn)行療效評(píng)價(jià)并對(duì)結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析,得出相應(yīng)的治療結(jié)論。結(jié)果:1、益氣聰明湯治療老年性癡呆臨床總有效率為78.12%,治療后治療組與對(duì)照組的MMSE量表、ADL量表、ADAS-cog量表評(píng)分都較治療前有所改善(p0.05),治療后兩組各積分比較無統(tǒng)計(jì)學(xué)差異(p0.05),中醫(yī)臨床癥狀積分方面治療組治療后在智能減退,善忘,神疲乏力,嗜睡,咳嗽咯痰,自汗出,耳鳴耳聾,二便失禁等癥狀都較治療前有好轉(zhuǎn)(p0.05);對(duì)照組治療前后比較,智能減退,善忘,呆鈍少言,反應(yīng)遲鈍,小便頻數(shù)或失禁有所好轉(zhuǎn)(p0.05);與對(duì)照組相比,治療組在神疲乏力,嗜睡,咳嗽咯痰,自汗出的癥狀改善上有統(tǒng)計(jì)學(xué)差異(p0.05)。2、治療過程中患者亦無明顯不適。結(jié)論:益氣聰明湯加味治療氣虛痰瘀型血管性癡呆安全有效。
[Abstract]:Objective: according to our many years clinical experience, we treat vascular dementia with Yiqi Lingtang. The main pathogenesis of vascular dementia is qi deficiency, phlegm stasis is the standard, phlegm is the main cause, phlegm is the main disease, although the disease is located in the brain, the main pathogenesis of vascular dementia is Qi deficiency, phlegm stasis is the standard, phlegm is the main cause, and the disease is located in the brain. But it is basically in the spleen, so the key to treatment is to invigorate qi and invigorate the spleen, and it is advocated to focus on resolving phlegm on the basis of simultaneous treatment of phlegm and blood stasis. This time, on the basis of sorting out the ancient and modern TCM documents, In order to treat vascular dementia with Qi deficiency and phlegm stasis, the clinical efficacy and safety were observed. Methods: according to the criteria of western medicine diagnosis, traditional Chinese medicine diagnosis and TCM syndrome differentiation, random grouping method was used to treat vascular dementia with Qi deficiency and phlegm stasis. From May 2015 to December 2015, 62 patients with vascular dementia were randomly divided into two groups, 32 patients in the treatment group, treated with Yiqi Lingtang decoction, from May 2015 to December 2015 in Department of Neurology, first affiliated Hospital of Guangxi University of traditional Chinese Medicine, and 62 patients with vascular dementia were randomly divided into two groups. 30 patients in the control group were treated with Donepezil Hydrochloride for 4 weeks and 3 courses. The cognitive function and the severity of dementia were evaluated by MMSE. ADL was used to evaluate the self-care ability of daily life of patients. The cognitive function and mental behavior of patients were evaluated by ADAS-cog. Before and after treatment, MMSE was performed by professional personnel and ADAS-Cog was evaluated by ADLL and ADAS-Cog before and after treatment. TCM syndromes and safety score were evaluated and the results were statistically analyzed. Results the total effective rate of the treatment of Alzheimer's disease was 78.12. After treatment, the scores of ADAS-cog in the treatment group and control group were improved compared with those before treatment, and the two groups after treatment improved the score of ADAS-cog scale. After treatment, the treatment group and the control group both improved the score of ADAS-cog scale, and the two groups after treatment improved the score of ADAS-cog scale. There was no statistical difference in the scores between the two groups (P 0.05). The intelligence of the treatment group was decreased after treatment in terms of clinical symptom integral of traditional Chinese medicine (TCM). The symptoms of forgetfulness, fatigue, drowsiness, cough and sputum, spontaneous sweating, tinnitus and deafness, and incontinence of the second stool were all better than those before and after treatment. Compared with the control group, the treatment group was tired, sleepy, cough and sputum. There was a statistical difference in the improvement of the symptoms of self-sweating, and there was no obvious discomfort in the treatment process. Conclusion: Yiqi Lingming decoction is safe and effective in the treatment of vascular dementia of Qi deficiency and phlegm stasis type.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R277.7

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