消朦灵片/方对玻璃体手术后视功能恢复的疗效观察
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摘要
背景
视网膜脱离(retinal detachment, RD)是眼科临床上的常见病症之一,本病的治疗,现代医学则仍以手术为主,手术原则即是封闭裂孔及解除或缓解玻璃体对视网膜的牵拉,而随着手术技术的改进,成功率已大为提高,一次手术成功率可达90%。但临床研究已发现,视网膜脱离玻璃体手术术后并发症多,视功能恢复不理想,解剖学复位视功能欠佳。所以配合手术治疗、增进患者视力、缩短病程也是治疗的关键。越来越多的研究显示,中医药的应用可促进视网膜下液的吸收,改善术后眼底血供,为术后视功能恢复进一步提供条件。
目的
研究中药消朦灵片／方对于玻璃体视网膜手术后病人自觉症状、视功能、视网膜黄斑部水肿以及中医症候的临床疗效及安全性评价。
方法
以我院行玻璃体视网膜手术的患者为研究对象(气阴亏虚,痰瘀互结),将纳入病例(61例)随机分为2组,对照组：单纯行玻璃体视网膜手术组,治疗组：行玻璃体视网膜手术后予以消朦灵方／片治疗组。两组手术后常规给与抗生素以及激素治疗3-5天,局部双氯芬酸钠眼液滴眼。治疗组手术后给与消朦灵治疗。12周为一疗程。观察治疗前及治疗12周后患者视力、眼压、炎症、视网膜情况、黄斑OCT值、眼底彩色照相、眼部超声以及中医症候的情况。
结果
两组病人术后12w疗效相比,治疗组显效率为67.7%,有效率为29.1%,对照组显效率为33.4%,有效率为63.3%,治疗组优于对照组,有显著性差异(P＜0.05)。12w视力情况、玻璃体混浊情况、视网膜出血、视网膜渗出、黄斑水肿的减轻,治疗组均优于对照组,有显著性差异(P＜0.05)。两组病人术后12w中医疗效相比,治疗组优于对照组,有显著性差异(P＜0.05)。
结论
①视网膜脱离的患者行玻璃体视网膜手术后,证属气阴两虚,痰瘀互结的患者予消朦灵片／方治疗,视功能明显改善,视力情况、玻璃体混浊情况、视网膜出血、视网膜渗出、黄斑水肿的减轻,治疗组均优于对照组,有显著性差异(P＜0.05)。②两组病人术后12w疗效相比,治疗组显效率为67.7%,有效率为29.1%,对照组显效率为33.4%,有效率为63.3%,治疗组优于对照组,有显著性差异(P＜0.05)。③两组病人术后12w中医疗效相比,治疗组优于对照组,有显著性差异(P＜0.05)。
Objectives
To evaluate the effect of Xiaomengling on the visual function, macular edema and chinese symptoms effect of patients after vitreoretinal surgery.
Methods
Collect 61 patients after vitrectomy and the symptoms is the deficiency of qi and yin, phlegm and blood obstruct. Divide the patients into two groups randomly. The patients in control group only receive the vitrectomy, and the patients in treatment group receive the vitrectomy and xiaomengling treatment. Both group use antibiotic and steroid 3-5days after vitrectomy, and the treatment group use xiaomengling in addition.12-week is a cure period. Observe and compare the patients'vision, NCT, inflammation, retina, macular OCT, B-ultrasonic test and Chinese symptoms.
Result
Compare the 12 weeks'effect of two groups, the markedly effective rate in treatment group is 67.7%, effective rate is 29.1%, the markedly effective rate in control group is 33.4%,the effective rate was 63.3%. Analyst the vision, the hemorrhage of retina, the exudation of retina, the alleviation of macular edema, the improvement of chinese symptoms, the effect of treatment group is better than the control group (P<0.05)
Conclusion
①the RD patients after vitrectomy and the symptoms is the deficiency of qi and yin, phlegm and blood obstruct receive xiaomengling treatment, the visual function improve conspicuously, and the the vision, XX, the hemorrhage of retina, the exudation of retina, the alleviation of macular edema, the effect of treatment group is better than the control group, the discrepancy is obvious (P<0.05).②Compare the 12 weeks'effect of two groups, the markedly effective rate in treatment group is 67.7%, effective rate is 29.1%, the markedly effective rate in control group is 33.4%, the effective rate was 63.3%, the effect of treatment group is better than the control group, the discrepancy is obvious (P<0.05).③The improvement of chinese symptoms in treatment group is better than the control group (P<0.05).
