【作者】 林名育；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿， 2009， 博士

【摘要】 原发性开角型青光眼(primary open angie glaucoma,POAG)是由于眼压升高导致视神经损害和视野缺损的一组发病率和致盲率都很高的眼病。虽然原发性开角型青光眼的发病率在我国较低,但其发病隐匿,病情进展缓慢,患者发现时往往视功能已遭受严重损害,故其危害性更大。目前常用的原发性开角型青光眼(POAG)降眼压手段包括药物治疗、激光治疗和手术治疗。对本病的早期治疗,目前还是以降眼压药物为主。而药物治疗中的滴眼剂、口服碳酸配酶抑制剂、静滴高渗脱水剂等,在长期使用过程中均有一定程度的毒副作用,使部分药物使用受到限制。在临床上寻找切实有效、方法简便、无毒副作用的降眼压手段是治疗青光眼工作中的重要任务。本论文主要通过针刺治疗前后及与对照组相比较,总结和评价其疗效,并初步探讨其作用机理,为原发性开角型青光眼的非手术治疗探索和开辟一条新途径。现代临床实验研究表明,针刺对眼的许多生理指标均有良性影响,主要表现在,对大多数眼病的视力都有提高,如早中期白内障、视神经萎缩、屈光不正、青光眼等等:对各类眼病状态下的眼压均有降低作用,尤其是青光眼:通过眼底荧光造影、超声多普勒检测,发现针刺可改善眼局部血液循环:对眼底病患者诱发电位潜时、波幅有明显改善。针刺治疗原发性开角型青光眼的大量临床和试验研究证明针刺可以改善微环循,影响房水的流出,保护视网膜的超微结构促进视网膜组织结构的修复,降低眼压。因此针灸对原发性开角型青光眼有效治疗的研究一直为人们所重视。为此,本研究在参阅国内外相关文献,了解青光眼研究现状的基础上,通过临床观察,客观评价针灸治疗对原发性开角型青光眼患者眼压和视野的影响,研究针灸治疗原发性开角型青光眼的临床价值和意义,为针灸治疗原发性开角型青光眼提供新的方法和途径。一文献研究通过文献考证,我国是世界上最早记载青光眼证治的国家之一.祖国医学在很早就对青光眼有深刻的认识和系统的治疗方法。本文参考国内外文献,将祖国医学中对原发性开角型青光眼的病名,病因病机,治疗方法的认识,和西医学对原发性开角型青光眼(primary open angle glaucoma,POAG)的流行病学调查、本病的病因及发病机制、分类、诊断的研究进展进行总结,统计了近年来对原发性开角型青光眼治疗手段,包括各种针灸疗法、取穴方法、中医药治疗方法、中西医结合治疗方法、西医手术进展及各种针对原发性开角型青光眼发病机理研究而成的新型药物等,总结出其优点及不足。通过随机对照研究探讨针灸治疗对原发性开角型的可行性。二、临床研究将2008年1月-2008年12月期间台湾诊所门诊诊断为原发性开角型青光眼的踩?将符合纳入标准及排除标准46例共82眼,按就诊先后顺序分为针灸治疗组和药物对照组.每组23例41只眼。目的:观察针刺原发性开角型青光眼患者太阳_双、球后_双、精明_双及肝经远端穴大敦_双,行间_双,光明_双、三阴交_双30min后和60min后患者眼压、临床症状与治疗前相比有无改变,并与药物对照组进行对比,观察两组病人分别进行针灸治疗和药物治疗后2周视野与治疗前相比有无改善,统计其疗效及有效率,从而证明针灸治疗原发性开角型青光眼是可行的。证明本研究根据近年研究进展精选的穴位对治疗原发性开角型青光眼是确实有效的。方法:对纳入本研究的原发性开角型青光眼患者46例82眼采用随机单盲对照的方法,设立Ⅰ组为针灸组41只眼,进行针灸治疗。Ⅱ组为药物组41只眼,接受常规西药治疗(0.5%噻吗心安滴眼液)。分别进行针灸治疗和药物治疗,记录针刺治疗前与治疗后30min、60min的眼压变化:统计治疗前与治疗后30min、治疗60min时眼部及全身症状累计积分,并与药物组进行对比,观察针刺的治疗效果;观察针灸治疗组和药物对照组的治疗疗效,统计其治疗有效率,观察2周后两组治疗前与治疗后的视野变化。结果:(一)针灸治疗对原发性开角型青光眼眼压有良好的降低作用。所有纳入选择标准的患眼,针刺后较针刺前眼压均有不同程度下降,且针后不同时段眼压下降程度不同.(二)针灸30min时眼压与治疗前眼压相比有明显的差异性,说明针灸所选穴位30min时已开始有降压作用。(三)针灸60min时眼压与治疗前眼压相比有明显的差异性,说明针灸所选穴位60min时降压作用仍在继续。(四)针灸30min时眼压与针灸治疗60min前眼压相比有明显的差异性,说明针灸后思者眼压随时间延长而逐渐降低。(五)针灸治疗与药物治疗对眼压影响对比无明显差异性,说明两组治疗对眼压的影响相同。(六)针灸治疗30min时原发性开角型青光眼患者的眼部及全身症状与治疗前相比有明显差异性,说明针灸所选穴位后除有降眼压作用外,还会减轻患者眼部及全身症状。(七)针灸治疗60min时原发性开角型青光眼患者的眼部及全身症状与治疗前相比有明显差异性,说明针灸可以改善原发性开角型青光眼患者的症状。(八)针灸治疗30min时与针灸治疗60min时原发性开角型青光眼患者的眼部及全身症状与治疗前相比有明显差异性,说明随针灸特定穴位后时间延长,症状改善越明显。(九)药物治疗30min时原发性开角型青光眼患者的眼部及全身症状与治疗前相比无明显差异性,说明0.5%噻吗心安(马来酸噻吗洛尔)眼水滴眼30min后对眼及全身症状无明显缓解。(十)药物治疗60min时原发性开角型青光眼患者的眼部及全身症状与治疗前相比有明显差异性,说明0.5%噻吗心安(马来酸噻吗洛尔)眼水滴眼60min后已对原发性开角型青光眼患者的症状有所改善。(十一)药物治疗30min时与药物治疗60min时原发性开角型青光眼患者的眼部及全身症状与治疗前相比有明显差异性,说明滴入0.5%噻吗心安(马来酸噻吗洛尔)眼水后症状的改善要在30-60min时开始。(十二)针灸组和药物组治疗2周后与治疗前视野对比无明显差异性。说明针灸治疗原发性开角型青光眼患者2周后视野无明显改变,同样滴入0.5%噻吗心安(马来酸噻吗洛尔)眼水治疗2周后对视野也无明显影响。结论:(一)针灸治疗对原发性开角型青光眼眼压有良好的降低作用。(二)针灸后不同时间段对眼压影响不同,针灸后1小时内患者眼压是呈逐步下降趋势的。针灸30min后与针灸60min时眼部及全身症状积分相比有明显差异性,说明针灸后小时内原发性开角型青光眼患者的症状仍在逐步减轻和缓解。(三)1小时内针灸治疗可以达到滴用0.5%噻吗心安(马来酸噻吗洛尔)眼水的降眼压水平。(四)针灸治疗后不同时间段对眼部及全身症状影响不同:针灸30min后与针灸60min时眼部及全身症状积分相比有明显差异性,说明针灸30min后原发性开角型青光眼患者的症状仍在逐步减轻和缓解(五)药物治疗30min后与治疗前相比,其患者的眼部及全身症状累计积分比较无明显差异性,说明药物治疗30min后患者眼部及全身症状改善不明显。(六)药物治疗60min后,其患者的眼部及全身症状与治疗前和治疗30min时比较有明显差异性,说明0.5%噻吗心安(马来酸噻吗洛尔)滴眼液对原发性开角型青光眼患者的症状改善是在滴入30min后开始起效的。(七)针灸组和药物组治疗2周后与治疗前视野对比无明显差异性,说明2周的治疗时间和观察时间对原发性开角型青光眼患者的视野未引起明显改变。(八)本研究参照中华人民共和国中医药行业标准《中医病症诊断疗效标准》(国家中医药管理局发布,1994年)并结合临床制定的疗效标准,通过统计分析,证明针灸对原发性开角型青光眼患者治疗的有效性可达87.8%。由此说明本研究所取穴位对原发性开角型青光眼的治疗作用是肯定的,同0.5%噻吗心安(马来酸噻吗洛尔)滴眼液对原发性开角型青光眼的治疗作用比较无明显差异性,0.5%噻吗心安(马来酸噻吗洛尔)滴眼液对原发性开角型青光眼患者的降压效果及症状改善在实验室研究和临床使用上都已被证实,由此可以说明本研究所取穴位对原发性开角型青光眼患者的治疗效果是可以肯定的。(九)针灸治疗与药物治疗后不同时间段两组之间眼压的比较均无明显差异性,只能说明治疗后30min和60min内,针刺与0.5%噻吗心安(马来酸噻吗洛尔)眼水对原发性开角型青光眼的降眼压作用无明显差异性。更多还原

