韦氏杞菊甘露方熏蒸治疗女性围绝经期干眼病的研究

发布时间：2017-12-28 06:01

本文关键词：韦氏杞菊甘露方熏蒸治疗女性围绝经期干眼病的研究　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:围绝经期女性是干眼的易患人群。围绝经期女性干眼的发病机制及其相关影响因素较为复杂,目前临床以对症治疗缓解症状为主,缺乏有效的针对病因的治疗。对于该特殊类型的干眼,中西医结合疗法是目前临床较为推崇的治疗方法。韦氏杞菊甘露方在临床中治疗此类干眼病已应用多年,初步获得了较好的疗效,但由于既往临床试验多以小规模病例观察为主,缺乏严格设计的前瞻性随机对照试验的支持,其证据强度偏弱,给后续推广韦氏眼科治疗干眼病的宝贵经验、并进一步开展药物的作用机制研究带来了不便,亟需对本方的临床疗效进行规范、严谨的再评价,故本研究拟采用前瞻性随机对照试验的方法评价杞菊甘露方治疗女性围绝经期干眼的临床疗效;验证水液缺乏型围绝经期女性干眼病肝肾不足、津液亏耗的中医病机。方法:1、选取本院眼科门诊就诊的水液缺乏型肝肾不足证围绝经期女性干眼病患者60例,按患者就诊的先后次序,采用计算机分配随机数字,将患者随机分为治疗组及对照组(各30例)。2、治疗组:30例患者(60眼)采用韦氏杞菊甘露方(枸杞子、菊花、北沙参、玉竹、麦冬、石斛、桑叶、薄荷)煎汤取汁后,用熏蒸仪器进行中药熏蒸治疗,曰1次,每次20分钟;联合玻璃酸钠滴眼液日四次点眼。对照组:30例患者(60眼)采用局部点玻璃酸钠滴眼液治疗,日四次。2组均连续治疗14 d。3、于治疗前及治疗14d后,分别观察患者泪膜破裂时间(BUT)、泪液分泌量(SIT)及角膜荧光素染色(FL),并对患者主观症状评分进行分析比较。结果:1、两组患者治疗前年龄、泪膜破裂时间(BUT)、角膜荧光染色(FL)、泪液分泌(SIT)及主观不适症状评分均无显著差异(P0.05);2、治疗14d后,试验组及对照组BUT优于治疗前(P0.05);试验组BUT、FL、主观症状评分的改善幅度好于对照组(P0.05),SIT改善幅度与对照组比较无统计学意义的差异(P0.05);3、观察统计两组总体治疗有效率,差异有明显统计学意义:试验组:76.7%;对照组:36.7%;4、统计分析水液缺乏型围绝经期女性干眼纳入患者的中医不适症状及舌脉资料,大致符合肝肾不足、津液亏耗的中医病机特点。且在中医不适症状表现上以目干疲劳(88.3%)、咽干口燥(63.3%)、失眠多梦(53.3%)及心烦(18.3%)等为主,提示水液缺乏型肝肾不足证围绝经期女性干眼患者中医不适症状表现的特殊性。结论:韦氏杞菊甘露方熏蒸联合玻璃酸钠滴眼液治疗对水液缺乏型肝肾不足证围绝经期女性干眼患者的BUT及FL两项客观指标及主观不适症状均有改善作用,该疗法在延长BUT、促进角膜上皮修复及减轻主观症状评分方面优于玻璃酸钠滴眼液组。为女性围绝经期干眼病患者的角结膜提供保护和营养作用,有助于组织损伤修复,在临床治疗该特殊类型干眼上疗效显著并切实可行。
[Abstract]:Objective: perimenopausal women are vulnerable to dry eyes. The pathogenesis and related influencing factors of dry eye in perimenopausal women are rather complex. At present, symptomatic treatment is the main way to relieve symptoms, and there is no effective treatment for the cause of the disease. For this special type of dry eye, the combination of traditional Chinese and Western medicine is the most respected method of treatment at present. Webster's party Qiju Ganlu in the clinical treatment of such a dry eye has been applied for many years, we obtained good effect, but because of previous clinical trials with a small number of cases observed, the lack of prospective randomized controlled trials and strict design support, the strength of evidence is weak, valuable experience, to promote follow-up Webster's treatment of dry eye eye and further to study the mechanism of drug action inconvenience, the urgent need for re evaluation standard and strict clinical curative effect of the party, so this study using the method of prospective randomized controlled trials evaluating treatment of perimenopausal women Qiju Ganlu therapeutic effect of dry eye; lack of water verification TCM type of perimenopausal women dry eye, fluid depletion of liver and kidney deficiency. Methods: 1. 60 cases of dry eye patients with fluid deficiency and liver and kidney deficiency were selected from our ophthalmology clinic. According to the order of patient visits, the patients were randomly assigned to treatment group and control group (30 cases). 2, the treatment group: 30 patients (60 eyes) with Webster's Party (Qiju Ganlu medlar, chrysanthemum, North Adenophora, polygonatum, ophiopogon root, Dendrobium, mulberry leaf, Bo He) Decoction juice, Chinese medicine fumigation treatment by fumigation instrument, 1 times a day, every 20 minutes four times a day at Sodium Hyaluronate Eye Drops. In the control group, 30 cases (60 eyes) were treated with local point Sodium Hyaluronate Eye Drops for four times. The 2 groups were treated with 14 d continuously. 3. Before and after 14d treatment, the tear film rupture time (BUT), tear secretion (SIT) and corneal fluorescein staining (FL) were observed respectively, and the subjective symptom scores were analyzed and compared. Results: 1, two groups of patients before treatment, age, break-up time (BUT), corneal fluorescein staining (FL), Schirmer (SIT) showed no significant difference and the subjective symptoms score (P0.05); 2, after 14d treatment, the experimental group and the control group BUT was better than before treatment (P0.05) test; group BUT, FL and subjective symptom scores improved significantly better than the control group (P0.05), the improvement of SIT and the control group the differences were not statistically significant (P0.05); 3, observation statistics of the two groups overall efficiency of treatment, there was significant difference in experimental group: 76.7%; control group: 4, 36.7%; statistical analysis of water deficiency in perimenopausal women into dry eye patients with TCM symptoms and tongue, pathogenesis is roughly in line with the liver and kidney deficiency, fluid depletion. In traditional Chinese medicine and discomfort symptoms with dry eye fatigue (88.3%), dry mouth and throat (63.3%), insomnia (53.3%) and upset (18.3%) etc, special tip water deficiency syndrome of liver and kidney deficiency perimenopausal women dry eye discomfort in patients with traditional Chinese medicine symptoms. Conclusion: Webster Qiju Ganlu Decoction fumigation and treatment of liquid water Sodium Hyaluronate Eye Drops deficiency deficiency of liver and kidney in perimenopausal women do two objective indexes of BUT and FL in patients with ocular and subjective symptoms were improved, the treatment in the extension of BUT and promote corneal epithelial repair and reduce subjective symptoms score better than the Sodium Hyaluronate Eye Drops group. It provides protection and nutrition for the conjunctiva of perimenopausal women with dry eye. It helps to repair tissue injury. It is effective and effective in the clinical treatment of this special dry eye.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R276.7

【参考文献】