耳穴疗法治疗视力不良在学龄儿童中的应用效果与评价
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摘要
背景中医耳穴疗法在综合医院对于视力不良的临床疗效明确。但其作为浦东新区社区卫生服务机构推行的中医预防保健项目时,需要使用更多适合社区实际卫生需求的指标评估其效果。目的探讨中医耳穴疗法治疗学龄儿童视力不良的疗效,研究干预对象对推行中医适宜技术的接受程度和响应程度,以寻找社区卫生服务机构开展耳穴干预视力不良的最佳策略。方法选择2012——2017年石笋小学1～5年级符合研究标准的学生685名、合计1116人次(1822只患眼)作为研究对象。使用中医耳穴磁贴方法,贴压单侧耳穴对学生进行视力干预,两耳交替使用,3个月为1个疗程,每年干预1个疗程。在干预前(基线)和干预结束后,采用国际标准对数视力表对学生进行裸眼和戴镜视力检查。收集整理学生的性别、年级、戴镜情况、纳入时间、干预时间及流动情况,观察学生的视力干预情况、干预疗效,耳穴干预疗效的影响因素分析采用多因素Logistic回归分析。结果研究期间有2名干预对象中途退出干预,最终有683名干预对象、合计1114人次(1818只患眼)参与本研究。其中一、二年级的学生较多,分别占27.8%和25.3%;不戴镜学生占88.3%;2012年和2016年首次纳入的人数较多,分别有143和158名学生;在耳穴干预时间上,干预1年的学生有345名,占50.5%。2016年和2017年的干预对象较多;当年新增干预对象较多的是2014年和2016年,分别新增了123、167名学生。轻度、中度、重度视力不良学生末次干预视力高于基线视力,戴镜、不戴镜学生末次干预视力高于基线视力,干预1、2、3、4年学生末次干预视力高于基线视力(P<0.001)。轻度视力不良学生的疗效优于中度、重度视力不良学生(P<0.05);不戴镜学生疗效优于戴镜学生(P<0.05);一、二年级疗效优于三、四、五年级(P<0.05);干预2、3年的疗效优于干预1年(P<0.05)。多因素Logistic回归分析结果显示,年级、戴镜、干预年数、基线视力水平是耳穴干预疗效的影响因素(P<0.05)。结论中医耳穴疗法治疗学龄儿童视力不良具有一定疗效,且操作简单、安全,干预对象的接受度和响应度较高,可以作为长期中医预防保健服务项目开展。
Background In the treatment experience of general hospital,the ear point embedding method of Traditional Chinese Medicine has definite clinical effect on poor vision.However,it needs to use more indicators suitable for the actual health needs of the community to evaluate the TCM prevention and health care project as the Community Health Service Centers in Pudong New Area.Objective This study aims to investigate the application and feedback of Traditional Chinese Medicine(TCM) technology,observe the efficacy of auricular acupoint sticking therapy among poor-vision children of schoolage and explore the best intervention strategy for community health service centers to carry out auricular intervention for poor eyesight.Methods A total of 685 pupils(1116 times,1822 eyes) from Grade 1 to Grade 5 of Shi Sun Primary School were selected with inclusive criteria.The poor-vision pupils were treated with singular application of auricular acupoint sticking therapy with alternative use on each ear.A course of treatment was 3 months and one treatment in each year.The uncorrected visual acuity and the visual acuity before and after the treatment were examined by national standard visual acuity chart.The information of gender,grade,glasses wearing,inclusion time,intervening time and population mobility was collected and the intervention effect was observed.The influencing factors of intervention efficacy were determined through multivariate logistic regression.Results Two intervention subjects withdrew from the study and there were 683 pupils(1114 times,1818 eyes) participating the study.The Grade 1 and Grade 2 pupils accounted for 27.8% and 25.3%,pupils without glasses for 88.3% and the number of newly enrolled subjects reached the highest in 2012 and 2016,with 143 and 158,respectively.There were 345 pupils treated with one-year intervention,accounting for 50.5%.The number of intervention subjects was larger in 2016 and 2017 and the increased number of intervention subjects was larger in 2014 and 2016,with 123 and 167 pupils,respectively.The last visual acuity of mild poor-vision group,medium poor-vision group and high poor-vision group was higher than their uncorrected visual acuity(P<0.001).The last visual acuity of glasses-wearing group and without-glasses groups was higher than their uncorrected visual acuity(P<0.001).The last visual acuity of one-year intervention group,two-year intervention group,three-year intervention group and four-year intervention group was higher than their uncorrected visual acuity(P<0.001).The intervention effect of mild poor-vision group was better than that of medium poor-vision group and high poor-vision group(P<0.05).The intervention efficacy of without-glasses group was better than that of glasses-wearing group(P<0.05).The intervention efficacy of Grade 1 group and Grade 2 group was better than that of Grade 3,4 and 5 groups(P<0.05).The intervention efficacy of two-year intervention group and three-year intervention group was better than that of one-year intervention group(P<0.05).The analysis result of multivariate logistic regression showed that grade,glasses wearing,intervening years and uncorrected visual acuity of pupils were factors influencing intervention efficacy(P<0.05).Conclusion The TCM ear point embedding method is an effective,simple and safe treatment method for poor vision pupils.The intervention subjects showed high adoption to auricular acupoint sticking therapy,which could be used as a long term TCM preventive health service.