【Abstract】 Primary open angle glaucoma(POAG) is because the intraocular pressure elevates causes the optic nerve harm and field of vision damage group of disease incidence rates and the blinding rate very high ophthalmopathy.Although primary although primary open-angle glaucoma morbidity in our country,but its low incidence,progress is slow,,hidden patients often find visual function has suffered serious damage,the more harmful.The common primary open-angle glaucoma(POAG) pressure drop include medication,laser therapy and surgical treatment.The early treatment,or in intraocular pressure(iop) drugs.But the eve drops drug treatment with oral carbonate,enzyme inhibitors,static drops of hypertonic dehydrating agents,it etc,in the long-term use of process all have certain degree of toxicity,so that some of the drug use is restricted. Clinically,looking for effective method is simple,non-toxic side effects of pressure drop is the important task of glaucoma work.This thesis mainly by acupuncture treatment compared with control group,and summarizing and evaluating its curative effect,and discusses the mechanism for primary open-angle glaucoma non-operative therapy and opened a new way.Modern clinical laboratory studies,acupuncture many physiological indexes eyes are benign,mainly displays in:for most eye vision has improved. such as early middle cataract,optic atrophy,improperly,glaucoma,etc: refractive The condition ofali kinds of eve.intraocuiarpressure,especially glaucoma,Through the fundus fluorescence imaging,doppler detection,found that acupuncture can improve eye local blood circulation,Results for patients with evoked potentials and potential fluctuation has obviously improved. Acupuncture treatment of primary open-angle glaucoma large clinical and experimental research proof by acupuncture can improve microring follow[49], influence of aqueous outflow,The ultrastructure of retinal protection, promote the organization structure repair retina,Reducing lop.Its effective treatment’s research has taken seriously for the people.Therefore,this research in refers to the domestic and foreign related literature,understood that glaucoma research present situation in the foundation,through the clinical observation,the objective evaluation acupunture therapy opens the angle glaucoma patient intraocular pressure and the field of vision influence to the primary stage,through compares the research acupunture therapy primary stage with the control group to open the angle giaucoma’s clinical value and the significance,holds the angle glaucoma for the acupunture therapy primary stage to provide the new method and the way.Literature research:Through the literatures.China is the earliest record of one country to glaucoma certificate,the motherland medicine in the very early on glaucoma have a profound understanding of the system and the treatment method.In this paper,the motherland medicine literature of primary open-angle glaucoma, etiology and treatment of disease,and western methods of primary open-angle glaucoma(primary glaucoma POAG),Angle to the epidemiology investigation, the etiology and pathogenesis of diagnosis,classification and research progress in recent years was summarized,the statistics of primary open-angle glaucoma treatments,including:all kinds of acupuncture,Location,TCM treatments,Combine traditional Chinese and western medicine treatment, Western medicine and surgery for all primary open-angie glaucoma pathogenesis of new drug research and etc,summarizes its advantages and disadvantages, think through randomized study,acupuncture treatment of primary open-angle glaucoma lop and vision effect is very feasible.Clinical research:in July 2007~2008 Taiwan outpatient clinic during the 