核桃灸结合辨证施护对糖尿病视网膜病变增殖期患者的作用探讨

Walnut moxibustion combined with syndrome differentiation nursing care for patients with diabetic retinopathy during proliferative stage

目的探讨核桃灸结合辨证施护在糖尿病视网膜病变(DR)增殖期的干预作用。方法采用前瞻性随机对照试验,选取2022年1月至2023年12月在济南市第二人民医院中医眼科就诊的184例DR增殖期患者作为研究对象,采用随机数字表法分为对照组、辨证施护组、核桃灸组、辨证施护+核桃灸组,每组46例。对照组男28例、女18例,年龄(52.19±8.06)岁,糖尿病病程(6.92±1.15)年,DR增殖期病程(8.22±1.30)个月,予以常规护理;辨证施护组男25例、女21例,年龄(55.09±9.22)岁,糖尿病病程(6.69±1.08)年,DR增殖期病程(8.41±1.36)个月,在对照组基础上予以辩证施护护理;核桃灸组男27例、女19例,年龄(53.37±10.14)岁,糖尿病病程(7.13±1.28)年,DR增殖期病程(8.70±1.42)个月,在对照组基础上予以核桃灸护理;辨证施护+核桃灸组男28例、女18例,年龄(53.95±9.16)岁,糖尿病病程(6.85±1.20)年,DR增殖期病程(8.59±1.44)个月,在对照组基础上予以辩证施护和核桃灸联合护理,各组均连续干预3个月。对比两组患者干预效果,干预前后最佳矫正视力(BCVA)、视敏度(MS)、黄斑中心凹厚度(cMT)、焦虑水平[采用焦虑自评量表(SAS)评估]、生活质量[采用中文版低视力者生活质量量表(CLVQOL)评估]及并发症发生情况。采用单因素方差分析、t检验、χ^(2)检验、确切概率法检验、秩和检验。结果辨证施护+核桃灸组总有效率高于辨证施护组、核桃灸组、对照组[95.56%(43/45)比80.43%(37/46)、81.40%(35/43)、61.36%(27/44)],差异有统计学意义(P<0.05)。干预前,各组患者BCVA、MS、cMT及SAS、CLVQOL评分比较,差异均无统计学意义(均P>0.05)。干预后,辨证施护+核桃灸组BCVA、MS及CLVQOL评分均高于辨证施护组、核桃灸组、对照组[(0.69±0.11)比(0.52±0.10)、(0.50±0.08)、(0.36±0.06),(22.90±3.95)dB比(19.78±3.76)dB、(20.04±3.53)dB、(17.22±3.14)dB,(85.53±14.65)分比(73.11±12.50)分、(69.39±11.72)分、(60.48±10.26)分],cMT及SAS评分均低于辨证施护组、核桃灸组、对照组[(229.17±29.96)μm比(339.05±52.27)μm、(354.92±56.43)μm、(434.11±63.89)μm,(30.59±5.15)分比(36.65±5.77)分、(37.83±5.62)分、(40.91±6.08)分],差异均有统计学意义(均P<0.05)。辨证施护+核桃灸组患者并发症发生率低于辨证施护组、核桃灸组、对照组[4.44%(2/45)比17.39%(8/46)、20.93%(9/43)、25.00%(11/44)],差异有统计学意义(P<0.05)。结论核桃灸结合辨证施护可有效改善DR增殖期患者干预效果及视力水平,缓解焦虑情绪,提高生活质量,降低并发症发生率。

Objective To investigate the effect of walnut moxibustion combined with syndrome differentiation nursing care for patients with diabetic retinopathy(DR)during proliferative stage.Methods One hundred and eighty-four patients with DR during proliferative stage treated at Department of Traditional Chinese Medicine Ophthalmology,Jinan Second People's Hospital from January 2022 to December 2023 were selected for the randomized controlled trial,and were divided into a control group,a syndrome differentiation group,a walnut moxibustion group,and syndrome differentiation+walnut moxibustion group by the random number table method,with 46 cases in each group.There were 28 males and 18 females in the control group;they were(52.19±8.06)years old;their diabetic course was(6.92±1.15)years;their DR course was(8.22±1.30)years.There were 25 males and 21 females in the syndrome differentiation group;they were(55.09±9.22)years old;their diabetic course was(6.69±1.08)years;their DR course was(8.41±1.36)years.There were 27 males and 19 females in the walnut moxibustion group;they were(53.37±10.14)years old;their diabetic course was(7.13±1.28)years;their DR course was(8.70±1.42)years.There were 28 males and 18 females in the syndrome differentiation+walnut moxibustion group;they were(53.95±9.16)years old;their diabetic course was(6.85±1.20)years;their DR course was(8.59±1.44)years.All the 4 groups took routine care;in addition,the syndrome differentiation group took syndrome differentiation nursing care,the walnut moxibustion group took walnut moxibustion,and the syndrome differentiation+walnut moxibustion group took syndrome differentiation nursing care and walnut moxibustion,for 3 months.The intervention effects,best corrected visual acuity(BCVA),visual acuities(MS),central macular thicknesses(cMT),anxiety levels[Self-rating Anxiety Scale(SAS)],and quality of life[Chinese-version Low Vision Quality of Life Questionnaire(CLVQOL)]before and after the intervention,and incidences of complications were compared between the two groups by one-way ANOVA,t test,χ^(2)test,Fisher exact test,and rank sum test.Results The total effective rate in the syndrome differentiation+walnut moxibustion group was higher than those in the syndrome differentiation group,walnut moxibustion group,and control group[95.56%(43/45)vs.80.43%(37/46),81.40%(35/43),and 61.36%(27/44)],with a statistical difference(P<0.05).Before the intervention,there were no statistical differences in BCVA,MS,cMT,and scores of SAS and CLVQOL between the four groups(all P>0.05).After the intervention,the BCVA,MS,and score of CLVQOL in the syndrome differentiation+walnut moxibustion group were higher than those in the syndrome differentiation group,walnut moxibustion group,and control group[(0.69±0.11)vs.(0.52±0.10),(0.50±0.08),and(0.36±0.06);(22.90±3.95)dB vs.(19.78±3.76)dB,(20.04±3.53)dB,and(17.22±3.14)dB;(85.53±14.65)vs.(73.11±12.50),(69.39±11.72),and(60.48±10.26)];the cMT and score of SAS in the syndrome differentiation+walnut moxibustion group were lower than those in the syndrome differentiation group,walnut moxibustion group,and control group[(229.17±29.96)μm vs.(339.05±52.27)μm,(354.92±56.43)μm,and(434.11±63.89)μm;(30.59±5.15)vs.(36.65±5.77),(37.83±5.62),and(40.91±6.08)];there were statistical differences(all P<0.05).The incidence of complications in the syndrome differentiation+walnut moxibustion group was lower than those in the syndrome differentiation group,walnut moxibustion group,and control group[4.44%(2/45)vs.17.39%(8/46),20.93%(9/43),and 25.00%(11/44)],with a statistical difference(P<0.05).Conclusion Walnut moxibustion combined with syndrome differentiation nursing care can effectively improve the intervention effect and vision level of patients with DR during proliferative stage,relieve their anxiety,improve their quality of life,and reduce the incidence of complications.