Clinical Research Of Post-strke Vascular Cognitive Impairment Treatment With Needling Back-shu Point

OjectiveThis randomized controlled clinical researeh adopts multi-disciplinary Synchronic observation and analysis methods and objectively observe and evaluate the clinical effect and safety of needling therapy to treat post-stroke vascular cognitive impairment within the category of vaseular cognitive impairment.MethodsThe Traditional Chinese Medicine diagnosis is in conjunction with "Diagnostic, Differentiation Types and Effect Evaluation Standards of Senile Dementia" by China Assoeiation for Traditional Chinese Medieine and "Diagnostic and Evaluation Standards of Stroke"(the second generation standard). The Modern Medicine diagnosis is induce from "The Plan of Diagnositc and treat on vascular cognitive impairment (VCI)"issued by the Chinese medical Association in2011, at the same time the grade of MoCA scale under26points. Dividing60subjects of the qualified post-stroke vascular cognitive impairment into the Treatment Group and the Controlled Group in equal. Using conventional treatment at group A, the medication for basic diseases, physical therapy, scalp needle, body acupuncture and rehabilitation training, etc; The treatment of group B is adding needlation of Five Back-Shu points to the normal treatment of group A. The following techniques are being used:Supply shenshu (BL23), xin shu(BL15), pishu(BL20) and reduce ganshu(BL18) with twirling or rotating; feishu(BL13) use with mild reinforcing-reducing. Patients with lateral position, the insertion of needles with twisting and rotating, the included angle with shaft and body surface is45degree. Pinpoint tip toward the head, the depth of the needle insertion about30mm. The reinfoceing method is slightly, the force downward when the thumb turn left in strong, and turn left in slight. Mild reinforcing-reducing method is exert the needle in average strength, it’s fit to the patients feel comfortable. The reducing method is after arrival of qi, twirling or rotating the needle heavily, the force upward when the thumb turn left in slight, and turn right in strong. Maintain the needle for30minutes after achieving qi, hand-manipulating of needle every10minutes. Treat6days a week, and this course cover4weeks.Recording the qualified subjects’gender, age, education degree, disease history, etg. Conduct cognitive function evaluation with MoCA scale. After the comparability of two groups is proved by basic material above, starting the treatmentaccordingtothetrial plan. Observe at the clinical effect before and after the treatment according to the grade of MoCA scale. Recording the adversereactions and analyze the possible causes, and solve the symptoms carefully.Statistical analysis:dealing the data with SPSS19software, For the classifiedmaterial istaken x2-test, The averages of the two samples are compared with T-test. For self circa comparison, take the T pair test;the curative effect between two groups, can be taken the rank sum test.ResultsThere are60qualified testee, all of them are the patients in acupuncture and Rehabilitation department of Guangdong Second provincial traditional Chinese Medicine hospital. After randomization, the distribution of two groups of gender, age, disease process, cognitive function, ADL has no obviously difference,it appears the baseline of both group at the same standuard. After the treatment, according to clinical evaluation of standards under the MoCA scale, a total effective rate of the treatment group is70%, the control group is53.33%, rank sum test, the curative effect of the two groups was statistically difference with the rank sum test. According to the clinical curative effect evaluation standard of TCM syndrome score, total effective rate of treatment group is66.67%, control group is70%, the rank sum test shows that the curative effect has no significant statistical difference. MoCA inventory data show that before experiment the control group19.53±2.34, after experiment for21.97±3.02, treatment group before experiment is19.73±2.12, after treatment for23.67±1.84. Compare the mean value of the same groups before and after experiment by the t test,it shows a significant clinical effect (P<0.01), and make a wilcoxon text between two group and the outcome is meaningful (P<0.01). The grades’mean value of ADL scale in control group is53.83±15.63, after experiment for69.33±12.51, treatment group before experiment is52.17±15.18, after treatment for70.50±14.64. Compare the mean value of the same groups before and after experiment by the t test,it shows a significant clinical effect(P<0.01), but it hasn’t significant between two groups. According to the TCM-scale assessment, the mean value of control groups is18.87±5.33, then it being10.33±5.50after experiment. With treatment groups are correspond to18.73±7.28and8.77±6.20, there is mean somethingin each group before and after treatment, but mean nothing between two groups in statics.ConclusionThrough this study suggest that treatment effect is better than the control group, needling the back-shu points base on normal treatment can improve the function of cognitive obviously after stroke, it makes sense of spreading this methods in the clinic. On the other side, this method hasn’t outstanding effect on improving the standard of Activities of Daily Life or relieveing the syndrome of TCM.