Background In the treatment experience of general hospital,the ear point embedding method of Traditional Chinese Medicine has definite clinical effect on poor vision.However,it needs to use more indicators suitable for the actual health needs of the community to evaluate the TCM prevention and health care project as the Community Health Service Centers in Pudong New Area.Objective This study aims to investigate the application and feedback of Traditional Chinese Medicine(TCM) technology,observe the efficacy of auricular acupoint sticking therapy among poor-vision children of schoolage and explore the best intervention strategy for community health service centers to carry out auricular intervention for poor eyesight.Methods A total of 685 pupils(1116 times,1822 eyes) from Grade 1 to Grade 5 of Shi Sun Primary School were selected with inclusive criteria.The poor-vision pupils were treated with singular application of auricular acupoint sticking therapy with alternative use on each ear.A course of treatment was 3 months and one treatment in each year.The uncorrected visual acuity and the visual acuity before and after the treatment were examined by national standard visual acuity chart.The information of gender,grade,glasses wearing,inclusion time,intervening time and population mobility was collected and the intervention effect was observed.The influencing factors of intervention efficacy were determined through multivariate logistic regression.Results Two intervention subjects withdrew from the study and there were 683 pupils(1114 times,1818 eyes) participating the study.The Grade 1 and Grade 2 pupils accounted for 27.8% and 25.3%,pupils without glasses for 88.3% and the number of newly enrolled subjects reached the highest in 2012 and 2016,with 143 and 158,respectively.There were 345 pupils treated with one-year intervention,accounting for 50.5%.The number of intervention subjects was larger in 2016 and 2017 and the increased number of intervention subjects was larger in 2014 and 2016,with 123 and 167 pupils,respectively.The last visual acuity of mild poor-vision group,medium poor-vision group and high poor-vision group was higher than their uncorrected visual acuity(P<0.001).The last visual acuity of glasses-wearing group and without-glasses groups was higher than their uncorrected visual acuity(P<0.001).The last visual acuity of one-year intervention group,two-year intervention group,three-year intervention group and four-year intervention group was higher than their uncorrected visual acuity(P<0.001).The intervention effect of mild poor-vision group was better than that of medium poor-vision group and high poor-vision group(P<0.05).The intervention efficacy of without-glasses group was better than that of glasses-wearing group(P<0.05).The intervention efficacy of Grade 1 group and Grade 2 group was better than that of Grade 3,4 and 5 groups(P<0.05).The intervention efficacy of two-year intervention group and three-year intervention group was better than that of one-year intervention group(P<0.05).The analysis result of multivariate logistic regression showed that grade,glasses wearing,intervening years and uncorrected visual acuity of pupils were factors influencing intervention efficacy(P<0.05).Conclusion The TCM ear point embedding method is an effective,simple and safe treatment method for poor vision pupils.The intervention subjects showed high adoption to auricular acupoint sticking therapy,which could be used as a long term TCM preventive health service.
