滋肾健脾化瘀片联合激光治疗糖尿病黄斑水肿的疗效观察

发布时间：2018-03-15 09:45

本文选题：糖尿病性黄斑水肿　切入点：中西医结合　出处：《广州中医药大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的观察滋肾健脾化瘀片联合激光光凝治疗糖尿病黄斑水肿的疗效。方法内分泌科确诊为糖尿病,经散瞳后眼底检查、FFA、OCT检查确诊为糖尿病性黄斑水肿,并排除其他原因引起黄斑水肿的患者43例(86眼)做为研究对象,随机分为对照组21例(42眼)和实验组22例(44眼),入选患者均用国际标准视力表检测治疗眼的最佳矫正视力,并行FFA、OCT检查,对照组：视网膜激光光凝治疗；实验组：口服滋肾健脾化瘀片联合视网膜激光光凝治疗,疗程为3个月。前一个月根据眼底情况采取全视网膜或次全视网膜激光光凝治疗,分2-3次进行眼底激光,同时口服滋肾健脾化瘀片3个月。治疗结束后观察各组最佳矫正视力、FFA及OCT变化情况。组内前后比较采用t检验,组间比较采用两组独立样本t检验,分类资料采用x2检验,分析两组治疗的效果,并做出相应的结论。结果对照组21例42眼,男13例26眼(占61.9%),女8例16眼(占38.1%)；年龄：43—72岁,平均(55.81±10.96)岁,实验组22例44眼,男8例16眼(占36.4%),女14例28眼(占63.6%)；年龄：29—74岁,平均(56.23±10.75)岁,两组患者的性别构成和平均年龄差异均无统计学意义(P0.05)；视力：两组治疗后视力均有提高,对照组治疗前(0.35±0.32),治疗后(0.44±0.32),治疗后视力平均提高0.09,差异有统计学意义(p0.05)；实验组治疗前(0.40±0.23),治疗后(0.59±0.23),治疗后视力平均提高0.19,差异有统计学意义(p0.05)；治疗后对照组总有效率为54.76%,实验组总有效率为79.55%,实验组视力明显优于对照组,差异有统计学意义(P0.05)。 OCT：对照组治疗前黄斑中心小凹视网膜厚度平均值：(349.24±202.87)um,治疗后为(291.83±158.98)um,激光治疗有效(t=5.996,p0.05)；实验组治疗前黄斑中心小凹视网膜厚度平均值为(327.80±150.98)um,治疗后为(247.80±112.77)um,滋肾健脾化瘀片联合激光治疗有效(t=5.912,p0.05)；两组中心小凹水肿改善值比较：对照组(57.40±62.05)um,实验组(80.00±89.75)um,两组改善值差异没有统计学意义(P0.05)；对照组治疗前黄斑中心凹lmm直径视网膜厚度平均值为(371.17±164.57)um,治疗后为(327.98±144.33)um,激光治疗有效(t=5.685,p0.05)；实验组治疗前黄斑中心凹区视网膜厚度平均值为黄斑中心凹1mm直径视网膜厚度平均值为(351.32±152.00)um,治疗后为(288.43±114.49)um,滋肾健脾化瘀片联合激光治疗亦有效(t=5.379,p0.05)；两组黄斑中心凹lmm直径视网膜水肿改善值比较：对照组(43.19±49.23)um,实验组(62.89±77.55)um,两组改善值差异没有统计学意义(P0.05); FFA：两组治疗前FFA表现为视网膜内有弥漫性渗漏区域,黄斑水肿。治疗后表现为渗漏区域范围减小,水肿减轻。对照组黄斑水肿渗漏消失或减轻为36眼,有效率为85.71%,实验组44眼治疗后黄斑水肿渗漏消失或减轻为44眼,有效率为100%,差异有统计学意义(P0.05)。结论激光光凝是治疗糖尿病黄斑水肿的有效方法,滋肾健脾化瘀片联合激光光凝治疗能加快糖尿病黄斑水肿的吸收及减轻视网膜血管的渗漏,提高患者的视力,改善视功能,是临床上治疗DME行之有效的方法。
[Abstract]:objective
To observe the curative effect of Yishen Jianpi Huayu tablet combined with laser photocoagulation in the treatment of diabetic macular edema.
Method
Department of Endocrinology diagnosed with diabetes, the fundus, FFA, OCT were diagnosed as diabetic macular edema, and exclusion of other causes of 43 cases of patients with macular edema caused by (86 eyes) as the research object, randomly divided into control group 21 cases (42 eyes) and 22 cases in the experimental group (44 eyes) were selected. The patients in the international standard best corrected visual acuity, eye detection and treatment of parallel FFA, OCT examination, control group: laser photocoagulation; experimental group: oral zishenjianpihuayu decoction combined with laser photocoagulation treatment, treatment for 3 months. One month before according to the fundus retina or take the whole time laser photocoagulation treatment, 2-3 times of fundus laser, and oral administration of zishenjianpihuayu Decoction for 3 months after the end of treatment were observed. The best corrected visual acuity, the changes of FFA and OCT. Within groups using t test, comparison between groups using two independent groups T test of vertical samples and X2 test for classification data were used to analyze the effect of the two groups and make the corresponding conclusions.
Result