12 months for the diagnosis of primary open-angle glaucoma and criteria,exclusion standard of patients,46 cases 82 by medical sequence into acupuncture treatment group and control group of 23 cases of 41 eyes.Goal:To observe acupuncture primary open-angle glaucoma after the double, double,smart,double double and liver the pool of distal hole big,double double,three Yin,rows inte double holes and 60min 30min patients after intraocular pressure,clinical symptom and treatment compared with drugs,and the changes in comparison,Two groups of patients were observed after medical treatment and acupuncture treatment with 2 weeks before treatment compared with vision without improvement,The efficacy and efficient,To prove acupuncture treatment of primary open-angle glaucoma is feasible,According to recent research shows that this research progress of acupoint selection for the treatment of primary open-angle glaucoma is effective。Method:This research on into the primary open-angle glaucoma eyes 46 cases 82 by random single randomized,double-blind,placebo-controlled,Ⅰgroup established for acupuncture group 41 eyes,acupuncture treatment.Ⅱgroup for drug group,ant accept conventional medicine therapy(Timolol maleate eye drops).Separately,acupuncture treatment and acupuncture treatment of drugs and treatment before record after the needle 60min 30min.after intraocuiar pressure(iop) change,Statistical treatment before and after the treatment 60min 30min,treatment when eye ministry and systemic symptom accumulative points,and comparing with the drug group,observe the curative effect of acupuncture.Observe acupuncture treatment group and control group, the curative effect of the treatment efficiency,Observe after 2 weeks before treatment with two groups of visual change after treatment.Result:(1) Acupuncture treatment of primary open-angle glaucoma to reduce intraocular pressure has a good role.All the selection criteria included with eyes,after acupuncture needle is to have the varying degree before intraocuiar pressure drop and pressure after needle at different levels.(2) After acupuncture treatment 30min the IOP compared with former have obvious difference.Acupuncture points that selected 30min has started a function.(3) After acupuncture treatment 60min the IOP former have obvious difference. 60min meridians that acupuncture chosen when function continues.(4) The IOP after acupuncture treatment 60min compared with acupuncture treatment 30min have obvious difference.After that acupuncture patient with prolonged lop and gradually reduced.(5) The acupuncture treatment and the impact of drug therapy on the IOP had no significant difference compared.Two groups of intraocular pressure that the same treatment effect.(6) 30min when acupuncture treatment of primary open-angle glaucoma patients with ocular and systemic symptoms and treatment of significant difference compared.After that acupuncture points is selected in addition,also can reduce the patients eye and systemic symptom.(7) 60min when acupuncture treatment of primary open-angle glaucoma patients with ocular and systemic symptoms and treatment of significant difference compared.That acupuncture can improve the primary open-angle glaucoma(8) Acupuncture and moxibustion treatment of 30min at 60min when the primary open-angle glaucoma patients with ocular and systemic symptoms and treatment of significant difference compared.With the characteristics of acupuncture points after that time,the more obvious improvement of symptoms.