视网膜脱离(retinal detachment, RD)是眼科临床上的常见病症之一,本病的治疗,现代医学则仍以手术为主,手术原则即是封闭裂孔及解除或缓解玻璃体对视网膜的牵拉,而随着手术技术的改进,成功率已大为提高,一次手术成功率可达90%。但临床研究已发现,视网膜脱离玻璃体手术术后并发症多,视功能恢复不理想,解剖学复位视功能欠佳。所以配合手术治疗、增进患者视力、缩短病程也是治疗的关键。越来越多的研究显示,中医药的应用可促进视网膜下液的吸收,改善术后眼底血供,为术后视功能恢复进一步提供条件。
目的
研究中药消朦灵片／方对于玻璃体视网膜手术后病人自觉症状、视功能、视网膜黄斑部水肿以及中医症候的临床疗效及安全性评价。
方法
以我院行玻璃体视网膜手术的患者为研究对象(气阴亏虚,痰瘀互结),将纳入病例(61例)随机分为2组,对照组：单纯行玻璃体视网膜手术组,治疗组：行玻璃体视网膜手术后予以消朦灵方／片治疗组。两组手术后常规给与抗生素以及激素治疗3-5天,局部双氯芬酸钠眼液滴眼。治疗组手术后给与消朦灵治疗。12周为一疗程。观察治疗前及治疗12周后患者视力、眼压、炎症、视网膜情况、黄斑OCT值、眼底彩色照相、眼部超声以及中医症候的情况。
结果
两组病人术后12w疗效相比,治疗组显效率为67.7%,有效率为29.1%,对照组显效率为33.4%,有效率为63.3%,治疗组优于对照组,有显著性差异(P＜0.05)。12w视力情况、玻璃体混浊情况、视网膜出血、视网膜渗出、黄斑水肿的减轻,治疗组均优于对照组,有显著性差异(P＜0.05)。两组病人术后12w中医疗效相比,治疗组优于对照组,有显著性差异(P＜0.05)。
结论
①视网膜脱离的患者行玻璃体视网膜手术后,证属气阴两虚,痰瘀互结的患者予消朦灵片／方治疗,视功能明显改善,视力情况、玻璃体混浊情况、视网膜出血、视网膜渗出、黄斑水肿的减轻,治疗组均优于对照组,有显著性差异(P＜0.05)。②两组病人术后12w疗效相比,治疗组显效率为67.7%,有效率为29.1%,对照组显效率为33.4%,有效率为63.3%,治疗组优于对照组,有显著性差异(P＜0.05)。③两组病人术后12w中医疗效相比,治疗组优于对照组,有显著性差异(P＜0.05)。
Objectives
To evaluate the effect of Xiaomengling on the visual function, macular edema and chinese symptoms effect of patients after vitreoretinal surgery.
Methods
Collect 61 patients after vitrectomy and the symptoms is the deficiency of qi and yin, phlegm and blood obstruct. Divide the patients into two groups randomly. The patients in control group only receive the vitrectomy, and the patients in treatment group receive the vitrectomy and xiaomengling treatment. Both group use antibiotic and steroid 3-5days after vitrectomy, and the treatment group use xiaomengling in addition.12-week is a cure period. Observe and compare the patients'vision, NCT, inflammation, retina, macular OCT, B-ultrasonic test and Chinese symptoms.
