雷火灸联合穴位按摩干眼治疗时间的量效研究

Study on time-dose-effect of thunder-fire moxibustion combined with acupoint mas⁃sage for dry eye

目的研究雷火灸联合穴位按摩治疗干眼的时间量效关系。方法纳入2021年8月—2022年4月中国中医科学院眼科医院诊治的干眼患者120例(240只眼),按随机数表法随机分为A组、B组、C组、D组,每组各30例(60只眼)。A组予0.1%玻璃酸钠滴眼液点双眼,B组、C组和D组分别在A组的基础上联合10 min、20 min和30 min雷火灸与穴位按摩治疗。4组均观察14 d。分别于治疗前、后检测患者的泪膜破裂时间(BUT)、泪液分泌试验(SⅠT)、角结膜荧光染色(FL)和干眼症状评分、舒适度评分并进行统计分析。结果(1)干眼指标:①BUT。与治疗前比较,4组均延长,差异均有统计学意义(t_(A组)=-2.699,P=0.009;t_(B组)=-3.942,P=0.000;t_(C组)=-5.447,P=0.000;t_(D组)=-3.074,P=0.003)。治疗后4组间比较,差异有统计学意义(F=4.803,P=0.004)。与A组比较,B组、C组均延长,差异均有统计学意义(t_(B组)=3.076,P=0.003;t_(C组)=3.732,P=0.000)。与C组比较,D组缩短,差异有统计学意义(t=2.464,P=0.017)。余组间两两比较,均无统计学意义(P>0.05)。②SⅠT。与治疗前比较,4组均增多,差异均有统计学意义(t_(A组)=-2.751,P=0.008;t_(B组)=-3.320,P=0.002;t_(C组)=-7.266,P=0.000;t_(D组)=-4.222,P=0.000)。治疗后4组间比较,差异有统计学意义(F=2.804,P=0.043)。与B组比较,C组增多,差异有统计学意义(t=-2.212,P=0.031)。余组间两两比较,均无统计学意义(P>0.05)。③FL。与治疗前比较,4组均降低,差异均有统计学意义(t_(A组)=4.474,t_(B组)=4.035,t_(C组)=7.341,t_(D组)=9.142,均P=0.000)。治疗后4组间比较,差异有统计学意义(F=6.021,P=0.001)。与A组比较,C组、D组均降低,差异均有统计学意义(t_(C组)=3.049,P=0.003;t_(D组)=2.489,P=0.016)。与B组比较,C组降低,差异有统计学意义(t=2.427,P=0.018)。余组间两两比较,均无统计学意义(P>0.05)。(2)干眼症状评分:与治疗前比较,4组均降低,差异均有统计学意义(t_(A组)=7.490,t_(B组)=10.316,t_(C组)=10.849,t_(D组)=8.778,均P=0.000)。治疗后4组间比较,差异有统计学意义(F=3.623,P=0.015)。与A组比较,C组降低,差异有统计学意义(t=-3.556,P=0.001)。与B组比较,C组降低,差异有统计学意义(t=-2.721,P=0.009)。与C组比较,D组升高,差异有统计学意义(t=2.248,P=0.029)。余组间两两比较,均无统计学意义(P>0.05)。(3)舒适度评分:C组、D组均较B组升高,差异均有统计学意义(t_(C组)=7.012,t_(D组)=4.315,均P=0.000)。D组较C组降低,差异有统计学意义(t=2.697,P=0.008)。(4)总有效率:A组总有效率为76.67%,B组为82.76%,C组为96.67%,D组为92.86%。4组比较,差异有统计学意义(χ^(2)=6.697,P=0.010)。结论雷火灸联合穴位按摩可改善干眼症状,且最佳治疗时长为20 min。

