血府逐瘀汤联合激光治疗视网膜静脉阻塞

Xuefuzhuyu decoction combined with retinal laser photocoagulation in the treatment of retinal vein occlusion

目的:观察中药方剂血府逐瘀汤联合视网膜光凝术治疗不同病程视网膜静脉阻塞患者的疗效。方法:①选择2004-04/2006-06新乡医学院第三附属医院眼科收治的视网膜静脉阻塞患者74例74眼。年龄25～76岁,平均62岁;病程5d～3年,其中病程<15d者9眼,15d～3个月41眼,～6个月7眼,～12个月4眼,～18个月6眼,～24个月5眼,～36个月2眼。②口服血府逐瘀汤(当归9g,生地9g,牛膝9g,红花9g,桃仁12g,柴胡6g,枳壳6g,桔梗6g,甘草3g,1剂/d,2次/d)联合视网膜光凝术治疗观察临床疗效。③疗效标准:痊愈:视网膜出血、水肿全部吸收,视力提高4行以上或恢复至病前水平。视网膜荧光血管造影显示毛细血管无灌注区消失,新生血管消退或纤维化,血管渗漏消失,黄斑水肿消退。显效:视网膜出血大部分吸收,视力提高3～4行,视网膜荧光血管造影显示视网膜循环状态大部分改善。好转:视网膜出血部分吸收,视力提高1～2行,视网膜荧光血管造影显示视网膜循环状态有所改善。无效:视力提高不足1行或下降,眼底无明显改善,视网膜荧光血管造影检查同治疗前。结果:74例患者全部获得随访,随访2～9个月。①痊愈39例(53%),其中病程<15d6例,15d～3个月27例,～6个月4例,～12个月2例。②显效14例(19%),其中病程<15d3例,15d～3个月8例,～6个月1例,～18个月2例。③好转13例(18%),其中病程15d～3个月6例,～6个月1例,～12个月1例,～18个月2例,～24个月3例。④无效8例(11%),其中病程～6个月1例,～12个月1例,～18个月2例,～24个月2例,～36个月2例。总有效率89%,病程在一年以上的患者无一例治愈,病程在3个月以内的患者无一例无效。结论:血府逐瘀汤联合视网膜光凝术治疗视网膜静脉阻塞效果显著,且病程愈短效果愈好。

AIM： To observe the curative effect of Xuefuzhuyu decoction combined with the retinal laser photocoagulation in treatment of patients with retinal vein occlusion （RVO）. METHODS：①Seventy-four patients （74 eyes） with RVO, who were 25- 76 years old with an mean age of 62 years and a course of disease ranged from 5 days to 3 years, were selected from the Department of Ophthalmology, Third Hospital Affiliated to Xinxiang Medical College between April 2004 and June 2006, including 9 eyes in patients with the course of disease less than 15 days, 41 eyes in patients with the course of disease ranged from 15 days to 3 months, 7 eyes in patients with the course of disease ranged from 3 months to 6 months, 4 eyes in patients with the course of disease ranged from 6 months to 12 months, 6 eyes in patients with the course of disease ranged from 12 months to 18 months, 5 eyes in patients with the course of disease ranged from 18 months to 24 months and 2 eyes in patients with the course of disease ranged from 24 months to 36 months. Based on retinal laser photocoagulation, patients orally took Xuefuzhuyu decoction （9 g of Danggui, 9 g of Shengdi, 9 g of Niuxi, 9 g of Honghua, 12 g of Taoren. 6 g of Caihu. 6 g of Jike, 6 g of Jugeng and 3 g of Gancao, one dose a day and twice a day） to observe the clinical effects. ③ Therapeutic criteria： Healed as complete absorption of retinal hemorrhage （RH） and edema, and the sight was enhanced more than 4 rows or recover to the level as before; retinal fluorescein angiography showed that no perfusion disappeared in blood capillaries, and newly born capillaries extinction and fibrosis were detected without vessel leakage or macular edema. Valid： Most of BH was absorbed with an enhancement of 3-4 rows in sight, and retinal fluorescein angiography showed that most of retinal circulation was ameliorated. hnproved： The sight was enhanced less than one row or decreased without significant improvement in eye ground, and no changes in retinal fluoreseein angiography. RESULTS： A follow-up of 2-9 months was done in 74 patients. ① 39 patients （53%） healed, including 6 patients with the course of disease less than 15 days, 27 patients between 15 days and e months, 4 patients between 3 months and 6 months, 2 patients between 6 months and 12 months. ② 14 patients （19%） got valid effect, including 3 patients with the course of disease less than 15 days, 8 patients between 15 days and 3 months, one patient between 3 months and 6 months, 2 patients between 6 months and 18 months. ③ 13 patients （18%） turned better, including 6 patients with the course of disease between 15 days and 3 months, one patient between 3 months and 6 months, one patient between 6 months and 12 months, 2 patients between 12 months and 18 months, 3 patients between 18 months and 24 months. ④It was invalid in 8 patients （11%）, including one patient with the course of disease ranged from 15 days to 6 months, one patient ranged from 6 months to 12 months, 2 patients ranged from 12 months to 18 months, 2 patients from 18 months to 24 months, 2 patients from 24 months to 36 months with a total effective rate of 89%. No patient whose course of disease above one year healed, and all patients whose course of disease below 3 months healed. CONCLUSION： The effeet of Xuefuzhuyu decoction combined with retinal laser photoeoagulation on patients with RVO is excellent, and the shorter the course of disease is. the better the effect is.