Result
Compare the 12 weeks'effect of two groups, the markedly effective rate in treatment group is 67.7%, effective rate is 29.1%, the markedly effective rate in control group is 33.4%,the effective rate was 63.3%. Analyst the vision, the hemorrhage of retina, the exudation of retina, the alleviation of macular edema, the improvement of chinese symptoms, the effect of treatment group is better than the control group (P<0.05)
Conclusion
①the RD patients after vitrectomy and the symptoms is the deficiency of qi and yin, phlegm and blood obstruct receive xiaomengling treatment, the visual function improve conspicuously, and the the vision, XX, the hemorrhage of retina, the exudation of retina, the alleviation of macular edema, the effect of treatment group is better than the control group, the discrepancy is obvious (P<0.05).②Compare the 12 weeks'effect of two groups, the markedly effective rate in treatment group is 67.7%, effective rate is 29.1%, the markedly effective rate in control group is 33.4%, the effective rate was 63.3%, the effect of treatment group is better than the control group, the discrepancy is obvious (P<0.05).③The improvement of chinese symptoms in treatment group is better than the control group (P<0.05).
引文
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[4]Hisatomi T, Sakamoto T, Sonoda KH, et al. Clearan ce of apoptotic phOtOreceptOrs:elimination f apoptotic debris into the subretinal space an d macrophage-mediated phagocytosis via phosphatidylserine receptor and integrin alphavbeta3. Am J Pathol,2003,162:1869-1879.
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[2]Rex TS, Lewis GP, Geller SF, et al Differential expression of coneopsin mRNA levels following experimental retinal detachment an dreattachment. Mol Vis,2002,8:114-118.
[3]Faude F Experimental retinal detachment causes widespread an dmultilayered degeneration in rabbit retina J Neurocytol,2001,30:379-390.
[4]Hisatomi T, Sakamoto T, Sonoda KH, et al. Clearan ce of apoptotic phOtOreceptOrs:elimination f apoptotic debris into the subretinal space an d macrophage-mediated phagocytosis via phosphatidylserine receptor and integrin alphavbeta3. Am J Pathol,2003,162:1869-1879.
[5]Coblentz FE, Radeke MJ, Lewis GP, et al. Evidence that gangli-on ceHs react to retinal detachment. Exp Eye Res,2003,76:333-342
[6]Tagawa H, Feke GT, Goger DG, et al. Retinal blood flow chang. es in eyes with rhegmatogenous retinal detachment and scleralbuckling procedures. Nippon Gan ka Gakkai Zasshi,1992,96:259-264.
[7]Lewis GP, Fisher SK. M ailer cell outgrowth after retinal detach-ment: association with cone photoreceptors. Invest Ophthalmol VisSci,2000,41: 1542-1545.
[8]Francke M, Faude F, Pannicke T, et al. Electrophysiology of rab-bit Mailer(glial) cells in experimental retinal detachm ent and PVR. Invest CIphthalmol Vis Sci,2001,42:1072-1079.
[9]谢琳.视网膜脱离后视功能损伤机制研究进展.国外医学(眼科学分册),2004,28(5)：337-338.
[10]杨影,郑燕林.孔源性视网膜脱离手术后的视功能恢复.中国中医眼科杂志,2002,12(2)：120-123.
[11]石一宁,搏延年.视网膜脱离手术后的视功能恢复.1995,19(21)：91-96.
[12]刘文.视网膜脱离显微手术.北京：人民卫生出版社,2004：1256
[13]郭荣珍,赵秉水.玻璃体切割术后视神经萎缩五例.中国眼底病杂志,2000,16(4)：243
[14]左绪宏.玻璃体切割术后视力无光感原因分析.青岛大学医学报,2007,43(2)： 172-173.
[15]颜华.玻璃体手术后视野缺损.中国实用眼科杂志,1998,16(9)：521-522.
[16]颜华,许瀛海.玻璃体切割手术对角膜内皮细胞的影响.中华眼底病杂志,2004,2：101-103.
[17]魏世辉,何守志.玻璃体切割气液交换并发性白内障的临床分析.中华眼科杂志,1994,6(30)：417-419.
[18]刘文.视网膜脱离显微手术.北京：人民卫生出版社2004：546
[19]吴娜,张红.后部玻璃体术后早期高眼压.国外医学(眼科学分册),2004,28(6)：384-387.
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