痰瘀同治法治疗前部缺血性视神经病变疗效观察

Observation of treatment on anterior ischemic optic neuropathy of both phlegm and blood stasis

目的：观察痰瘀同治法治疗前部缺血性视神经病变的临床疗效。方法将57例前部缺血性视神经病变患者随机分为痰瘀同治组31例（31只眼）和活血化瘀组26例（26只眼）。痰瘀同治组内服自拟活血化瘀、化痰祛浊中药煎剂，活血化瘀组内服桃红四物汤。2组均根据兼证进行中药加减，同时给予静脉滴注小牛血去蛋白提取物注射液（爱维治）。治疗30 d后观察疗效。结果痰瘀同治组31只眼，显效24只眼（77.42%），有效3只眼（9.68%），无效4只眼（12.90%），总有效率87.10%；活血化瘀组26只眼，显效11只眼（42.31%），有效8只眼（30.77%），无效7只眼（26.92%），总有效率73.08%。2组疗效不同（Z=-2.509，P=0.012），显效率差异有统计学意义（χ2=7.356，P=0.007）。痰瘀同治组视野平均敏感度改善情况好于活血化瘀组（t=2.307，P=0.0249）。结论痰瘀同治法治疗前部缺血性视神经病变能有效提高视力，改善视野，临床疗效优于活血化瘀法。

OBJECTIVE To observe the clinical curative effect of treating both phlegm and blood stasis in treatment of anterior ischemic optic neuropathy. METHODS Fifty-seven patients with anterior ischemic optic neu-ropathy were randomly divided into the phlegm and blood stasis group （31 cases, 31 eyes ） and blood stasis group （26 cases, 26 eyes）. Phlegm and blood stasis group was given oral administration of self promoting blood circulation and removing blood stasis, removing Phlegm Decoction, and promoting blood circulation. Removing blood stasis group was given Taohong Siwu decoction. The effects and evidence of Chinese medicine decoction, and intra-venous drip of Deproteinized Calf Blood Extractives In-jection （Actovegin） of 2 groups were measured. Clinical observation on treatment was 30 d. RESULTS The phlegm and blood stasis group, among 31 eyes, 24 eyes were markedly effective （77.42%）, 3 eyes effective （9.68%）, 4 eye ineffective （12.90%）, and the total efficiency rate was 87.10%;blood stasis group, among 26 eyes, 11 eyes were markedly effective （42.31%）, 8 eyes effective （30.77%）, 7eyes ineffective （26.92%）, and the total efficiency rate was 73.08%. The effect of the 2 groups of different （Z=-2.509, P=0.012）, effective rate was statistically significant （χ2=7.356, P=0.007）. There was statistical significance before and after treatment in the two groups in view of mean light sensitivity differences （t=2.307, P=0.0249）. CONCLUSIONS Treating both phlegm and blood stasis of ante-rior ischemic optic neuropathy could effectively improve eyesight, visual field, and the clinical curative effect was superior to that of promoting blood circulation and removing blood stasis.