体位、意识状态对高压氧治疗患者血压、心率的影响

Effects of hyperbaric oxygen on blood pressure and heart rate in patients with different postures and conscious states

目的 观察不同体位、意识状态对高压氧（hyperbaric oxygen,HBO）治疗患者血压、心率的影响.方法 HBO治疗患者共57例,按体位和意识状态分组,其中意识清醒组43例,意识障碍组14例,坐位组37例,卧位组20例.对行HBO治疗的57名患者分别于HBO治疗前、加压结束前、稳压25min、减压结束前、HBO治疗结束后lh测量血压及心率,并进行统计学分析.结果 意识清醒组患者仅在减压时收缩压、舒张压、平均动脉压[ （129.42±21.47）mm Hg、（81.79±12.65） mmnHg、（97.67±14.38）mm Hg]与治疗前[（121.72±16.31）mm Hg、（75.51±9.77） mm Hg、（90.91±9.64） mm Hg]比较升高,差异有统计学意义（P＜0.05）；坐位组患者仅在减压时舒张压、平均动脉压[（81.30±12.36） mmHg、（97.11±13.99） mm Hg]与治疗前[（75.38±9.48）mm Hg、（91.14±9.51）mm Hg]比较升高（P＜0.05）；其余时间点、其他组别患者、组间比较则变化不明显（P＞0.05）.意识清醒组、坐位组患者从加压时开始,直到治疗结束后1h,心率较治疗前均明显减慢（P＜0.05）；意识障碍组、卧位组患者从稳压时开始到减压前,心率较治疗前均明显减慢（P＜0.05）,治疗结束后lh恢复到治疗前水平（P＞0.05）.结论HBO治疗时,除高分压氧作用外,体位、意识状态可能是血压、心率的变化影响因素,应引起足够的重视.

Objective To observe the effects of hyperbaric oxygen （HBO） on blood pressure and heart rate in patients with different physical postures and conscious states.Methods Patients were divided into different groups based on their postures or conscious states.Blood pressure and heart rate were measured in 57patients prior to treatment,before termination of compression,during maintenance of pressure for 25 min,before termination of decompression and 1 hour after completion of treatment.Statistical analyses were also made in the study.Results In conscious patients,systolic pressure,diastolic pressure and mean arterial pressure[（ 129.42 ± 21.47 ） mm Hg、（81.79 ± 12.65 ） mm Hg、（97.67 ± 14.38 ） mm Hg ]during the stage of decompression increased significantly,as compared with those of pre-treatment[（ 121.72 ± 16.31 ） mm Hg、（75.51 ± 9.77 ） mm Hg、（ 90.9 1 ± 9.64） mm Hg ],with statistical significance （ P 〈 0.05 ）.In sitting patients,diastolic pressure and mean arterial pressure[（81.30 ± 12.36 ）mm Hg、（97.11 ± 13.99 ）mm Hg]during the stage of decompression increased significantly,as compared with those of pre-treatment[（ 75.38 ± 9.48 ） mm Hg、（91.14 ± 9.51 ）mm Hg],also with statistical significance （ P 〈 0.05 ）.No significant differences could be noted in other time points,when comparisons were made between the groups （ P 〉 0.05 ）.From the start of compression to 1 h after treatment,heart rate in conscious and sitting patients all decreased significantly,as compared with that of pre-treatment,with statistical significance （ P 〈 0.05 ）.For patients in the conscious disorder group and the laid-up group,heart rate measured from the time of pressure maintenance to the start of decompression decreased significantly,as compared with that of pre-treatment,with statistical significance（P 〈 0.05 ）.One hour after treatment,heart rate retumed to pre-treatment level （ P 〉 0.05 ） Conclusions HBO therapy could decrease heart rate of patients and elevate blood pressure during the stage of decompression.Besides the effect of high oxygen partial pressure,physical posture,psychological state and ambient temperature might all be influencing factors involved,to which attention should be paid.