| Objective:1 To investigate the efficacy of acupuncture in the treatment of paralytic strabismus.2 To retrospectively analyze the clinical data of patients with acquired paralytic strabismus(syndrome of wind-phlegm obstructing collaterals),and to explore the clinical effect of acupuncture method of "shu-jing-tong-luo" in the treatment of paralytic strabismus(syndrome of wind-phlegm obstructing collaterals).To provide more basis for clinical application of acupuncture method of "shu-jing-tong-luo" in the treatment of acquired paralytic strabismus(syndrome of wind-phlegm obstructing collaterals).Methods:1 Chinese and English literatures were searched through China National Knowledge Internet,Wanfang,Pub Med,Embase and other databases,and the searching time limit was from the establishment of the database to January 20,2021.The subjects were patients with paralytic strabismus,the experimental group was treated with acupuncture of extraocular muscle or combined with routine acupuncture,and the control group was treated with routine acupuncture or drug therapy.The outcome indicators included total effective rate,strabismus and distance of eye movement.On this basis,qualified randomized controlled trials were included.Two researchers independently selected the literature to extract the data and checked them.Repeated literatures were screened by Note Express software.After reading abstracts and full texts,appropriate literatures were selected for inclusion in the study.Bias risk assessment tools and Jadad improvement scale were used to evaluate the quality of the included study.Rev Man5.3was used for data analysis.Heterogeneity was analyzed with I~2statistics.2 Using the method of retrospective analysis,the cases of ophthalmology in the Department of Ophthalmology of the first affiliated Hospital of Tianjin University of traditional Chinese Medicine from January 1,2018 to January 1,2020 were collected.According to the inclusion and exclusion criteria,the patients were diagnosed as eye deviation(syndrome of wind-phlegm obstructing collaterals)in traditional Chinese medicine.130 cases were diagnosed as paralytic strabismus by western medicine.According to the clinical treatment plan,65 patients who received routine acupuncture combined with "relaxing meridians and dredging collaterals" on the basis of routine western medicine were divided into the experimental group.65 patients who received routine acupuncture and medicine on the basis of routine western medicine were divided into the control group.The clinical indexes of improving strabismus,limitation of eye movement,diplopia distance,TCM syndrome score,TCM syndrome curative effect and overall curative effect were compared between the two groups after 3 courses of treatment.Statistical methods:input the data into the Excel database and use SPSS21.0 statistical software for statistical processing.The measurement data in accordance with or close to the normal distribution are expressed by the average plus or minus standard deviation(variance ±S).The measurement data in accordance with the normal distribution are analyzed by t-test,and the grade data of non-normal distribution are analyzed by rank sum test,using the median(lower quartile).The upper quartile(M),that is,M(P25 and P75),the difference was statistically significant(P < 0.05),and the changes of each parameter were evaluated accordingly.Results:1 Meta analysis included 14 randomized controlled trials,all of which were in Chinese literature,with a total of 1213 patients.Meta analysis showed that there were 7studies on efficiency,test group:control group [RR=1.26,95%CI(1.16,1.36),P<0.00001]).Subgroup analysis:acupuncture of extraocular muscles:conventional drugs were included in 3 studies [RR=1.42,95%CI(1.24),P1.64),P<0.00001],acupuncture combined with routine acupuncture:routine acupuncture included 4 studies,RR=1.23,95%CI(1.23),P 1.35),P<0.00001),suggesting that the total effective rate of the test group was better than that of the control group.Seven studies reported strabismus,I~2= 77%,using random effect model,experimental group:control group[MD=-10.49,95%CI(-12.17),P 8.82%<0.00001].Subgroup analysis:acupuncture of extraocular muscle:drug therapy was included in 4 studies [MD=-8.81,95%CI(-9.52),P 8.10),P<0.00001],acupuncture of extraocular muscle plus routine acupuncture and medicine:routine drugs were included in 3 studies [MD=-16.19,95%CI(-19.13,-13.26),P<0.00001)].Heterogeneity came from the difference of intervention measures between the two groups.Sensitivity analysis:excluding the inclusion of the literature one by one,it was found that before and after elimination,P < 0.05,MD was maintained at-11.28 to-9.46,95%CI was maintained at-13.33 to-9.23,indicating that the results were robust,and I~2 was maintained at 59%,81%,with medium and high heterogeneity.Two studies reported the distance of eye movement,I~2= 93%,and the experimental group:the control group [MD=3.97,95%CI(1.95,6.00),P<0.0001])had high heterogeneity and should be treated with caution.2 Results of retrospective analysis(1)The difference of strabismus reduction was 8(8,12)in the test group and 6(4,10)in the control group after treatment.The curative effect of the experimental group was better than that of the control group in improving strabismus(P<0.05).(2)After treatment,there were 28 patients with normal eye movement,28 patients with mild limitation of eye movement,8 patients with moderate limitation of eye movement and 1 patient with severe limitation of eye movement in the trial group.After treatment in the control group,20 cases returned to normal eye movement,26 patients had mild limitation of eye movement,15 patients had moderate limitation of eye movement,and 4 patients had severe limitation of eye movement.The curative effect of the experimental group was better than that of the control group in improving the limitation of eye movement(P<0.05).(3)The difference of diplopia distance between the experimental group and the control group after treatment was 9(4～12.5)and 6(2～9)respectively.In reducing the distance of diplopia,the effect of the test group was better than that of the control group(P<0.05).(4)The difference of TCM syndrome score after treatment in the test group was6(4～8),and that in the control group was 6(2～10).In terms of reducing the score of TCM syndrome,the effect of the test group was better than that of the control group(P<0.05).(5)In terms of the curative effect of TCM syndrome,12 patients in the experimental group were cured,the symptoms of diplopia,dizziness and nausea disappeared,49 patients were effective,while 9 patients in the control group were cured and 49 patients were effective.There was no significant difference in the curative effect of TCM syndrome between the two groups(P>0.05).(6)The overall curative effect of the experimental group was better than that of the control group(P<0.05).Conclusion:1 For acquired paralytic strabismus(syndrome of wind-phlegm obstructing collaterals),the acupuncture method of "relaxing meridians and dredging collaterals" in the experimental group combined with routine acupuncture and medicine plus western medicine basic treatment and the control group routine acupuncture and medicine plus western medicine basic treatment are effective;In improving the degree of strabismus,the limited degree of eye movement,the distance of diplopia,the score of TCM syndrome and the total effective rate,the curative effect of the test group was better than that of the control group;In terms of the curative effect of TCM syndrome,both groups are effective;Ihe acupuncture method of "relaxing meridians and dredging collaterals" is effective in the treatment of acquired paralytic strabismus(syndrome of wind-phlegm obstructing collaterals).2 Meta analysis shows that acupuncture of extraocular muscles can improve the degree of strabismus and reduce the distance of eye movement in the treatment of paralytic strabismus. |
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