中药辅助治疗儿童弱视的临床研究

发布时间：2018-06-13 16:25

本文选题：弱视 + 中药　；参考：《南京中医药大学》2011年硕士论文

【摘要】：目的：导师魏伟教授集多年的临床经验总结弱视病机多属禀赋不足、元精亏虚,治疗应以补肾、填精、明目、开窍为原则,借鉴已故名老中医江育仁教授治疗小儿智力低下经验方,经加减制成“益视合剂”(院内制剂)用于儿童弱视治疗长达20余年。本研究旨在科学、客观地评价“益视合剂”的疗效,以指导儿童弱视的临床治疗。并且通过客观的检测手段初步探讨其作用机理。方法：根据病例选择标准共纳入36例61眼进行观察,将其分为两组,以屈光矫正加精细目力训练的传统治疗为对照组,在传统治疗基础上配合服用“益视合剂”的为治疗组,以4周为1个治疗疗程,共观察3个疗程。于治疗前及每个疗程结束后行视力检查,于治疗前和第3个疗程结束后行图形视觉诱发电位(P-VEP)及光学相干断层扫描(OCT)检查。分别观察两组视力情况,P100波波峰潜时及振幅大小,黄斑区视网膜神经上皮层厚度和视乳头旁视网膜经纤维层(RNFL)厚度,以客观评价"益视合剂"的疗效,初步探讨其作用机理。结果：1.3个疗程结束后,治疗组34眼,基本治愈18眼,进步11眼,无效5眼,总有效率为85.3%,基本治愈率为52.9%；对照组27眼,基本治愈8眼,进步8眼,无效11眼,总有效率为59.3%,基本治愈率为29.6%。两组疗效有显著性差异(P0.05),治疗组疗效明显优于对照组,其中屈光不正性弱视及中度弱视疗效较好。2.OCT检查：治疗后黄斑区视网膜神经上皮层厚度及视乳头旁RNFL厚度有不同程度的下降,尤其是黄斑内环区上方视网膜,外环区上方、鼻侧及下方视网膜厚度变化有统计学差异。3.P-VEP检查：经治疗后在空间频率1.Ocpd及0.3cpd刺激下测得的P100波的波峰振幅较治疗前有轻度的提高,潜时较治疗前有小幅度的延长,然而,只有在空间频率为0.3cpd刺激下的P100波波峰潜时的改变具有统计学意义(P0.05)。结论：中药益视合剂作为辅助治疗方法可以显著提高儿童弱视的治愈率,缩短治疗时间,在改善视网膜及视中枢的形态和功能方面起到一定的作用。
[Abstract]:Objective: to sum up the clinical experience of professor Wei Wei for many years and summarize that the pathogenesis of amblyopia is mostly due to the deficiency of endowment and deficiency of essence. The treatment should be based on the principle of tonifying the kidney, filling the essence, opening the eyes and opening the orifices. Referring to the late Professor Jiang Yuren's experience in the treatment of children's mental retardation, "Yi Shi mixture" (hospital preparation) has been used in the treatment of amblyopia for more than 20 years. The purpose of this study was to scientifically and objectively evaluate the curative effect of Yi Shi mixture in order to guide the clinical treatment of amblyopia in children. And through the objective detection means, the mechanism of its action is preliminarily discussed. Methods: according to the criteria of case selection, 36 cases (61 eyes) were observed and divided into two groups: the control group was treated with refractive correction and fine visual training, and the treatment group was treated with "Yi Shi mixture" on the basis of traditional treatment. Four weeks were used as a course of treatment and three courses of treatment were observed. Visual acuity examination was performed before and after each course of treatment, and visual evoked potential (P-VEP) and optical coherence tomography (Oct) were performed before and after the third course of treatment. The time and amplitude of P100 wave peak latency, the thickness of retinal neuroepithelial layer in macular area and the thickness of RNFL in retinal parapapillary retinal layer were observed in order to evaluate the curative effect of "Yishi mixture" objectively and to explore its mechanism. Results: 1.After the end of three courses of treatment, 34 eyes in the treatment group were basically cured, 18 eyes were cured, 11 eyes were improved, 5 eyes were ineffective, the total effective rate was 85.3, and the basic cure rate was 52.9%, while in the control group, 27 eyes were basically cured, 8 eyes were improved, 11 eyes were ineffective. The total effective rate was 59.3 and the basic cure rate was 29.6. There was significant difference between the two groups (P 0.05). The curative effect of the treatment group was better than that of the control group. Among them, ametropia amblyopia and moderate amblyopia were better. 2. Oct: the retinal neuroepithelial layer thickness of macular area and the RNFL thickness of parapapillary region decreased in varying degrees after treatment, especially above the inner macular area and the outer ring area. There were significant differences in retinal thickness between the nasal side and the inferior retinal thickness. 3. P-VEP examination: after treatment, the amplitude of the peak of the P100 wave stimulated by 1. Ocpd and 0.3cpd was slightly higher than that before treatment, and the latent time was slightly longer than that before treatment. However, Only when the spatial frequency is 0.3cpd, the change of peak potential time of P100 wave is statistically significant. Conclusion: Chinese medicine Yishi mixture as an auxiliary treatment method can significantly improve the cure rate of amblyopia in children, shorten the time of treatment, and play a certain role in improving the shape and function of retina and visual center.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R777.44

【引证文献】