摘要
目的:探讨复方血栓通胶囊联合大剂量甲基强地松龙冲击治疗视神经挫伤的可行性,并进行疗效分析。方法:选择2004-07/2005-12温州医学院附属眼视光医院眼病门诊收治的视神经挫伤患者52例,均自愿参加观察。按随机数字表法分为4组,常规治疗组10例,复方血栓通胶囊治疗组12例,激素治疗组14例,联合治疗组16例。①常规治疗组采用维生素B1、维生素E、地巴唑、芦丁等治疗。后3组均在①基础上进行治疗。②复方血栓通胶囊组口服复方血栓通胶囊(主要由三七、丹参和黄芪等组成),3粒/次,3次/d,1个月为1个疗程。③激素冲击组静脉滴注甲基强地松龙500mg,1次/d,连续5d后改为强的松片,按1～1.5mg/kg口服,2周后减半量,直至5～10mg/d后维持2周。④联合治疗组口服复方血栓通胶囊的同时应用大剂量激素冲击治疗,用量与方法同上。治疗2个月后观察视觉诱发电位、视力恢复及视乳头变化情况,并对各组的临床疗效进行对比分析:①显效:视力≥1.0,或按盲目标准提高4个级别以上,视觉诱发电位波形正常。②有效:视力<1.0,但较治疗前提高二三行或提高二三个盲目级别,视觉诱发电位波形改善。结果:52例患者全部进入结果分析,无脱落。①治疗后各组患者视力均有不同程度上升,联合治疗组视力超过0.5者所占比例显著高于常规治疗组、复方血栓通胶囊组及激素冲击组(50.0%,20.0%,16.7%,21.4%,P<0.05)。②联合治疗组治疗后视觉诱发电位异常转化为正常者所占比例显著高于常规治疗组、复方血栓通胶囊组及激素冲击组(78.6%,42.9%,50.0%,50.0%,P<0.05)。③联合治疗组的显效率显著高于常规治疗组、复方血栓通胶囊组、激素冲击组[56.3%,10%,16.7%,28.6%(χ2=5.562,4.504,2.330,P<0.05)];联合治疗组总有效率显著高于常规治疗组[87.5%,40%(χ2=6.518,P=0.011)]。结论:复方血栓通胶囊联合大剂量甲基强地松龙治疗可明显改善单纯性视神经挫伤患者的视力及视觉诱发电位波形,疗效明显优于传统的单纯大剂量激素冲击、扩血管及神经营养治疗,具有较好的临床应用前景。
AIM： To study the feasibility of compound Xueshuantong capsule for promoting blood circulation by removing stasis combined with high dosage of methylprednisolone in the treatment of optic nerve contusion, and analyze its curative effect.
METHODS： Totally 52 outpatients with optical nerve contusion treated at the Eye Hospital of Wenshou Medical College between July 2004 and December 2005 were selected. They were volunteers and randomized into four groups： routing treatment group （A group, n =10）, compound Xueshuantong capsule group （B group, n=12）, hormone treatment group （C group, n=14） and combined treatment group （D group, n=16）.①A group： The patients were treated generally with vitamin B1, vitamin E, bendazol and rutin, etc. The treatments of other three groups were all based on this kind of treatment.②B group： The patients were taken orally with compound Xueshuantong capsule （mainly consisted of Sanchi, dan-shen root and membranous milkvetch root）, 3 granulations once, three times per day, and lasted for one month as a course. ③C group： The patients were infused intraperitoneally with 500 mg methylprednisolone, once per day continuously for five days, and then taken orally with 1-1.5 mg/kg deltacortone. Two weeks later, half dosage was reduced until 5-10 mg per day which was remained for another two weeks.④D group： The patients were taken orally with compound Xueshuantong capsule accompanying high dosage of hormone, with the same dosage and method as above. After two courses of treatments, flash visual evoked potential （F-VEP）, visual acuity and changes of optic papilla were observed to contrast and analyze the curative effects between groups：①Effectual： Visual acuity≥1.0, or rise over 4 blind grades, and F-VEP wave was normal.①Effective： Visual acuity〈1.0, but increased 2-3 levels or 2-3 blind grades compared with pre-treatment, and F-VEP wave was improved.
RESULTS： Totally 52 patients entered the result analysis without drop.①To some extent, all the patients＇ visual acuity increased, and the percentage of patients whose visual acuity exceeded 0.5 was remarkably higher in D group than in A, B and C groups （50.0%, 20.0%, 16.7%, 21.4%, P 〈 0.05）. ②The percentage of patients whose F-VEP was transformed from abnormality to normality ：was also remarkably higher in D group than in A, B and C groups （78.6%, 42.9%, 50.0%, 50.0%, P 〈 0.05）. ③The effectual ratio of D group was significantly higher than those of A, B and C groups [56.3%, 10%, 16.7%, 28.6% （X^2=5.562, 4.504, 2.330, P 〈 0.05）]. The total effective ratio was significantly higher in D group than in A group [87.5%, 40% （X^2=6.518, P=0.011）].
CONCLUSION： Compound Xueshuantong capsule combined with high dosage of methylprednisolone can obviously improve the visual acuity and F-VEP wave in the patients with optic nerve contusion, and the curative effect is distinctly better than that of high dose of hormone, vessel dilatation medicine or neurotrophic treatment respectively, so the combined treatment is hopeful for the clinical application.
出处
《中国临床康复》
CSCD
北大核心
2006年第23期4-6,共3页
Chinese Journal of Clinical Rehabilitation
