黄斑复明汤加减结合针刺治疗老年性黄斑变性的临床研究

发布时间：2018-03-31 00:30

  本文选题：老年性黄斑变性　切入点：视瞻昏渺　出处：《河北医科大学》2016年硕士论文

【摘要】：目的:通过观察研究黄斑复明汤加减结合针刺治疗老年性黄斑变性的临床疗效及作用机理,进一步探讨老年性黄斑变性的中医辨治规律,为针药并用治疗老年性黄斑变性提供临床依据。老年性黄斑变性亦称年龄相关性黄斑变性(age-related macular degeneration,AMD),为黄斑区结构的衰老性改变,多发于50以上的老年人,具有加龄性改变特点,是以视物变形及中心视力严重受损为特征的致盲性眼病,严重影响患者的生活质量。目前现代医学对于本病尚无特效治疗方法,祖国医学称本病为“视瞻昏渺”,该病与肝脾肾三脏关系最为密切。肾主盛衰,肾藏精,精充则目明;肝藏血,开窍于目,肝受血而能视;脾主运化,脾失健运,聚湿生痰,故肝肾不足、脾失健运是本病的基本病因病机,导师白世淼教授从肝、脾、肾三脏论治,治疗以补益肝肾,健脾化湿,活血化瘀为大法,自拟黄斑复明汤加减为基本方,临床根据全身辨证以及眼底辨病加减用药治疗本病,同时配合针刺治疗,针药并用,临床疗效显著。方法:严格按照老年性黄斑变性的诊断标准、纳入标准和排除标准,筛选、收集2014年3月至2016年1月河北省中医院眼科就诊的老年性黄斑变性患者60例。将60例符合纳入标准的AMD患者,随机分为治疗组30例和对照组30例。两组在年龄、性别以及病程方面差异无显著意义(P0.05),具有可比性。治疗组采用黄斑复明汤加减结合针刺治疗;对照组口服西药维生素C片和维生素E软胶囊,局部给予七叶洋地黄双苷滴眼液点眼治疗。4周以后,观察两组患者的临床疗效、自觉症状(视物变形、眼前暗影)、光学相干断层成像(optical coherence tomography,简称OCT)的变化情况,并进行统计学研究。治疗组:内服自拟黄斑复明汤(枸杞子、女贞子、丹参、当归、决明子各15g,菟丝子、牡丹皮、茯苓、白术、菊花、木贼、石菖蒲各10g,黄芪12g,三七粉3g(冲),甘草6g),根据临床症状及眼底症状进行加减。水煎取汁300ml,分早晚两次温服。针刺处方:局部取穴:太阳穴、攒竹穴、承泣穴、风池穴、翳明穴。根据临床辨证进行远端取穴,穴位多取双侧。操作方法:眼周穴位需缓慢进针,进针得气后有酸胀感,忌提插捻转。为防止出血出针后要用消毒棉签轻轻按压针孔1-3分钟。远端穴位需结合全身辨证,采用不同手法,以虚者补之,实者泻之,或平补平泻为原则。每次留针30分钟,1次/日。对照组:维生素C片0.2g口服(3次/日)、维生素E软胶囊0.1g口服(1次/日),均于餐后半小时服用。七叶洋地黄双苷滴眼液点患眼,每次1滴(4次/日)。4周为一疗程,观察临床疗效,并对比治疗前后的观察指标。结果:1治疗前后两组临床疗效比较(Table 6):按照临床疗效评定标准,治疗组30例中,显效8例,有效19例,无效3例,显效率为:26.7%,总有效率为90.0%。对照组30例中,显效1例,有效18例,无效11例,显效率为:3.3%,总有效率为63.3%。经过医学统计学处理,两组疗效有统计学差异(P0.05),说明针药并用疗效优于西药。2治疗前后两组自觉症状(视物变形、眼前暗影)比较(Table 4、Table5):两组视物变形症状皆有改善,治疗组改善情况优于对照组(P0.05);两组眼前暗影症状皆有改善,治疗组改善情况明显优于对照组(P0.01)。3治疗前后两组OCT检查比较(Table7):OCT检查结果显示,黄斑区玻璃膜疣及黄斑区水肿的高度等方面皆有改善,且优于对照组(P0.05)。结论:1黄斑复明汤加减结合针刺治疗老年性黄斑变性在临床疗效、自觉症状及OCT检查眼底表现方面均优于西药对照组。2针药并用治疗疗效可靠,能够改善全身症状,具有不易反复等优势。3安全性分析:两组患者在观察期间均未发现药物相关不良反应。4针药并用治疗老年性黄斑变性充分体现了中医药的特色,疗效显著,费用低廉,安全方便,在治疗老年性黄斑变性时具有较高的使用及推广价值。
[Abstract]:Objective: To observe the clinical effect and mechanism of yellow fuming Decoction and acupuncture treatment of senile macular degeneration, to further explore the Chinese medicine for senile macular degeneration, with acupuncture and medicine treatment of senile macular degeneration. To provide clinical evidence for age-related macular degeneration or age-related macular degeneration (age-related macular degeneration, AMD), for senile macular structure changes occurred in more than 50 of the elderly, has the characteristics of change with age, with metamorphopsia and central visual damage characterized by blindness, serious impact on the quality of life of patients. Modern medicine for this disease there is no specific treatment, Chinese medicine this disease is called "shizhanhunmiao", the disease of liver and spleen and kidney three dirty close relationship. The kidney and kidney essence, essence, mitsunori bright eyes; liver blood, liver opens into the eyes, by blood and can Optic; transportation of spleen, spleen, poly sputum, the liver and kidney deficiency, spleen is the basic pathogenesis of this disease, Professor Bai Shimiao from the liver, spleen, kidney three dirty treatment, in the treatment of Tonifying the liver and kidney, spleen dampness, promoting blood circulation and removing blood stasis method with macular fuming decoction as the basic method, according to the clinical syndrome differentiation and disease differentiation and treatment of the ocular fundus disease, combined with acupuncture treatment, acupuncture and medicine, clinical curative effect. Methods: according to the diagnostic criteria of senile macular degeneration, inclusion and exclusion criteria, screening, 60 patients with senile macular degeneration were collected from March 2014 to January 2016 Hebei Provincial Hospital of Ophthalmology. 60 cases of patients with AMD were randomly divided into treatment group 30 cases and 30 cases in the control group. The two groups in age, no significant differences in gender and disease duration (P0.05), comparable. Treatment group with macular The acupuncture treatment combined with fuming Decoction; the control group oral vitamin C tablets and vitamin E soft capsule, after topical administration of seven leaf digitalisglycosides eye drops for.4 weeks. The clinical efficacy of two groups of patients, symptoms (metamorphopsia, eye shadow), optical coherence tomography (optical coherence tomography, referred to as OCT) changes were studied. The treatment group: oral administration of self macular fuming Decoction (Lycium, Ligustrum lucidum, salvia, angelica, cassia 15g, dodder, Poria, Atractylodes, peony, chrysanthemum, Equisetales, Shichangpu 10g, Astragalus 12g, 37 3G (red powder), 6g), licorice and according to clinical symptoms and ocular symptoms. Decoction of 300ml, and the two day. The acupuncture prescription: local acupoints: temple, cuanzhu acupoint, Chengqi point, Fengchi, Yiming points. According to the clinical syndrome of distal acupoints, acupoints more bilateral. Operation 鏂规硶:鐪煎懆绌翠綅闇，

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