从肝肺论治对准分子激光角膜屈光手术围手术期的干预作用

【作者】 周春阳；

【导师】 郑燕林；

【作者基本信息】 成都中医药大学 ， 中医眼科学， 2013， 博士

【摘要】 目的通过准分子激光角膜屈光手术围手术期中医药干预,观察中医从肝肺论治对准分子激光角膜屈光手术术后常见并发症的防治作用。方法采用随机对照前瞻性研究设计。1.近视LASEK术患者185例(370眼),分为LASEK围手术期常规处理的B组,和常规处理联合术前3d起至术后1mo口服珍青明目片的A组。从LASEK术疼痛自觉症状程度、疼痛持续时间、角膜上皮修复时间、术后视力、术后角膜前表面高阶像差、术后CS检测、术后haze等情况等方面进行比较,观察珍青明目片对LASEK围手术期的干预作用。2.设置LASIK围手术期常规处理的D组,和常规处理联合术后1w至术后1mo杞菊熏眼方煎液雾化熏蒸术眼的C组。从LASIK术后干眼自觉症状评分、BUT、Schirmer试验、角膜荧光素着染评分、视力、角膜前表面高阶像差、CS、等方面进行比较,观察杞菊熏眼方煎液雾化熏蒸对LASIK术后干眼的干预作用。结果1. LASEK术后当天和次日,A组疼痛自觉症状评分明显低于B组(P<0.05)；A组观察对象LASEK术后疼痛持续时间明显短于B组(P<0.05)；A组术后角膜上皮修复时间明显短于B组(P<0.05)；A、B两组术后UCVA在术后1w比较,A组较B组明显偏高(P<0.05)；两组术后角膜前表面高阶像差比较,术后1w,A组C3±1、C3±3两种高阶像差较B组明显偏低(P<0.05)；术后1w,A组6c/deg、12c/deg两空间频率CS较B组为高(P<0.05)。术后1mo,对A、B两组间haze发生率比较,A组明显低于B组(P<0.05)。2.在术后1mo,C组干眼自觉症状评分明显比D组为低(P<0.05)；术后1mo,C、D两组间UCVA之间无区别(P>0.05)；两组间1mo时BUT比较,C组较D组有明显延长(P<0.05)：1mo时Schirmer试验长度比较,C组较D组明显变长(P<0.05)；1mo时角膜荧光素着染评分比较,C组较D组明显减轻(P<0.05)；角膜前表面像差比较,术后1mo, C组C3±1较D组明显偏低(P<0.05)：术后1mo,C组12c/deg、18c/deg两空间频率CS较D组为高(P<0.05)。结论1.珍青明目片在术后早期能明显改善LASEK的自觉症状,促进角膜上皮修复,改善包括视力、对比敏感度、高阶像差等在内的视觉质量,并能一定程度上抑制haze的形成；2.杞菊熏眼方雾化熏蒸LASIK术眼,能减轻LASIK术后患者干眼症状,改善BUT、Schirmer试验长度、角膜荧光素着染等与泪膜稳定状态密切相关的指标；并提高包括角膜前表面高阶像差、CS等在内的视觉质量；3.中医从肝肺论治方法围手术期应用对准分子激光手术术后并发症有一定防治作用。更多还原

【Abstract】 Objective To examine the effect of treatment by regulating Liver and Lung on perioperative intervention treatment for excimer laser corneal refractive surgery, for evaluating the possibility of Chinese Medicine on the prevention of common complication of excimer laser corneal refractive surgery.Methods Randomized, controlled and prospective study was used.1. Totally185patients370eyes who underwent LASEK were divided into group A and group B. Group B was treated with Conventional medicine, group A was treated with conventional medicine and ZHENQINGMINGMU Tablet from preoperative3d to postoperative1mo. Postoperative pain score, duration of postoperative pain, time to epithelial healing, postoperative UCVA, high order aberration of cornea, postoperative CS, haze were contrasted between group A and group B.2. Totally132patients264eyes who underwent LAS1K were divided into group C and group D. Group D was treated with Conventional medicine, group C was treated with conventional medicine and atomization of QIJUXUNYAN Formula from postoperative1w to postoperative1mo. Postoperative dry eye score, BUT, Schirmer score, cornea staining, postoperative UCVA, high order aberration of cornea, postoperative CS were contrasted between group C and group D.Results1. Postoperative pain score of group A was lower than group B in postoperative Od and1d (P<0.05); Duration of postoperative pain of group A was shorter than group B in postoperative Od and1d too (P<0.05); Time to epithelial healing of group A was shorter than group B(P<0.05); Postoperative UCVA of group A was higher than group B in postoperative1w (P<0.05); Contrasting with high order aberration of cornea, C3±1and C3±3of group A was lower than group B in postoperative1w (P<0.05); Postoperative CS in6c/deg and12c/deg of group A was higher than group B in postoperative1w (P<0.05); Incidence of haze in group A was lower than group B in postoperative1mo (P<0.05)2. Postoperative dry eye score of group C was lower than group D in postoperative1mo (P<0.05); Postoperative UCVA of group C and group D was similar in postoperative Imo (P>0.05); BUT of group C was longer than group D in postoperative1mo (P<0.05); Schirmer score of group C was longer than group D in postoperative1mo (P<0.05); Cornea staining score of group C was lower than group D in postoperative1mo (P<0.05); Contrasting with high order aberration of cornea, C3±1of group C was lower than group D in postoperative1mo(P<0.05); Postoperative CS in12c/deg and18c/deg of group C was higher than group D in postoperative Imo (P<0.05)Conclusion1. ZHENQINGMINGMU Tablet can improve postoperative pain, epithelial healing, postoperative UCVA, high order aberration of cornea, postoperative CS, cornea haze of patients who underwent LASEK in early postoperative;2. Atomization of QIJUXUNYAN Formula can improve postoperative dry eye, BUT, secretion of tears, cornea staining, high order aberration of cornea, postoperative CS of patients who underwent LASIK.3. There is significant effect of treatment by regulating Liver and Lung on prevention of common complication of excimer laser corneal refractive surgery.更多还原