CAJ | 학술논문

目的探讨应用睑板腺按摩联合妥布霉素地塞米松眼膏治疗东北地区睑板腺功能障碍性干眼的临床疗效.方法回顾性分析2013年1-11月东北地区诊治的睑板腺功能障碍性干眼患者403例(767眼)的临床资料,其中治疗组1采用“按摩+妥布霉素地塞米松眼膏+人工泪液(卡波姆眼用凝胶)”治疗,治疗组2采用“妥布霉素地塞米松眼膏+人工泪液”治疗,对照组只用人工泪液治疗,观察记录治疗前及治疗后1,3个月泪膜破裂时间(BUT)、泪液分泌试验(SchirmerⅡ)、角膜染色评分以及干眼症状改善程度.结果三组治疗前主观症状、BUT、SchirmerⅡ、角膜染色评分比较差异无统计学意义(P＞ 0.05).治疗后1个月,治疗组1、治疗组2患者主观症状、BUT、SchirmerⅡ、角膜染色评分较治疗前明显好转(P＜0.01),但对照组与治疗前比较差异无统计学意义(P＞0.05).治疗后3个月,治疗组1、治疗组2有效率分别为87.1％(122/140),60.8％(79/130),显著高于对照组的48.9％(65/133),差异有统计学意义(P＜0.05).治疗组1、治疗组2有效率比较差异也有统计学意义(P＜0.05).结论睑板腺功能障碍性干眼的治疗应从病因着手进行热敷+按摩+抗炎综合治疗,有利于泪膜脂质层的稳定性和均匀性重建,恢复泪膜的完整性,使干眼及眼表炎性反应消除.但睑板腺功能障碍性干眼仍需门诊持久的观察治疗以及日常生活饮食的指导.患者良好的治疗依从性是临床疗效的关键.
목적 탐토응용검판선안마연합타포매소지새미송안고치료동북지구검판선공능장애성간안적림상료효.방법 회고성분석2013년1-11월동북지구진치적검판선공능장애성간안환자403례(767안)적림상자료,기중치료조1채용“안마+타포매소지새미송안고+인공루액(잡파모안용응효)”치료,치료조2채용“타포매소지새미송안고+인공루액”치료,대조조지용인공루액치료,관찰기록치료전급치료후1,3개월루막파렬시간(BUT)、루액분비시험(SchirmerⅡ)、각막염색평분이급간안증상개선정도.결과 삼조치료전주관증상、BUT、SchirmerⅡ、각막염색평분비교차이무통계학의의(P＞ 0.05).치료후1개월,치료조1、치료조2환자주관증상、BUT、SchirmerⅡ、각막염색평분교치료전명현호전(P＜0.01),단대조조여치료전비교차이무통계학의의(P＞0.05).치료후3개월,치료조1、치료조2유효솔분별위87.1％(122/140),60.8％(79/130),현저고우대조조적48.9％(65/133),차이유통계학의의(P＜0.05).치료조1、치료조2유효솔비교차이야유통계학의의(P＜0.05).결론 검판선공능장애성간안적치료응종병인착수진행열부+안마+항염종합치료,유리우루막지질층적은정성화균균성중건,회복루막적완정성,사간안급안표염성반응소제.단검판선공능장애성간안잉수문진지구적관찰치료이급일상생활음식적지도.환자량호적치료의종성시림상료효적관건.
Objective To observe the clinical effect of xerophthalmia of meibomian glands dysfunction treated with meibomian glands massage and tobramycin dexamethasone in the northeast area.Methods The clinical data of 403 patients (767 eyes) with xerophthalmia of meibomian glands dysfunction in the northeast area in January to November 2013 were analyzed retrospectively.The patients were divided into 3 groups.Patients of treatment goup 1 were combined modality therapy by meibomian glands massage and tobramycin dexamethasone and artificial tears (carbomer eye ophthalmic gel).Patients of treatment goup 2 were treated with tobramycin dexamethasone and artificial tears.Patients of control group were only used by artificial tears.Tear film break-uptime (BUT),tear secretion test (Schirmer Ⅱ),corneal staining score and symptom score were measured before treatment and after treatment for 1,3 months.Results There was no significant difference in the subjective symptoms,BUT,Schirmer Ⅱ,corneal staining score before treatment among three groups (P ＞ 0.05).Compared with that before treatment,the subjective symptoms,BUT,Schirmer Ⅱ,corneal staining score after treatment for 1 month was improved in treatment group 1 and treatment group 2 (P ＜ 0.01),but there was no significant difference in control group (P ＞ 0.05).After treatment for 3 months,the effective power in treatment group 1 [87.1％(122/140)] and treatment group 2 [60.8％(79/130)] was higher than that in control group [48.9％(65/133)],and there was significant difference (P ＜ 0.05).And there was significant difference between treatment group 1 and treatment group 2 (P ＜ 0.05).Conclusions Xerophthalmia of meibomian glands dysfunction in the northeast area due to speciality in the geographical environment and food habits.Combined modality therapy (applied heating,meibomian glands massage and tobradex) can provide a new direction of xerophthalmia of meibomian glands dysfunction,retrieve in the lipids component of the tear film and eliminate the inflammation.But,dependence of the out-patients are very important in the therapeutic process.