120例原发性青光眼抗青光眼术后中医证候调查分析

目的:探讨原发性青光眼抗青光眼术后中医证候的特征及演变规律。方法:120例原发性青光眼术后患者随访至术后1个月及6个月时分别填写《青光眼术后中医证候调查表》,总结分析证候分布特征及演变情况。结果:(1)术后1个月,106例(88.3%)患者能依据调查表确定证型,肝郁气滞、气滞血瘀、气虚血瘀、气血两虚、肝肾阴虚证分别占19.2%、19.2%、15.0%、15.8%、19.2%例;各类型青光眼具体证型,无明显分布规律。不能确定证候类型者以APACG较多。(2)术后6个月,114例(95.0%)患者能依据调查表确定证型。肝郁气滞、气滞血瘀、气虚血瘀、气血两虚、肝肾阴虚证分别占15.8%、15.0%、12.5%、27.5%、24.2%;3种类型原发性青光眼证候分布均以气血两虚、肝肾阴虚较多见。(3)术后1个月及6个月证候类型较术前均发生显著变化,主要为青光眼急性发作期的肝经实证类证候消失。(4)证候兼夹情况:术后6个月,64.1%患者伴有血瘀证。(5)证候演变情况:术后1～6个月,69.3%患者证候未发生变化;证候变化以气滞血瘀证转化为气虚血瘀证,气虚血瘀证转化为气血两虚证为主。结论:(1)术后证候类型较术前发生显著变化。(2)术后6个月证候相对更趋稳定,其结果基本能反映青光眼术后患者的证候特点。(3)三种不同类型的原发性青光眼患者术后证候类型相同,且以气血两虚、肝肾阴虚证相对较多。说明各类青光眼在抗青光眼术后具有相同的病理基础和证候特点。(4)血瘀证贯穿本病始终。

Study on the TCM Syndromes of 120 Patients with Primary Glaucoma after Surgery

Objective:To investigate the characteristics of TCM syndromes and evolution in primary glaucoma after surgery.Methods:120 patients were followed up for 6 months at least.The assigned TCM physicians investigated syndromes of these patients with the TCM Syndromes Questionnaire with primary glaucoma 1 and 6 months after surgery respectively.After investigation,the distribution and the evolution of TCM syndromes were analyzed.Results:(1)After 1 month,88.3% patients can be diagnosed the TCM syndrome based on the questionnaire.The occurrence rate of TCM syndromes about qi stagnation due to depression of the liver,qi stagnation and blood stasis,qi deficiency and blood stasis,qi deficiency of both qi and blood,yin deficiency of liver and kidney were as following:19.2%,19.2%,15.0%,15.8%,19.2%.(2)After 6 months,95.0% patients can be determined the TCM syndromes.The occurrence rate of TCM syndromes refer to the five types were as following:15.8%,15.0%,12.5%,27.5%,24.2%;three types of primary glaucoma had the same distribution,of which,qi deficiency of both qi and blood,yin deficiency of liver and kidney were more common.(3)After 1 and 6 months,compared with the preoperative,the significant changes were disappeared for liver excess syndromes with acute glaucoma.(4)Syndromes and accompanied symptoms and signs:after 6 months,64.1% were accompanied with blood stasis.(5)The evolution of the syndrome:from 1 to 6 months,69.3% patients with the syndrome didn’t change;the mainly syndrome changes were qi stagnation and blood stasis into qi deficiency and blood stasis and qi deficiency and blood stasis into qi deficiency of both qi and blood.Conclusions:(1)The syndrome types of glaucoma after surgery have a significant change than the preoperative.(2)After 6 months,the TCM syndrome is relatively more stable and can reflect the syndrome characteristics of glaucoma after surgery.(3)Three types of glaucoma have the same type of syndrome,relatively,qi deficiency of both qi and blood and yin deficiency of liver and kidney were more common.(4)Blood stasis is an important pathology characteristic with the disease.