益气活血通窍法对放射性视神经病变晚期患者的疗效观察

Observation on curative effect of method of tonifying Qi activating blood and smoothening orifices in the treatment of later stage patients with radiation-induced optic neuropathy

目的:评价益气活血通窍药物对放射性视神经病变晚期患者视功能的改善作用。方法:选择放射性视神经病变(RION)晚期患者12例21眼,应用益气活血通窍药物黄芪注射液、川芎嗪注射液和醒脑静注射液静脉滴注,两周为一疗程。于治疗前、第一疗程结束和第二疗程结束行视力、视野和视觉诱发电位检查,记录最佳矫正视力、中心视野平均光敏度和平均缺损、以及视觉诱发电位振幅值,比较患者治疗前后的视功能改变。结果:第一疗程和第二疗程后视力改善的有效率分别为38.10%和57.14%,两个疗程的疗效差异有统计学意义(P<0.05)。治疗前中心视野平均光敏度(MS)和平均缺损(MD)分别为(12.16±5.20d B)和(15.60±2.39d B),第一疗程后分别为(13.92±4.68d B)和(13.85±1.39 d B),第二疗程后分别为(15.55±5.32d B)和(11.87±2.00 d B),其中第二疗程后的MS值和MD值与治疗前比较有统计学差异(P<0.05)。13眼闪光视觉诱发电位(F-VEP)于治疗前、第一疗程和第二疗程后的P2波平均振幅值分别为(5.08±2.35μv)、(7.36±2.58μv)和(9.25±3.06μv),其中第二疗程后与治疗前比较有统计学差异(P<0.05);6眼图形视觉诱发电位(P-VEP)检查于治疗前、第一疗程和第二疗程后的P100波平均振幅值分别为(3.33±1.45μv)、(4.70±1.42μv)和(6.53±1.94μv),其中第二疗程后平均振幅与治疗前比较有统计学差异(P<0.05)。结论:益气活血通窍法对晚期RION患者具有保持和改善视力、提高中心视野光敏度和视觉诱发电位振幅的作用,对于改善晚期RION患者视功能和提高生活质量有临床应用价值。

To evaluate the improvementeffect of medicines with the function of tonifying Qi activating blood and smoothening orifices on later stage patients ofRadiation-induced optic neuropathy.Methods:Twenty-one eyes of12later stage patients withRadiation-induced optic neuropathy were treatedwiththe medicines oftonifying Qi activating blood and smoothening orifices including Astragalus injection, ligustrazine hydrochloride injection and Xingnaojing injection, 2 weeks as a course. Visual acuity, visual field and visual evoked potentialexamination were tested before therapy, after 2 weeks( 1st therapy) and 6 weeks( 2nd therapy). The best corrected visual acuity(BCVA),mean sensitivity (MS) and mean defect(MD)of central visual field(CVF)and mean amplitude(MA) in visual evoked potential(VEP) wererecorded and compared with the condition before treatment.Results:The effectiverate of BCVA improvement were38.10% and 57.14%of the two courses,and the BCVA after2nd therapy improved significantly than 1st therapy(P<0.05). The mean sensitivity(MS) and mean defect(MD) ofCVF beforetreatment were 12.16±5.20dB and15.60±2.39dB, those were 13.92±4.68dB and 13.85±1.39 dB after 1st therapy,and 15.55±5.32dB,11.87±2.00 dB after 2nd therapy. The differences of MS and MD before therapy and after the 2nd therapy were significant(P<0.05).The P2 wave MA of F-VEP in 13 eyes were 5.08±2.35μv, 7.36±2.58μv and 9.25±3.06μv beforetreatment ,afterthe 1st therapy and the 2nd therapy.There was significant difference betweenthe conditionbefore therapy andthe2nd therapyin MA(P<0.05).The P100 wave MA of P-VEP in 6 eyes were 3.33±1.45μv、4.70±1.42μvand 6.53±1.94μv before therapy ,afterthe1st therapy and the 2nd therapy. The differences of MA were significantly compared withconditions before therapy andthe 2nd therapy(P<0.05).Conclusion:Themethod of tonifying Qi activating blood and smoothening orifices can help later stagepatientswithRadiation-induced optic neuropathyimprove the visual function includingBCVA,MS and MDof CVF and MAof VEP. It has clinical value to improve the visual functions and life quality.