目的 研究目偏牵正汤联合针刺治疗目偏视疗效,为目偏视提供临床治疗思路.方法 纳入2019年6月—2022年6月年重庆市中医院眼科住院及门诊的目偏视患者122例,随机分为观察组62例,对照组60例.对照组予营养神经、改善微循环、基础病治疗,观察组在对照组治疗基础上给予目偏牵正汤加减口服联合针刺治疗,10 d为1个疗程,共观察3个疗程,观察2组眼球运动受限程度、复视像检查、三棱镜斜视度变化.结果 2组治疗前眼球运动受限程度、复视像检查、三棱镜斜视度比较,差异均无统计学意义(P>0.05).(1)眼球运动受限程度比较:治疗后2组眼球运动受限程度均较治疗前降低,差异均有统计学意义(Z 观察组=-6.710,P=0.000;Z 对照组=-2.953,P=0.003).治疗后2组间比较,观察组眼球运动受限程度低于对照组,差异有统计学意义(Z=-4.523,P=0.000).(2)复视像检查比较:治疗后2组两组复视分离最大方向的复视像间距均较治疗前降低,差异均有统计学意义(Z观察组=-8.266、Z对照组=-4.168,均P=0.000).治疗后2组间比较,观察组复视分离最大方向的复视像间距低于对照组,差异有统计学意义(Z=-5.331,P=0.000).(3)三棱镜斜视度比较:治疗后2组三棱镜斜视度均较治疗前降低,差异均有统计学意义(Z观察组=-8.348,P=0.000;Z对照组=-2.850,P=0.004).治疗后2组间比较,观察组三棱镜斜视度低于对照组,差异有统计学意义(Z=-6.430,P=0.000).(4)临床疗效:观察组总有效率(100.00%)高于对照组(78.33%),差异有统计学意义(χ2=15.035,P=0.000).其中,动眼神经麻痹治疗总有效率,观察组(100.00%)高于对照组(84.62%),差异有统计学意义(P=0.041);而外展神经麻痹和滑车神经麻痹总有效率,2组间差异均无统计学意义(P>0.05).结论 目偏牵正汤联合针刺治疗能够改善眼球运动受限、复视症状,治疗目偏视临床疗效较好.
OBJECTIVE To investigate the therapeutic effects of Mupian Qianzheng Decoction combined with acupuncture in the treatment of ocular deviation and provide clinical insights for its management.METHODS A total of 122 patients with ocular deviation admitted to the Ophthalmology Department of Chongqing Hospital of Traditional Chinese Medicine from June 2019 to June 2022 were included in the study.They were randomly divided into the observation group(OG)with 62 patients and the control group(CG)with 60 patients.The control group received treatment focusing on nutritional support for nerves,improvement of microcirculation,and basic disease management.The observation group,in addition to the treatment provided to the control group,received additional oral administration of Mupian Qianzheng Decoction combined with acupuncture.Each treatment cycle lasted for 10 days,with a total of three cycles observed.The degree of restricted eye movement,ffusional image inspection,and prism strabismus angle degreeuin two groups were observed.RESULTS Before treatment,there were no statistically significant differences between the two groups in terms of the degree of restricted eye movement,fusional image inspection,and prism strabismus angle(P>0.05).(1)Comparison of degree of restricted eye movement:The degree of restricted eye movement in both groups decreased significantly after treatment compared to before treatment(ZOG=-6.710,P=0.000;ZCG=-2.953,P= 0.003).Post-treatment comparison between the two groups revealed that the observation group had a lower degree of restricted eye movement than the control group,with statistically significant differences(Z=-4.523,P=0.000).(2)Comparison of fusional image inspection:The fusional image separation in the maximum direction decreased significantly in both groups after treatment compared to before treatment(ZOG=-8.266,ZCG=-4.168,both P=0.000).When comparing the two groups after treatment,the observation group exhibited a smaller fusional image separation in the maximum direction than the control group,with statistically significant differences(Z=-5.331,P= 0.000).(3)Comparison of prism strabismus angle degree:The prism strabismus angle in both groups decreased significantly after treatment compared to before treatment(ZOG=-8.348,P=0.000;ZCG=-2.850,P=0.004).Post-treatment comparison between the two groups revealed that the observation group had a lower prism strabismus angle degree than the control group,with statistically significant differences(Z=-6.430,P=0.000).(4)Clinical efficacy:The overall effective rate in the observation group(100.00%)was higher than that in the control group(78.33%),and the difference was statistically significant(χ2=15.035,P=0.000).Specifically,for the treatment of oculomotor nerve paralysis,the overall effective rate in the observation group(100.00%)was higher than that in the control group(84.62%),and the difference was statistically significant(P= 0.041).However,there was no statistically significant difference between the two groups in the overall effective rates for abducent nerve paralysis and trochlear nerve paralysis(P>0.05).CONCLUSIONS The combination of Mupian Qianzheng Decoction with acupuncture can improve restricted eye movement,fusional symptoms,and overall clinical efficacy in the treatment of ocular deviation.The treatment regimen demonstrates particularly favorable outcomes in cases of oculomotor nerve paralysis.