本文選題：老年性黃斑變性　切入點：視瞻昏渺　出處：《河北醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:通過觀察研究黃斑復(fù)明湯加減結(jié)合針刺治療老年性黃斑變性的臨床療效及作用機理,進一步探討老年性黃斑變性的中醫(yī)辨治規(guī)律,為針?biāo)幉⒂弥委熇夏晷渣S斑變性提供臨床依據(jù)。老年性黃斑變性亦稱年齡相關(guān)性黃斑變性(age-related macular degeneration,AMD),為黃斑區(qū)結(jié)構(gòu)的衰老性改變,多發(fā)于50以上的老年人,具有加齡性改變特點,是以視物變形及中心視力嚴(yán)重受損為特征的致盲性眼病,嚴(yán)重影響患者的生活質(zhì)量。目前現(xiàn)代醫(yī)學(xué)對于本病尚無特效治療方法,祖國醫(yī)學(xué)稱本病為“視瞻昏渺”,該病與肝脾腎三臟關(guān)系最為密切。腎主盛衰,腎藏精,精充則目明;肝藏血,開竅于目,肝受血而能視;脾主運化,脾失健運,聚濕生痰,故肝腎不足、脾失健運是本病的基本病因病機,導(dǎo)師白世淼教授從肝、脾、腎三臟論治,治療以補益肝腎,健脾化濕,活血化瘀為大法,自擬黃斑復(fù)明湯加減為基本方,臨床根據(jù)全身辨證以及眼底辨病加減用藥治療本病,同時配合針刺治療,針?biāo)幉⒂?臨床療效顯著。方法:嚴(yán)格按照老年性黃斑變性的診斷標(biāo)準(zhǔn)、納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),篩選、收集2014年3月至2016年1月河北省中醫(yī)院眼科就診的老年性黃斑變性患者60例。將60例符合納入標(biāo)準(zhǔn)的AMD患者,隨機分為治療組30例和對照組30例。兩組在年齡、性別以及病程方面差異無顯著意義(P0.05),具有可比性。治療組采用黃斑復(fù)明湯加減結(jié)合針刺治療;對照組口服西藥維生素C片和維生素E軟膠囊,局部給予七葉洋地黃雙苷滴眼液點眼治療。4周以后,觀察兩組患者的臨床療效、自覺癥狀(視物變形、眼前暗影)、光學(xué)相干斷層成像(optical coherence tomography,簡稱OCT)的變化情況,并進行統(tǒng)計學(xué)研究。治療組:內(nèi)服自擬黃斑復(fù)明湯(枸杞子、女貞子、丹參、當(dāng)歸、決明子各15g,菟絲子、牡丹皮、茯苓、白術(shù)、菊花、木賊、石菖蒲各10g,黃芪12g,三七粉3g(沖),甘草6g),根據(jù)臨床癥狀及眼底癥狀進行加減。水煎取汁300ml,分早晚兩次溫服。針刺處方:局部取穴:太陽穴、攢竹穴、承泣穴、風(fēng)池穴、翳明穴。根據(jù)臨床辨證進行遠端取穴,穴位多取雙側(cè)。操作方法:眼周穴位需緩慢進針,進針得氣后有酸脹感,忌提插捻轉(zhuǎn)。為防止出血出針后要用消毒棉簽輕輕按壓針孔1-3分鐘。遠端穴位需結(jié)合全身辨證,采用不同手法,以虛者補之,實者瀉之,或平補平瀉為原則。每次留針30分鐘,1次/日。對照組:維生素C片0.2g口服(3次/日)、維生素E軟膠囊0.1g口服(1次/日),均于餐后半小時服用。七葉洋地黃雙苷滴眼液點患眼,每次1滴(4次/日)。4周為一療程,觀察臨床療效,并對比治療前后的觀察指標(biāo)。結(jié)果:1治療前后兩組臨床療效比較(Table 6):按照臨床療效評定標(biāo)準(zhǔn),治療組30例中,顯效8例,有效19例,無效3例,顯效率為:26.7%,總有效率為90.0%。對照組30例中,顯效1例,有效18例,無效11例,顯效率為:3.3%,總有效率為63.3%。經(jīng)過醫(yī)學(xué)統(tǒng)計學(xué)處理,兩組療效有統(tǒng)計學(xué)差異(P0.05),說明針?biāo)幉⒂茂熜?yōu)于西藥。2治療前后兩組自覺癥狀(視物變形、眼前暗影)比較(Table 4、Table5):兩組視物變形癥狀皆有改善,治療組改善情況優(yōu)于對照組(P0.05);兩組眼前暗影癥狀皆有改善,治療組改善情況明顯優(yōu)于對照組(P0.01)。3治療前后兩組OCT檢查比較(Table7):OCT檢查結(jié)果顯示,黃斑區(qū)玻璃膜疣及黃斑區(qū)水腫的高度等方面皆有改善,且優(yōu)于對照組(P0.05)。結(jié)論:1黃斑復(fù)明湯加減結(jié)合針刺治療老年性黃斑變性在臨床療效、自覺癥狀及OCT檢查眼底表現(xiàn)方面均優(yōu)于西藥對照組。2針?biāo)幉⒂弥委煰熜Э煽?能夠改善全身癥狀,具有不易反復(fù)等優(yōu)勢。3安全性分析:兩組患者在觀察期間均未發(fā)現(xiàn)藥物相關(guān)不良反應(yīng)。4針?biāo)幉⒂弥委熇夏晷渣S斑變性充分體現(xiàn)了中醫(yī)藥的特色,療效顯著,費用低廉,安全方便,在治療老年性黃斑變性時具有較高的使用及推廣價值。
[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 鏂規(guī)硶:鐪煎懆絀翠綅闇，

本文編號：1688363