【摘要】：目的：觀察研究視網膜光凝術聯(lián)合中藥(補益肝腎,活血化瘀)治療糖尿病視網膜病變增殖期(Ⅳ期)肝腎陰虛兼血瘀型的臨床療效。 方法：選2010年12月至2012年3月云南省第二人民醫(yī)院眼科眼底病區(qū)門診及住院的糖尿病增殖型視網膜病變Ⅳ期證屬肝腎陰虛兼血瘀型的患者60例(76眼),按隨機均等原則分為治療組與對照組,治療組30例40只眼,應用中成藥(杞菊地黃丸及血塞通分散片)配合視網膜光凝治療；對照組30例36只眼僅接受視網膜光凝治療。治療組每1-2周進行一次光凝,根據(jù)情況分次完成,術后第一天開始服用杞菊地黃丸(濃縮丸)及血塞通分散片,三個月為一個療程,一療程結束后隨訪；觀察組僅進行光凝術治療,術后三個月隨訪。通過對這兩組患者進行治療前后視力、眼底改變及眼底熒光造影結果的客觀比較,觀察兩組的有效率,并做出相應的結論。 結果： 1.視力：治療3個月后,治療組視力(屈光不正者用最佳矯正視力)為0.50±0.50,對照組0.40±0.38,兩組組比較有統(tǒng)計學意義(P0.05),治療組視力提高優(yōu)于對照組。 2.用檢眼鏡觀察糖尿病患者治療前后眼底出血、滲出及水腫等的變華情況,經相關統(tǒng)計學分析,治療組有效率為92.5%,對照組有效率為75%,兩組相比較有統(tǒng)計學意義(P0.05) 3.眼底熒光血管造影檢查：治療3個月后,治療組滲漏面積為1.75±1.50,對照組總滲漏面積為2.00±1.50,兩組比較有統(tǒng)計學差異性(P0.05),治療組優(yōu)于對照組。 4.新生血管消退比較：治療3個月后,治療組有效率為90.0%,對照組有效率為72.2%,兩組比較有統(tǒng)計學差異性(P0.05),治療組優(yōu)于對照組。 5.黃斑水腫療效比較：治療3個月后,治療組有效率為86.4%,對照組有效率為68.4%,兩組比較有統(tǒng)計學差異性(P0.05),治療組優(yōu)于對照組。 6.總體療效：治療組總體療效的有效率是75%,對照組總體療效的有效率是52.8%,兩組比較有統(tǒng)計學差異性(P0.05),治療組優(yōu)于對照組。 結論：在視網膜光凝治療與中藥的聯(lián)合療法中,中藥的藥效可與視網膜光凝術產生協(xié)同作用,彌補治療的不足。與單純激光治療相比,聯(lián)合療法能更有效的促使增殖期糖網病新生血管的消退,減輕黃斑水腫,能更好的改善患者視功能。因此,視網膜光凝術后聯(lián)合中藥治療增殖型糖尿病視網膜病變具有一定優(yōu)勢。
[Abstract]:Objective: to observe the clinical effect of retinal photocoagulation combined with traditional Chinese medicine (tonifying liver and kidney, promoting blood circulation and removing blood stasis) in the treatment of diabetic Retinopathy with deficiency of liver and kidney yin and blood stasis. Methods: from December 2010 to March 2012, 60 patients (76 eyes) with stage IV syndrome of diabetic hyperplasia with deficiency of liver and kidney yin and blood stasis were selected from the outpatients and inpatients of ophthalmic fundus disease area of the second people's Hospital of Yunnan Province. According to the principle of random equality, 30 patients (40 eyes) in the treatment group were randomly divided into treatment group and control group. The patients in the treatment group were treated with Chinese patent medicine (Qiju Dihuang Pill and Xuesaitong dispersible tablet) combined with retinal photocoagulation. In the control group, 30 cases (36 eyes) were treated with retinal photocoagulation only. In the treatment group, photocoagulation was performed every 1 week and completed according to the situation. Qiju Dihuang pills (concentrated pills) and Xuesaitong dispersible tablets were taken on the first day after operation, three months as a course of treatment, and followed up at the end of a course of treatment. The observation group was treated with photocoagulation only and followed up three months after operation. Through the objective comparison of visual acuity, fundus changes and fundus fluorescein angiography between the two groups before and after treatment, the effective rate of the two groups was observed and the corresponding conclusions were drawn. Result: 1. Visual acuity: after 3 months of treatment, the visual acuity of the treatment group (ametropia group with best corrected visual acuity) was 0.50 鹵0.50, and that of the control group was 0.40 鹵0.38. There was significant difference between the two groups (P 0.05). The visual acuity of the treatment group was better than that of the control group. 2. The fundus bleeding, exudation and edema of diabetic patients before and after treatment were observed by ophthalmoscope. The effective rate was 92.5% in the treatment group and 75% in the control group. There was significant difference between the two groups (P 0.05). Fundus fluorescein angiography: after 3 months of treatment, the leakage area of the treatment group was 1.75 鹵1.50, and the total leakage area of the control group was 2.00 鹵1.50. There was significant difference between the two groups (P 0.05). The treatment group was better than the control group. 4. Comparison of neovascularization regression: after 3 months of treatment, the effective rate was 90.0% in the treatment group and 72.2% in the control group. There was significant difference between the two groups (P 0.05). The treatment group was superior to the control group. 5. Comparison of the curative effect of macular edema: after 3 months of treatment, the effective rate was 86.4% in the treatment group and 68.4% in the control group. There was significant difference between the two groups (P 0.05). The treatment group was better than the control group. 6. The overall curative effect: the effective rate of the treatment group was 75%, and that of the control group was 52.8%. There was significant difference between the two groups (P 0.05). The treatment group was better than the control group. Conclusion: in the combined therapy of retinal photocoagulation and traditional Chinese medicine, the efficacy of traditional Chinese medicine can have synergistic effect with retinal photocoagulation, and make up for the deficiency of treatment. Compared with laser alone, combined therapy can promote the regression of neovascularization in proliferating glycoreticular disease, reduce macular edema and improve the visual function of patients. Therefore, retinal photocoagulation combined with traditional Chinese medicine has certain advantages in the treatment of proliferating diabetic Retinopathy.
【學位授予單位】：云南中醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R587.2;R774.1

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