摘要
针灸督脉经穴治疗血管性痴呆(vascular dementia,VD)常用的方法有:毫针针刺、灸法、针灸并用、电针、芒针、梅花针、穴位埋线等。目前,临床研究存在的主要问题有:单个研究样本量偏小;诊断标准、纳入标准、排除标准尚未完全统一;疗效判定多采用以记忆、语言、行为改善情况作为观察指标的量表,评分结果易受主观因素影响,客观化的指标应用较少;疗效观察多以短期、近期为主;研究集中于已确诊的中晚期患者,针灸督脉预防VD发生的研究较少;治疗以改善患者智能障碍为主,对同时可能出现的精神、神经症状关注不够;治疗方案中关于操作过程的细节以及量化标准的描述不够明确。动物实验研究存在的主要问题有:复制的VD模型多是缺血性和低灌注造成的,出血性VD模型报道较少,无法全面反映针灸督脉治疗VD的疗效及机制;多采取跳台实验和Morris水迷宫法对VD动物模型进行行为学观察,不能精确评价模型的真实状态;现阶段的机制研究思路有局限性;虽选取多个实验指标观察,但多是对每个指标单独进行研究与阐述。今后针灸督脉防治VD的临床研究中应加大样本量,统一诊断、纳入和排除标准,规范各种针灸疗法的标准化方案,完善疗效评价体系,增加生化、影像学等指标,客观评价脑功能恢复程度,关注患者精神、神经症状的改善情况,追踪回访观察长期疗效,尝试对脑卒中患者早期干预的研究,求证针灸督脉治疗效果的真实性、稳定性与持续性。动物实验机理研究方面,应积极摸索新的VD模型复制方法,探求更加客观的评价标准,充分结合分子生物学等现代医学理论和技术,开展多指标、多通路、多层面的机制研究。
The common methods of acupuncture and moxibustion on GV for vascular dementia(VD) include filiform acupuncture,moxibustion,combined acupuncture and moxibustion,electric acupuncture,elongate needling,plum blossom acupuncture,and acupoint catgut-embedding therapy,etc.At present,the main problems in clinical research are as follows:The sample size of a single study is too small.Diagnostic criteria,inclusion criteria and exclusion criteria have not been completely unified.The scales with memory,language and behavior improvement as observation indicators are often used in the judgment of curative effect.The scoring results are easily affected by subjective factors,and objective indicators are rarely used.The observation of curative effect is mainly short-term and short-term.The research focuses on the middle and late stage patients who have been diagnosed,and there are few studies on acupuncture and moxibustion on GV to prevent VD.The treatment focuses on improving the patient′s mental retardation,and does not pay enough attention to the mental and neurological symptoms that may occur at the same time.The details of the operation process and the quantitative standards in the treatment plan are not clear enough.The main problems in animal experimental research are as follows:most of the replicated VD models are caused by ischemia and hypoperfusion,and there are few reports on hemorrhagic VD models,which cannot fully reflect the efficacy and mechanism of acupuncture and moxibustion on GV for VD.The platform-jumping experiment and Morris water maze method are often used to observe the behavior of VD animal models,which cannot accurately evaluate the real state of the models.At present,the mechanism research ideas have limitations.Although several experimental indicators are selected for observation,most of them are studied and elaborated separately for each indicator.In the future,it is necessary to increase the sample size,unify the diagnosis,inclusion and exclusion criteria,standardize the standardized schemes of various acupuncture treatments,improve the efficacy evaluation system,increase biochemical and imaging indicators,objectively evaluate the degree of brain function recovery,pay attention to the improvement of patients′ mental and neurological symptoms,follow-up and observe the long-term efficacy,and try to study the early intervention of stroke patients,verify the authenticity,stability and continuity of the therapeutic effect of acupuncture and moxibustion on GV.In terms of animal experimental mechanism research,we should actively explore new methods of VD model replication,seek more objective evaluation standards,fully combine modern medical theories and technologies such as molecular biology,and carry out multi-target,multi-channel and multi-level mechanism research.
作者
王陈妮
刘芳
刘燕
WANG Chen-ni;LIU Fang;LIU Yan(Anqing Medical College,Anqing,Anhui,China,246052)
出处
《河南中医》
2022年第11期1758-1765,共8页
Henan Traditional Chinese Medicine
基金
安徽省高等学校自然科学研究重点项目(KJ2019A1233)
安徽省高等学校省级质量工程项目(2018jxtd157)。
关键词
血管性痴呆
针灸疗法
督脉经穴
文献综述
vascular dementia(VD)
acupuncture and moxibustion therapy
GV
literatur summary
作者简介
王陈妮(1981-),女,安徽安庆人,医学硕士,讲师。
