本文選題：糖尿病性黃斑水腫　切入點(diǎn)：中西醫(yī)結(jié)合　出處：《廣州中醫(yī)藥大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 觀察滋腎健脾化瘀片聯(lián)合激光光凝治療糖尿病黃斑水腫的療效。 方法 內(nèi)分泌科確診為糖尿病,經(jīng)散瞳后眼底檢查、FFA、OCT檢查確診為糖尿病性黃斑水腫,并排除其他原因引起黃斑水腫的患者43例(86眼)做為研究對(duì)象,隨機(jī)分為對(duì)照組21例(42眼)和實(shí)驗(yàn)組22例(44眼),入選患者均用國際標(biāo)準(zhǔn)視力表檢測治療眼的最佳矯正視力,并行FFA、OCT檢查,對(duì)照組：視網(wǎng)膜激光光凝治療；實(shí)驗(yàn)組：口服滋腎健脾化瘀片聯(lián)合視網(wǎng)膜激光光凝治療,療程為3個(gè)月。前一個(gè)月根據(jù)眼底情況采取全視網(wǎng)膜或次全視網(wǎng)膜激光光凝治療,分2-3次進(jìn)行眼底激光,同時(shí)口服滋腎健脾化瘀片3個(gè)月。治療結(jié)束后觀察各組最佳矯正視力、FFA及OCT變化情況。組內(nèi)前后比較采用t檢驗(yàn),組間比較采用兩組獨(dú)立樣本t檢驗(yàn),分類資料采用x2檢驗(yàn),分析兩組治療的效果,并做出相應(yīng)的結(jié)論。 結(jié)果 對(duì)照組21例42眼,男13例26眼(占61.9%),女8例16眼(占38.1%)；年齡：43—72歲,平均(55.81±10.96)歲,實(shí)驗(yàn)組22例44眼,男8例16眼(占36.4%),女14例28眼(占63.6%)；年齡：29—74歲,平均(56.23±10.75)歲,兩組患者的性別構(gòu)成和平均年齡差異均無統(tǒng)計(jì)學(xué)意義(P0.05)； 視力：兩組治療后視力均有提高,對(duì)照組治療前(0.35±0.32),治療后(0.44±0.32),治療后視力平均提高0.09,差異有統(tǒng)計(jì)學(xué)意義(p0.05)；實(shí)驗(yàn)組治療前(0.40±0.23),治療后(0.59±0.23),治療后視力平均提高0.19,差異有統(tǒng)計(jì)學(xué)意義(p0.05)；治療后對(duì)照組總有效率為54.76%,實(shí)驗(yàn)組總有效率為79.55%,實(shí)驗(yàn)組視力明顯優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 OCT：對(duì)照組治療前黃斑中心小凹視網(wǎng)膜厚度平均值：(349.24±202.87)um,治療后為(291.83±158.98)um,激光治療有效(t=5.996,p0.05)；實(shí)驗(yàn)組治療前黃斑中心小凹視網(wǎng)膜厚度平均值為(327.80±150.98)um,治療后為(247.80±112.77)um,滋腎健脾化瘀片聯(lián)合激光治療有效(t=5.912,p0.05)；兩組中心小凹水腫改善值比較：對(duì)照組(57.40±62.05)um,實(shí)驗(yàn)組(80.00±89.75)um,兩組改善值差異沒有統(tǒng)計(jì)學(xué)意義(P0.05)；對(duì)照組治療前黃斑中心凹lmm直徑視網(wǎng)膜厚度平均值為(371.17±164.57)um,治療后為(327.98±144.33)um,激光治療有效(t=5.685,p0.05)；實(shí)驗(yàn)組治療前黃斑中心凹區(qū)視網(wǎng)膜厚度平均值為黃斑中心凹1mm直徑視網(wǎng)膜厚度平均值為(351.32±152.00)um,治療后為(288.43±114.49)um,滋腎健脾化瘀片聯(lián)合激光治療亦有效(t=5.379,p0.05)；兩組黃斑中心凹lmm直徑視網(wǎng)膜水腫改善值比較：對(duì)照組(43.19±49.23)um,實(shí)驗(yàn)組(62.89±77.55)um,兩組改善值差異沒有統(tǒng)計(jì)學(xué)意義(P0.05); FFA：兩組治療前FFA表現(xiàn)為視網(wǎng)膜內(nèi)有彌漫性滲漏區(qū)域,黃斑水腫。治療后表現(xiàn)為滲漏區(qū)域范圍減小,水腫減輕。對(duì)照組黃斑水腫滲漏消失或減輕為36眼,有效率為85.71%,實(shí)驗(yàn)組44眼治療后黃斑水腫滲漏消失或減輕為44眼,有效率為100%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論 激光光凝是治療糖尿病黃斑水腫的有效方法,滋腎健脾化瘀片聯(lián)合激光光凝治療能加快糖尿病黃斑水腫的吸收及減輕視網(wǎng)膜血管的滲漏,提高患者的視力,改善視功能,是臨床上治療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.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R587.2;R774.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉路宏;吳學(xué)今;李敏;賴小玲;白海琴;;激光聯(lián)合中藥治療糖尿病黃斑水腫的臨床觀察[J];廣西醫(yī)學(xué);2008年03期

2 李霏;;六味地黃湯類方藥治療糖尿病并發(fā)癥初探[J];河北中醫(yī);2007年03期

3 張懿先;辨證治療糖尿病視網(wǎng)膜病變48例臨床觀察[J];湖南中醫(yī)藥導(dǎo)報(bào);2003年09期

4 易細(xì)香,余楊桂,張淳,黃仲委,王舜杏,李志英;糖尿病視網(wǎng)膜病變的證候統(tǒng)計(jì)與病機(jī)研究[J];遼寧中醫(yī)雜志;2005年08期

5 王燕;李志英;余楊桂;;中藥配合眼部川芎嗪直流電離子導(dǎo)入治療糖尿病視網(wǎng)膜病變74例療效觀察[J];新中醫(yī);2006年01期

6 劉玲,郭霞;糖目清治療糖尿病性視網(wǎng)膜病變的臨床總結(jié)[J];山東中醫(yī)雜志;2000年03期

7 吳丹巍,殷長青,鄭軍,韓麗蓉;辨證分型為主治療糖尿病性視網(wǎng)膜病變臨床觀察[J];上海中醫(yī)藥雜志;2000年06期

8 王小川;余楊桂;;滋腎健脾化瘀片治療氣陰兩虛型糖尿病視網(wǎng)膜病變療效觀察[J];中國中醫(yī)眼科雜志;2006年03期

9 鄒月蘭;王燕;余楊桂;;滋腎健脾化瘀片對(duì)糖尿病大鼠視神經(jīng)組織的保護(hù)作用[J];中國中醫(yī)眼科雜志;2008年01期

10 梁俊芳;孫景瑩;紀(jì)麗君;;活血利水法聯(lián)合倍頻固體激光治療糖尿病彌漫性黃斑水腫的臨床觀察[J];中國中醫(yī)眼科雜志;2008年02期

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