The control group of 21 eyes of 42 patients, male 13 cases 26 eyes (61.9%), female 8 cases 16 eyes (38.1%); age: 43 - 72 years old, the average (55.81 + 10.96), experimental group of 22 eyes of 44 patients, male 8 cases 16 eyes (36.4%), female 14 cases 28 eyes (63.6%); age: 29 to 74, the average (56.23 + 10.75) years of age, gender and the average age of the two groups of patients showed no significant difference (P0.05);
Visual acuity: the visual acuity was improved after treatment in the two groups, the control group before treatment (0.35 + 0.32), (0.44 + 0.32) after treatment, after treatment, the average visual acuity increased 0.09, the difference was statistically significant (P0.05); experimental group before treatment (0.40 + 0.23), (0.59 + 0.23) after treatment, after treatment, visual acuity the average increase of 0.19, the difference was statistically significant (P0.05); the control group after treatment the total effective rate was 54.76%, the total efficiency of the experimental group 79.55%, experimental group was significantly better than the control group, the difference was statistically significant (P0.05).
OCT: the control group before the treatment of macular foveal thickness average: (349.24 + 202.87) um, after treatment for (291.83 + 158.98) um laser therapy (t=5.996, P0.05); experimental group of macular foveal thickness before the average (327.80 + 150.98) um, after treatment (247.80 + 112.77) um, effective zishenjianpihuayu decoction combined with laser therapy (t=5.912, P0.05); the two group center pit value comparison: control group improved edema (57.40 + 62.05) um, the experimental group (80 + 89.75) um, two groups to improve the value of the difference was not statistically significant (P0.05); the control group before treatment the diameter of the foveal retinal thickness average LMM (371.17 + 164.57) um, after treatment for (327.98 + 144.33) um laser therapy (t=5.685, P0.05); the experimental group of macular retinal thickness before the concave area average diameter of foveal retinal thickness (the average value of 1mm is 35 1.32 + 152) um, after treatment for (288.43 + 114.49) um, zishenjianpihuayu decoction combined with laser therapy is also effective (t=5.379, P0.05); the two group of foveal retinal edema, improve the value of LMM in diameter: the control group (43.19 + 49.23) um, the experimental group (62.89 + 77.55) um, two to improve the value of the difference was not statistically significant (P0.05);
FFA: the two groups before treatment FFA showed intraretinal diffuse leakage area, macular edema. After treatment for leakage area decreased, edema. The control group of macular edema leakage disappeared or reduced in 36 eyes, efficiency was 85.71%, 44 eyes in the experimental group after the treatment of macular edema leakage disappeared or reduced to 44 eye, efficiency is 100%, the difference was statistically significant (P0.05).
conclusion
Laser photocoagulation is an effective method for the treatment of diabetic macular edema, zishenjianpihuayu decoction combined with laser photocoagulation for diabetic macular edema can accelerate the absorption and reduce the leakage of the retinal vessels, improve visual acuity, improve visual function is effective methods in treatment of DME.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R587.2;R774.5

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