针刺对青光眼性视神经萎缩患者视力恢复及眼血流动力学指标的影响

Effect of acupuncture on vision recovery and ocular hemodynamics in patients with glaucomatous optic atrophy

目的观察针刺对青光眼性视神经萎缩患者视力恢复及眼血流动力学指标的影响。方法将2015年2月—2018年5月在西安市中医医院治疗的300例青光眼性视神经萎缩患者随机分为2组,对照组150例给予马来酸噻吗洛尔滴眼液+拉坦前列腺素滴眼液+注射用鼠神经生长因子治疗,观察组150例在对照组基础上给予中医针刺法治疗,连续治疗12周,比较2组临床总有效率以及治疗后中医证候积分(视物模糊、头晕目胀、视野缩窄、情志抑郁)、视力、视野(光敏度、视野缺损)、血流动力学指标[眼动脉收缩峰值流速(PSV)、舒张末流速(EDV)、阻力指数(RI)]改善情况,并统计2组治疗期间不良反应发生情况。结果治疗后,观察组总有效率为78.1%(217/278),明显高于对照组的58.5%(165/282),差异有统计学意义(P<0.05);2组治疗后视物模糊、头晕目胀、视野缩窄、情志抑郁积分均明显低于治疗前(P均<0.05),且观察组各症状积分均明显低于对照组(P均<0.05);2组治疗后视力、光敏度、视野缺损均明显改善(P均<0.05),PSV、EDV均明显高于治疗前(P均<0.05),RI均明显低于治疗前(P均<0.05),且观察组治疗后以上指标较对照组改善更明显(P均<0.05);2组治疗期间不良反应发生率比较差异无统计学意义(P>0.05)。结论中医针刺法联合西医常规治疗能够显著改善青光眼性视神经萎缩患者的临床症状和体征,提高光敏度,减轻视野缺损,改善眼动脉血流动力学指标和视力,且不增加不良反应,疗效确切。

Objective It is to observe the effects of acupuncture on vision recovery and ocular hemodynamics in patients with glaucomatous optic atrophy.Methods 300 patients with glaucomatous optic atrophy treated in Xi'an Hospital of Traditional Chinese Medicine from February 2015 to May 2018 were randomly divided into 2 groups.150 patients in the control group were treated with timolol maleate eye drops+latano prost eye drops+mouse nerve growth factor injection,150 cases in the observation group were treated with traditional Chinese medical acupuncture on the basis of the control group,and both groups were continuously treated for 12 weeks.The total clinical effectiveness of the two groups and the improvement of TCM syndrome score(blurred vision,dizziness,narrowed visual field,emotional depression),visual acuity,visual field(photosensitivity,visual field defect),hemodynamic indicators[peak systolic velocity(PSV)and end diastolic velocity(EDV)of ophthalmic artery,resistance index(RI)]after treatment were compared between the 2 groups,the occurrence of adverse reactions during the treatment was counted in the 2 groups.Results After treatment,the total effective rate of the observation group was 78.1%(217/278),which was significantly higher than that 58.5%(165/282)of the control group(P<0.05).The scores of blurred vision,dizziness,narrowed vision,and emotional depression in the two groups were significantly higher after treatment than those before treatment in the 2 groups(P<0.05),and the scores of all syndromes in the observation group were significantly lower than those in the control group(P<0.05).The visual acuity,photosensitivity,and visual field defects of the two groups were significantly improved after treatment(P<0.05),both PSV and EDV were significantly increased(P<0.05),and RI was significantly decreased(P<0.05),and the improvement of the above indicators in the observation group was more significant than those in the control group after treatment(P<0.05).There was no significant difference in the incidence of adverse reactions during treatment between the two groups(P>0.05).Conclusion Traditional Chinese medical acupuncture combined with conventional western medicine treatment can significantly improve the clinical symptoms and signs,increase photosensitivity,reduce visual field defects,improve ophthalmic artery hemodynamics and vision without increase of side effect in the treatment of patients with glaucomatous optic atrophy,its curative effect is definite.