不同频次面部刮痧护理技术治疗干眼的临床疗效观察

Clinical Observation of Different Frequency Facial Scraping Nursing Technology in Treating Dry Eye

目的观察不同频次面部刮痧护理技术治疗干眼的临床疗效。方法纳入2015年1月—2018年12月中国中医科学院眼科医院诊治的干眼患者83例(166只眼),随机分为对照组(A组)28例(56只眼)、护理1组(B组)28例(56只眼)和护理2组(C组)27例(54只眼)。A组予0.1%玻璃酸钠滴眼液点双眼,B组予面部刮痧疗法,每个手法重复3次,C组予面部刮痧疗法,每个手法重复5次。3组均观察1个月。分别于治疗前和治疗后检测受试者的泪膜破裂时间(BUT)、泪液分泌试验(SⅠT)、角膜荧光素钠染色(FL)评分和眼表疾病指数(OSDI)评分。结果3组治疗前BUT、SⅠT、FL评分和OSDI评分比较,差异均无统计学意义(P>0.05)。(1)BUT:3组治疗后BUT均较治疗前延长,差异均有统计学意义(t_(A组)=6.100,t_(B组)=9.430,t_(C组)=17.816,均P=0.000)。治疗后3组间BUT比较,差异有统计学意义(F=26.772,P=0.000)。组间两两比较,C组BUT长于A组(t=6.363,P=0.000)和B组(t=6.103,P=0.000),差异均有统计学意义。(2)SⅠT:3组治疗后SⅠT均较治疗前延长,差异均有统计学意义(t_(A组)=7.131,t_(B组)=12.515,t_(C组)=14.198,均P=0.000)。治疗后3组间SⅠT比较,差异有统计学意义(F=16.780,P=0.000)。组间两两比较,C组SⅠT长于A组(t=4.787,P=0.000)和B组(t=4.559,P=0.000),差异均有统计学意义。(3)FL评分:3组治疗后FL评分均较治疗前降低,差异均有统计学意义(t_(A组)=6.931,t_(B组)=12.313,t_(C组)=15.579,均P=0.000)。治疗后3组间FL评分比较,差异有统计学意义(F=6.264,P=0.003)。组间两两比较,C组FL评分低于A组(t=3.329,P=0.002)和B组(t=3.167,P=0.003),差异均有统计学意义。(4)OSDI评分:3组治疗后OSDI评分均较治疗前降低,差异均有统计学意义(t_(A组)=11.684,t_(B组)=13.248,t_(C组)=16.189,均P=0.000)。治疗后3组间OSDI评分比较,差异有统计学意义(F=6.264,P=0.003)。组间两两比较,C组OSDI评分低于A组(t=3.151,P=0.003)和B组(t=2.880,P=0.006),差异均有统计学意义。(5)临床疗效:A组总有效率为67.86%,B组为71.43%,C组为96.29%,3组比较,差异有统计学意义(χ^(2)=7.859,P=0.010)。组间两两比较,C组总有效率高于A组(χ^(2)=7.010,P=0.030)和B组(χ^(2)=5.250,P=0.048),差异均有统计学意义。结论刮痧疗法可作为治疗干眼的一种补充替代疗法,且多次重复刮痧手法的疗效确切,能够促进患者泪液分泌,提高患者生活质量。

OBJECTIVE To observe the clinical effect of different frequency facial scraping nursing technology on dry eye.METHODS A total of 83 patients(166 eyes)with dry eye diagnosed and treated in Eye Hospital,China Academy of Chinese Medical Sciences from January 2015 to December 2018 were randomly divided into control group(group A,28 cases,56 eyes),nursing group 1(group B,28 cases,56 eyes)and nursing group 2(group C,27 cases,54 eyes).Group A was given 0.1%sodium hyaluronate eye drops for both eyes,group B was given facial scraping therapy with each manipulation repeated three times,and group C was given facial scraping therapy with each manipulation repeated five times.All three groups were observed for one month.The tear film break-up time(BUT),SchirmerⅠtest(SⅠT),corneal fluorescein sodium staining(FL)score and ocular surface disease index(OSDI)score of the subjects were measured before and after treatment.RESULTS There were no significant differences in BUT,SⅠT,FL score and OSDI score among the three groups before treatment(P>0.05).(1)BUT:After treatment,BUT was prolonged in all three groups compared with before treatment,and the differences were statistically significant(tgroup A=6.100,tgroup B=9.430,tgroup C=17.816,all P=0.000).The comparison of BUT among the three groups after treatment showed significant differences(F=26.772,P=0.000).The pairwise comparison between groups showed that BUT in group C was longer than that in group A(t=6.363,P=0.000)and group B(t=6.103,P=0.000),and the differences were statistically significant.(2)SⅠT:After treatment,SⅠT was prolonged in all three groups compared with before treatment,and the differences were statistically significant(tgroup A=7.131,tgroup B=12.515,tgroup C=14.198,all P=0.000).The comparison of SⅠT among the three groups after treatment showed significant differences(F=16.780,P=0.000).The pairwise comparison between groups showed that SⅠT in group C was longer than that in group A(t=4.787,P=0.000)and group B(t=4.559,P=0.000),and the differences were statistically significant.(3)FL scores:After treatment,FL scores were reduced in all three groups compared with before treatment,and the differences were statistically significant(tgroup A=6.931,tgroup B=12.313,tgroup C=15.579,all P=0.000).The comparison of FL scores among the three groups after treatment(F=6.264,P=0.003)showed significant differences.The pairwise comparison between groups showed that FL scores in group C were lower than those in group A(t=3.329,P=0.002)and lower than those in group B(t=3.167,P=0.003),and the differences were statistically significant.(4)OSDI scores:After treatment,OSDI scores were reduced in all three groups compared with before treatment,and the differences were statistically significant(tgroup A=11.684,tgroup B=13.248,tgroup C=16.189,all P=0.000).The comparison of OSDI scores among the three groups after treatment showed significant differences(F=6.264,P=0.003).The pairwise comparison between groups showed that OSDI scores in group C were lower than those in group A(t=3.151,P=0.003)and group B(t=2.880,P=0.006),and the differences were statistically significant.(5)Clinical efficacy:The total effective rate of group A was 67.86%,group B was 71.43%,and group C was 96.29%.There was a significant difference between the three groups(χ^(2)=7.859,P=0.010).When comparing the groups pairwise,group C had a higher total effective rate than group A(χ^(2)=7.010,P=0.030)and group B(χ^(2)=5.250,P=0.048),with significant differences.CONCLUSIONS Scraping therapy may become a complementary alternative treatment for dry eyes,and repeated scraping therapy has a precise therapeutic effect,which can promote tear secretion and improve patients'quality of life.