OBJECTIVE To investigate the time-dose-effect of thunder-fire moxibustion combined with acupoint massage for dry eye.METHODS A total of 120 patients(240 eyes)with dry eye who were diagnosed and treated in Eye Hospital of China Academy of Chinese Medical Sciences from August 2021 to April 2022 were included.They were randomly divided into Group A,Group B,Group C and Group D according to table of random numbers,with 30 patients(60 eyes)in each group.The patients of group A were treated with 0.1%sodium hyaluronate eye drops on both eyes.The patients of group B,C and D were treated with thunder-fire ten-minute,20-minute,and 30-minute thunder-fire moxibustion combined with acupoint massage respectively on the basis of Group A.All patients of four groups were observed for 14 days.Before and after treatment,tear film break-up time(BUT),SchirmerⅠtest(SⅠT),keratoconjunctival fluorescent staining(FL),dry eye symptom score and comfort score were measured and statistically analyzed.RESULTS(1)Dry eye indicators:①Compared with those before treatment,BUT of the four groups were all prolonged,with statistically significant differences(t_(group A)=-2.699,P=0.009;t_(group B)=-3.942,P=0.000;t_(group C)=-5.447,P=0.000;t_(group D)=-3.074,P=0.003).After treatment,the difference between the four groups was statistically significant(F=4.803,P=0.004).Compared with that of Group A,BUT of Group B and Group C were both prolonged,with statistically significant difference(t_(group B)=3.076,P=0.003;t_(group C)=3.732,P=0.000).Compared with that of Group C,BUT of Group D was significantly shorter(t=2.464,P=0.017).There was no significant difference between other two pairs of groups(P>0.05).②Compared with those before treatment,SⅠT of the four groups all increased,with statistically significant differences(t_(group A)=-2.751,P=0.008;t_(group B)=-3.320,P=0.002;t_(group C)=-7.266,P=0.000;t_(group D)=-4.222,P=0.000).After treatment,the difference between the four groups was statistically significant(F=2.804,P=0.043).Compared with that of Group B,SⅠT of Group C increased significantly(t=-2.212,P=0.031).There was no significant differences between the other two pairs of groups(P>0.05).③Compared with those before treatment,FL of the four groups all decreased,with statistically significant differences(t_(group A)=4.474,t_(group B)=4.035,t_(group C)=7.341,t_(group D)=9.142,all P=0.000).After treatment,the difference between the four groups was statistically significant(F=6.021,P=0.001).Compared with that of Group A,FL of both Group C and Group D decreased significantly(t_(group C)=3.049,P=0.003;t_(group D)=2.489,P=0.016).Compared with that of Group B,FL of Group C decreased significantly(t=2.427,P=0.018).There was no significant differences between the other two pairs of groups(P>0.05).(2)Dry eye symptom score:Compared with those before treatment,scores of the four groups all decreased,with statistically significant differences(t_(group A)=7.490,t_(group B)=10.316,t_(group C)=10.849,t_(group D)=8.778,all P=0.000).After treatment,the difference between the four groups was statistically significant(F=3.623,P=0.015).Compared with that of Group A,dry eye symptom scores of Group C decreased significantly(t=-3.556,P=0.001).Compared with that of Group B,dry eye symptom scores of Group C decreased significantly(t=-2.721,P=0.009).Compared with those of Group C,dry eye symptom scores of Group D decreased significantly(t=2.248,P=0.029).There was no significant difference between the other two pairs of groups(P>0.05).(3)Comfort score:Score of both Group C and Group D were significantly higher than those of Group B(t_(group C)=7.012,t_(group D)=4.315,P=0.000).Scores of Group D were significantly lower than those of Group C(t=2.697,P=0.008).(4)Total effective rate:The total effective rate was 76.67%in Group A,82.76%in Group B,96.67%in Group C,and 92.86%in Group D.The difference between the four groups was statistically significant(χ^(2)=6.697,P=0.010).CONCLUSIONS Thunder-fire moxibustion combined with acupoint massage can alleviate the symptoms of dry eye,and the optimal treatment duration is twenty minutes.