益气养阴活血化瘀中药对青光眼术后视神经保护作用的研究

Clinical study of supplymenting qi and nourishing yin,activating blood and dissolving stagnation Chinese herbs on the optic neuroprotective effects of postoperative glaucoma surgery

目的:观察益气养阴活血化瘀中药对抗青光眼术后、眼压已控制青光眼患者视神经保护作用的临床疗效,并从血液流变学方面探讨其相关作用机制。方法:将60例99眼已行抗青光眼术后、眼压已控制青光眼患者随机分配到治疗组(益气养阴、活血化瘀中药)、对照组(益脉康胶囊),其中治疗组30例50眼,对照组30例49眼。疗程4wk。观察比较治疗前后视力、眼压、视野(平均光敏度与平均缺损)、图形视觉诱发(LP100,AP100)和血液流变学指标的变化。结果:视力:两组均能提高患者的中心视力,治疗后治疗组与对照组比较差异均有统计学意义(P<0.05)。眼压:两组治疗前后比较、两组组间比较差异均无统计学意义(P>0.05)。视野(平均光敏度与平均缺损):两组治疗前后视野平均光敏度、视野平均缺损比较差异均有显著统计学意义(P<0.01),治疗后治疗组视野平均光敏度、视野平均缺损与对照组比较差异均有显著统计学意义(P<0.01)。图像视觉诱发电位(LP100,AP100):两组治疗前后LP100,AP100比较差异均有显著统计学意义(P<0.01),治疗后治疗组LP100,AP100与对照组比较差异均有显著统计学意义(P<0.01)。血液流变学变化:治疗组治疗后在全血粘度高切、红细胞电泳、血浆粘度、红细胞聚集指数4项指标上与治疗前比较差异有显著统计学意义(P<0.01),在全血粘度低切1项指标上与治疗前比较差异有统计学意义(P<0.05)。治疗后治疗组与对照组在全血粘度高切、全血粘度低切、红细胞电泳、血浆粘度、红细胞聚集指数5项指标上比较差异均有统计学意义(P<0.05)。结论:益气养阴活血化瘀中药对抗青光眼术后、眼压已控制的青光眼患者有视神经保护作用,能提高视力、增强视野平均光敏度和减少视野缺损、增强视神经电生理活动、改善血液流变学等指标。同时认为其治疗效果主要是通过减轻血液的高粘状态和血管血流阻力、改善视神经的血流供应而起作用。

AIM： To observe the optic neuroprotective effects of supplymenting qi and nourishing yin,activating blood and dissolving stagnation Chinese herbs on patient with controlled intraocular pressure after glaucoma surgery and to discuss the correlated mechanism action from hemorheology·METHODS： Sixty patients（99 eyes） were randomly divided into two groups,the treatment group included 30 patients（50 eyes）,the control group included 30 patients（49 eyes）.The treatment group were treated by supplymenting qi and nourishing yin,activating blood and dissolving stagnation Chinese herbs,while the control group were treated by Yimaikang capsules.In the course of 60 days treatment,the difference of visual acuity,intraocular pressure,visual field（average light sensitivity and average defect）,pattern visual evoked potential（LP100,AP100）and hemorheology index were observed and compared·RESULTS： Visual acuity： The central visual acuity of two groups were both improved.The treatment group was better than control group（P〈0.05）.Intraocular pressure： pre-treatment and post-treatment,there was no statistical significance（P〈0.05） between two groups.Visual field（average light sensitivity and average defect）： The average light sensitivity and average defect were obviously improved（P〈0.01）.The treatment group was better than the control group（P〈0.01）.Pattern visual evoked potential（LP100,AP100）： LP100 and AP100 were obviously sensitive（P〈0.01）.The treatment group was more sensitive than the control group（P〈0.01）.Hemorheology： In the treatment group,there were obviously statistical significance（P〈0.01） on blood viscosity high-shear,erythrocyte electrophoresis,plasma viscosity,index of erythrocyte aggregation between pre-treatment and post-treatment,there was statistical significance（P〈0.05） on blood viscosity hypo-shear between pre-treatment and post-treatment.Post-treatment.There were statistical significance（P〈0.05） on blood viscosity high-shear,blood viscosity hypo-shear,erythrocyte electrophoresis,plasma viscosity,index of erythrocyte aggregation between the treatment group and the control group·CONCLUSION： Supplymenting qi and nourishing yin,activating blood and dissolving stagnation Chinese herbs have good efficiency on the optic neuroprotection in the treatment of the cases with glaucoma of controlled intraocular pressure,can elevate visual acuity,enhance average light sensitivity and average defect of visual field,enhance electrophysiology activity of optic nerve,and improve ocular hemorheology.These effects result from improving blood flow supply of optic nerve.