引文
[1]上海市卫生和计划生育委员会.关于印发《上海市中医药事业发展“十三五”规划》的通知[Z].(2017-04-27)[2017-12-11].http://www.shanghai.gov.cn/nw2/nw2314/nw39309/nw39385/nw40603/u26aw52164.html.Shanghai Health and Family Planning commission.Notice on the development of the 13th five-year plan for the development of traditional Chinese medicine in Shanghai[Z].(2017-04-27)[2017-12-11].http://www.shanghai.gov.cn/nw2/nw2314/nw39309/nw39385/nw40603/u26aw52164.html.
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[5]YANG Y T,HUANG Q F,JIA Y F,et al.Current situation and analysis of clinical application of auricular acupoint sticking therapy[J].Acupunct Tuina Sci,2016,14(2):141-148.DOI:10.1007/s11726-016-0915-5.
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[8]颉瑞萍,曹水清,刘雪.耳穴贴压治疗青少年假性近视55例疗效观察[J].甘肃科技,2016,32(16):139-140.
[9]张宇叶,武平,吴双,等.耳穴贴压配合眼周穴位按压治疗儿童弱视初探[J].湖南中医杂志,2016,32(2):99-101.DOI:10.16808/j.cnki.issn1003-7705.2016.02.049.
[2]上海市浦东新区卫生和计划生育委员会.关于印发《2017年浦东新区中医药工作要点》的通知[Z].(2017-05-18)[2017-12-18].http://www.pudong.gov.cn/shpd/InfoOpen/InfoDetail.aspx?Id=812770.Shanghai Pudong New Area Health and Family Planning commission.Notice on the 2017 key points of Traditional Chinese Medicine in Pudong New Area[Z].(2017-05-18)[2017-12-18].http://www.pudong.gov.cn/shpd/InfoOpen/InfoDetail.aspx?Id=812770.
[3]刘耀萌,哈略,黄畅,等.耳穴在近视和视疲劳治疗中的临床研究进展[J].环球中医药,2017,10(1):120-123.DOI:10.3969/j.issn.1674-1749.2017.01.040.LIU Y M,HA L,HUANG C,et al.Advances in clinical research on auricular therapy for myopia and asthenopia[J].Global Traditional Chinese Medicine,2017,10(1):120-123.DOI:10.3969/j.issn.1674-1749.2017.01.040.
[4]文娟,王舷.中西医防治青少年近视的概况[J].中医眼耳鼻喉杂志,2015,5(2):114-116.DOI:10.3969/j.issn.1674-9006.2015.02.019.WEN J,WANG X.An overview of the prevention and treatment of juvenile myopia by integrative medicine[J].Journal of Chinese Ophthalmology and Otorhinolaryngology,2015,5(2):114-116.DOI:10.3969/j.issn.1674-9006.2015.02.019.
[5]YANG Y T,HUANG Q F,JIA Y F,et al.Current situation and analysis of clinical application of auricular acupoint sticking therapy[J].Acupunct Tuina Sci,2016,14(2):141-148.DOI:10.1007/s11726-016-0915-5.
[6]中国学生体质与健康研究组.2005年中国学生体质与健康调研报告[M].北京:高等教育出版社,2007:14-31.Chinese Student Constitution and Health Research Group.Research report on physical fitness and health of Chinese students 2005[M].Beijing:Higher Education Press,2007:14-31.
[7]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:30.State Administration of Traditional Chinese Medicine.Standards for diagnosis and curative effect of Chinese medical symptom[S].Nanjing:Nanjing University Publishing House,1994:30.
[8]颉瑞萍,曹水清,刘雪.耳穴贴压治疗青少年假性近视55例疗效观察[J].甘肃科技,2016,32(16):139-140.
[9]张宇叶,武平,吴双,等.耳穴贴压配合眼周穴位按压治疗儿童弱视初探[J].湖南中医杂志,2016,32(2):99-101.DOI:10.16808/j.cnki.issn1003-7705.2016.02.049.