世界中医药

目的：探究眼针联合甲钴胺穴位注射对外伤性动眼神经麻痹疗效，以期丰富治疗方法，提高疗效。方法：选取2017年1月至2018年1月湖北省中医院收治的外伤性动眼神经麻痹患者76例作为研究对象，按照就诊顺序编号随机分为对照组和观察组，每组38例。对照组予常规治疗，观察组加用眼针联合甲钴胺穴位注射，共治疗2周，观察并比较2组治疗前、治疗后复视评分、瞳孔大小、睑裂高度的变化；观察并比较2组治疗前、完成治疗后在神经生长因子（NGF）、脑源性神经营养因子（BDNF）、血清胶质纤维酸性蛋白（GFAP）变化；观察并比较2组治疗前、完成治疗后同视机变化；治疗过程中进行不良反应评价；完成治疗后进行疗效评价。结果：1）2组患者治疗前复视评分、瞳孔大小、睑裂高度比较，差异无统计学意义（均P>005），治疗后2组复视评分、瞳孔大小较治疗前均显著下降（P<005），睑裂高度较治疗前显著升高（P<005），治疗后观察组复视评分、瞳孔大小显著低于对照组、睑裂高度显著高于对照组（均P<005）。2）2组患者治疗前NGF、BDNF、GFAP比较，差异无统计学意义（P>005），治疗后2组NGF、BDNF、GFAP较治疗前显著升高（P<005），完成治疗后观察组NGF、BDNF、GFAP显著高于对照组（P<005）。3）2组患者同视觉三级指标治疗前Ⅰ级、Ⅱ级、Ⅲ级比较，差异无统计学意义（P>005），完成治疗后2组Ⅰ级、Ⅱ级、Ⅲ级比率较治疗前均显著升高（P<005），完成治疗后观察组Ⅰ级、Ⅱ级、Ⅲ级均显著高于对照组（P<005）。4）完成治疗后观察组患者显效率、总有效率显著高于对照组，2组比较差异有统计学意义(P<005)。5）2组安全性比较，差异无统计学意义（P>005）。结论：眼针联合甲钴胺穴位注射能提高外伤性动眼神经麻痹神经传导速度，促进神经生长因子，从而缩小瞳孔，改善复视症状，提高疗效。

English Summary:

To explore the efficacy of ocular acupuncture combined with mecobalamin acupoint injection in traumatic oculomotor nerve palsy，in order to enrich the treatment methods and improve the efficacy.Methods:A total of 76 patients with traumatic oculomotor nerve palsy were enrolled as research objects in the Hubei Provincial Hospital of TCM from January 2017 to January 2018.They were randomly divided into control group(38 cases)and observation group(38 cases).The control group was given routine treatment，and the observation group was also given ocular acupuncture combined with mecobalamin acupoint injection for 2 weeks.Changes of diplopia score，pupil size and palpebral fissure height before and after the treatment were observed and compared between the 2 groups.Changes of nerve growth factor(NGF)，brain-derived neurotrophic factor(BDNF)and serum glial fibrillary acidic protein(GFAP)before and after the treatment were observed and compared between the 2 groups.Changes of synoptophore before and after the treatment in the 2 groups were observed and compared.Adverse reactions were evaluated in the course of the treatment and the efficacy was evaluated after the treatment.Results:There was no significant difference in the diplopia score，pupil size and palpebral fissure height between the 2 groups before the treatment(P>005).After the treatment，the diplopia score and pupil size in both groups were decreased significantly compared with those before the treatment，and the palpebral fissure height was increased significantly compared with that before the treatment(P<005).After the treatment，the diplopia score and pupil size in the observation group were significantly lower than those in the control group，and the palpebral fissure height was significantly higher than that in the control group(P<005). 2)There was no significant difference in the NGF，BDNF and GFAP between the 2 groups before the treatment(P>005).After the treatment，the NGF，BDNF and GFAP in the 2 groups were significantly higher than those before the treatment(P<005).After the treatment，the NGF，BDNF and GFAP in the observaiton group were significantly higher than those in the control group(P<005). 3)There was no significant difference in grades I，II and III of the synoptophore indexes between the 2 groups before the treatment(P>005).After the treatment，the ratios of grades I，II and III in the 2 groups were significantly higher than those before the treatment(P<005).After the treatment，the ratios of grades I，II and III in the observation group were significantly higher than those in the control group(P<005). 4)After the treatment，the marked and total effective rates in the observation group were significantly higher than those in the control group，with statisticaly significant difference(P<005). 5)There was no significant difference in safety between the 2 groups(P>005).Conclusion:Ocular acupuncture combined with acupoint injection of mecobalamin can improve the nerve conduction velocity and nerve growth factor in traumatic oculomotor nerve palsy，thereby reducing pupil size，improving diplopia symptoms and improving the efficacy.

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