针刺联合心理干预对注意缺陷多动障碍患儿注意力、反应抑制能力及脑血流的影响

目的:观察针刺联合心理干预治疗注意缺陷多动障碍(ADHD)患儿的临床疗效,探讨针刺治疗的相关机制。方法:将100例ADHD患儿随机分为观察组(50例,脱落2例)和对照组(50例,脱落1例)。对照组给予常规心理干预治疗;观察组在对照组基础上加用针刺,穴取太冲、内关、神门、三阴交、百会、四神聪等,每天1次,治疗3个月。采用剑桥自动化成套神经心理测试量表(CANTAB)评价两组治疗前后注意力及反应抑制能力,采用Digi-Lite型彩色经颅多普勒仪测定两组治疗前后脑动脉的血流速度,并比较疗效。结果:在注意力方面,治疗后观察组平均延迟时间短于治疗前及对照组(P<0.05),快速视觉信息处理A’信号的统计量(RVP A’)值高于治疗前及对照组(P<0.05);在反应抑制方面,治疗后两组Go信号错误数、停止信号反应时间、停止Go信号错误数均较治疗前降低(P<0.05),观察组停止信号错误数亦较治疗前降低(P<0.05),观察组Go信号错误数、停止信号错误数均低于对照组(P<0.05)。治疗后两组双侧大脑后动脉(PCA)平均血流速度均较治疗前增快(P<0.05),观察组左侧大脑中动脉(MCA-L)、双侧大脑前动脉(ACA)平均血流速度较治疗前增快(P<0.05),且观察组左侧大脑后动脉(PCA-L)、MCA-L、双侧ACA平均血流速度均快于对照组(P<0.05)。观察组注意力缺陷型ADHD患儿总有效率为90.5%(19/21),高于对照组的50.0%(11/22,P<0.05);观察组总有效率为83.3%(40/48),亦高于对照组的63.3%(31/49,P<0.05)。结论:针刺联合心理干预治疗可以提高ADHD患儿的注意力及反应抑制能力,其机制可能与调节脑血流的动力有关。

Effect of combination of acupuncture and psychological intervention on attention,response inhibition and cerebral blood flow in children with attention deficit hyperactivity disorder

Objective To observe the clinical curative effect on attention deficit hyperactivity disorder(ADHD)and explore the relevant mechanism of acupuncture in treatment.Methods A total of 100 ADHD children were randomized into an observation group(50 cases,2 cases dropped off)and a control group(50 cases,1 case dropped off).In the control group,the routine psychological intervention was used.In the observation group,on the base of the treatment as the control group,acupuncture was applied to Taichong(LR 3),Neiguan(PC 6),Shenmen(HT 7),Sanyinjiao(SP 6),Baihui(GV 20),Sishencong(EX-HN 1),etc.,once daily,for 3 months.The Cambridge neuropsychological tests automated battery(CANTAB)was adopted to evaluate attention and response inhibition in two groups before and after treatment.Digi-Lite color transcranial Doppler was used to measure cerebral arterial blood velocity.The therapeutic effect was compared between the two groups.Results Regarding evaluation of attention,the mean delay time in the observation group after treatment was shorter than that before treatment and that in the control group separately(P<0.05),and rapid visual information processing A’statistics(RVP A’)value was higher than that before treatment and that in the control group separately(P<0.05).For evaluation of response inhibition,the number of Go signal error,the time of stop signal response and the number of stop Go signal error after treatment were all reduced as compared with those before treatment in the two groups(P<0.05).The number of stop signal error was also reduced after treatment as compared with that before treatment in the observation group(P<0.05).The number of Go signal error and the number of stop signal error in the observation were lower than those in the control group(P<0.05).After treatment,the average flow velocity of bilateral posterior cerebral artery(PCA)was increased than that before treatment in the two groups(P<0.05).The average flow velocity of the left middle cerebral artery(MCA-L)and bilateral anterior cerebral artery(ACA)after treatment was increased than that before treatment in the observation group(P<0.05),and the average flow velocity of left PCA,MCA-L and bilateral ACA in the observation group was faster than that in the control group(P<0.05).The total effective rate was 90.5%(19/21)in the observation group,remarkably higher than 50.0%(11/22)in the control group in children with attention deficit(P<0.05).The total effective rate was 83.3%(40/48)in the observation group,also higher than 63.3%(31/49)in the control group(P<0.05).Conclusion Acupuncture combined with psychological intervention may improve attention and response inhibition in ADHD children,which is possibly related to the regulation of cerebral blood flow.