(9) At 30min treatment of primary open-angle glaucoma patients with ocular and systemic symptoms compared with pre-treatment had no significant differences.Mean that 0.5%Timolol maieate eye drons showed 30min eye drops eyes and systemic symptom after no obvious relief.(10) 60min when drug treatment of primary open-angle glaucoma patients with ocular and systemic symptoms and treatment of significant difference compared. Mean that 0.5%Timolol maleate eye drops showed it to 60min eye drops since primary open-angle glaucoma symptoms improved.(11) 30min treatment with the drug treatment 60min when the primary open-angle glaucoma patients with ocular and systemic symptoms and treatment of significant difference compared,That drip 0.5%Timolol maleate eye drops of symptom improement after water in 30~60min began..(12) Acupuncture treatment group and drug group 2 weeks after pre-treatment vision compared with no significant differences.That acupuncture treatment of primary open-angle glaucoma horizons significantly changed after 2 weeks, drip 0.5%Timolol maleate eye drops treatment after 2 weeks to vision also had no significant effect.Conclusion:1.Acupuncture treatment of primary open-angle glaucoma to reduce IOP has a good role.2.Different time period after acupuncture on IOP effects of different one-hour period after acupuncture in patients with IOP is a gradual downward trend.3 l hour acupuncture treatment for IOP level can be achieved with drops of 0.5%timolol Eve Drops.4.In different period after acupuncture treatment of eye and systemic symptom of different:after 60min 30min acupuncture with acupuncture points when compared to the eye and systemic symptom is obvious difference, acupuncture within hours after primary open-angle glaucoma symptoms in gradually reduce and ease5.Drug treatment compared with treatment after 30min before,the patient’s eye and systemic symptom accumulative points,no significant difference with 30min drug therapy after eye and systemic symptom improvement is not obvious.6.60min drug therapy,the patient’s eye and systemic symptom and treatment before and during treatment have obvious difference 30min,0.5%Timolol maleate eye drops in primary open-angle glaucoma symptom improement in 30min drip began after the effect.7.2weeks of treatment time and observation time on the primary open-angle glaucoma patients did not cause significant changes in vision.8.This study of the People’s Republic of China to the traditional Chinese medicine industry standard disease diagnosis curative standard issued by the state dministration of traditional Chinese medicine(1994),and combined with clinical curative standard of proof,through the statistics and analysis of acupuncture and moxibustion primary pen-angle glaucoma treatment efficiency can reach 87.8%.Thus says this research institute to take points primary open-angle glaucoma treatment effect is positive,with 0.5%Timolol maieate eye drops in primary open-angle glaucoma treatment effect is not obvious difference,0.5%thiazide? Mind(Malay acid thiazide? Explain) eyedrops in primary open-angle glaucoma the hypotensive effect and improvement of symptoms in laboratory studies and clinical use.which has been proved that this research institute to take points primary open-angle glaucoma treatment effect can be sure.9.Acupuncture treatment and drug treatment in different period after the comparison between the two groups of intraocular pressure(iop) were not significantly difference,but after treatment,acupuncture and 60min 30min to 0.5%thiazide??Mind(Malavacid’s eyes) showed water to primary open-angle glaucoma has no obvious difference pressure drop role.更多还原