摘要目的:研究核桃灸治疗后天性麻痹性斜视对患者斜视度、眼球活动度、氧化应激水平的影响。方法:采用前瞻性研究，选取2021年1月至2022年12月在济南市第二人民医院中医眼科接受治疗的90例后天性麻痹性斜视患者作为研究对象，其中男52例、女38例，年龄（42.87±3.86）岁，病程（21.73±3.23）d，通过随机数字表法分为基础治疗组（30例）、针刺组（30例）、核桃灸组（30例）。基础治疗组针对病因治疗原发病，给予红花注射液静脉滴注，甲钴胺注射液穴位注射；针刺组在基础治疗组的基础上给予针刺治疗；核桃灸组在基础治疗组的基础上给予核桃灸治疗，共治疗4周。对比3组治疗前及治疗4周后斜视度、眼球活动度、氧化应激水平［超氧化物歧化酶（SOD）、丙二醛（MDA）、谷胱甘肽过氧化物酶（GSH-PX）］，治疗后临床疗效及治疗期间不良反应发生情况。统计学方法采用 χ2检验、 t检验、单因素方差分析。 结果:核桃灸组总有效率高于针刺组、基础治疗组［93.33%（28/30）比73.33%（22/30）、63.33%（19/30）］，差异有统计学意义（ χ2=7.826， P=0.020）。治疗4周后，核桃灸组斜视度及MDA水平均低于针刺组、基础治疗组［（13.51±3.52）PD比（23.64±3.52）PD、（20.18±3.90）PD，（3.96±0.46）nmol/L比（4.34±0.48）nmol/L、（4.91±0.45）nmol/L］，眼球活动度及SOD、GSH-PX水平均高于针刺组、基础治疗组［（287.72±21.46）mm 2比（246.01±24.23）mm 2、（231.73±20.81）mm 2，（128.82±15.25）U/ml比（117.90±14.46）U/ml、（109.02±15.52）U/ml，（138.97±18.26）U/L比（123.85±12.32）U/L、（113.14±11.31）U/L］，差异均有统计学意义（均 P<0.05）。治疗期间，3组患者不良反应发生率比较，差异无统计学意义（ χ2=1.450， P=0.484）。 结论:核桃灸可降低后天性麻痹性斜视患者斜视度，提高眼球活动度，调节氧化应激水平，疗效确切，安全性高。

abstractsObjective:To study the effect of walnut moxibustion on strabismus degree, eye movement, and oxidative stress in patients with acquired paralytic strabismus.Methods:Ninety patients with acquired paralytic strabismus treated at Department of Ophthalmology of Traditional Chinese Medicine, Jinan Second People's Hospital from January 2021 to December 2022 were selected for the randomized controlled trial, including 52 males and 38 females who were (42.87±3.86) years and whose disease course was (21.73±3.23) d. They were divided into a walnut moxibustion group, an acupuncture group, and a basic treatment group by the random number table method, with 30 cases in each group. All the 3 groups took basic treatment for the primary diseases and were intravenously injected safflower injection and injected mecobalamine through acupoints; in addition, the acupuncture group took acupuncture, and the walnut moxibustion group walnut moxibustion. All the three groups were treated for 4 weeks. The strabismus degrees, eye movement, and levels of oxidative stress indicators [superoxide dismutase (SOD), malonaldehyde (MDA), and glutathione peroxidase (GSH-PX)] before and after 4 weeks' treatment, curative effects after 4 weeks' treatment, and incidence rates of adverse reactions during the treatment were compared between the three groups χ2 test, t test, and one-way analysis of variance were used for the statistical analysis. Results:The total effective rate after 4 weeks' treatment in the walnut moxibustion group was higher than those in the basic treatment group and the acupuncture group [93.33% (28/30) vs. 73.33% (22/30) and 63.33% (19/30)], with a statistical difference ( χ2=7.826; P=0.020). After 4 weeks' treatment, the strabismatic degree and level of MDA in the walnut moxibustion group were lower than those in the acupuncture group and the basic treatment group [(13.51±3.52)PD vs. (23.64±3.52)PD and (20.18±3.90)PD; (3.96±0.46)nmol/L vs. (4.34±0.48)nmol/L and (4.91±0.45)nmol/L]; the eye movement and levels of SOD and GSH-PX in the walnut moxibustion group were higher than those in the acupuncture group and the basic treatment group [(287.72±21.46)mm 2vs. (246.01±24.23)mm 2 and (231.73±20.81)mm 2; (128.82±15.25)U/ml vs. (117.90±14.46)U/ml and (109.02±15.52)U/ml; (138.97±18.26)U/L vs. (123.85±12.32)U/L and (113.14±11.31)U/L]; there were statistical differences (all P<0.05). There was no statistical difference in the incidence rate of adverse reactions between the 3 groups ( χ2=1.450; P=0.484). Conclusion:Moxibustion with walnut can reduce the strabismus of patients with acquired paralytic strabismus, improve their eye movement, and adjust their level of oxidative stress, and is effective and safe.