高压氧治疗急性脑梗死的时间窗研究

Therapeutic window of hyperbaric oxygenation for acute cerebral infarction

目的研究高压氧在不同时间窗治疗时对急性脑梗死患者疗效的影响。方法将120例首次发病的急性前循环脑梗死患者随机分为A、B、C、D组,每组30例。4组患者均给予相同的基础药物治疗,A组患者在发病后24h内开始高压氧治疗,B组患者在发病后24～72h内进行高压氧治疗,C组患者在发病后72h～7d内进行高压氧治疗,D组患者未给予高压氧治疗。结果在治疗后第14,28及90天时,发现4组患者神经功能缺损评分及日常生活活动能力评分均较治疗前显著改善,其中A组患者的改善幅度显著优于B、C、D组,差异具有统计学意义(P<0.05);B组患者的改善幅度显著优于C、D组,差异亦有统计学意义(P<0.05);C、D组间疗效差异无统汁学意义(P>0.05)。4组患者在治疗期间均未发生严重不良反应。结论高压氧治疗时间窗对首次发病的急性前循环脑梗死患者疗效具有重要影响,开始治疗时间越早则疗效越佳,以发病后24h内进行高压氧治疗疗效最佳,24～72h内干预则疗效次之,超过72 h则无显著疗效。

Objective To study the influence of different starting time of hyperbaric oxygenation （HBO） therapy on acute cerebral infarction patients. Methods A total of 120 patients with first-time acute cerebral infarction were randomly and evenly divided into 4 groups： groups A, B, C and D. All the patients were treated with routine clinical regime. In addition, the patients in groups A, B and C started with HBO within 24 hours, between 24 and 72 hours and after 72 hours post-onset of the disease, respectively, while those in group D without HBO. All the patients were evaluated in terms of their neurological function and their performance in activities of daily living, using the National Institutes of Health stroke survey （NIHSS） and Barthel Index （BI）. ResnIts At 14, 28 and 90 days after treatment, the patients in group A scored significantly better with NIHSS and BI than those in groups B, C and D（ P 〈0.05 ） , those in group B scored better with NIHSS and BI than groups C and D （P〈0.05）, and groups C and D scored similar with NIHSS and BI（P〉0.05）. No serious adverse reaction was found in the four groups. Conclusion The earlier the HBO therapy was started, the better the treatment. There will be no significant effects of HBO if it was started after 72 hours post-onset of the disease. HBO therapy appears safe.