高压氧综合治疗急性脑梗死的疗效及最佳治疗时间窗的研究

Effect of comprehensive HBO therapy on acute cerebral infarction and study of best therapeutic time window

目的比较高压氧（hyperbaric oxygen，HBO）治疗与常规疗法治疗急性脑梗死（acute cerebral infarction，ACI）的疗效及探讨HBO治疗的最佳治疗时间窗。方法将2006年6月至2010年12月入住我院的ACI患者196例经知情同意后分为HBO组（98例）和对照组（98例），HBO组再按HBO治疗时问分为〈6h、6～48h、〉48h3个亚组，在常规治疗的基础上加用HBO，HBO治疗采用多人氧舱，在舱内停留120min，压力0．25MPa（2．5ATA），戴面罩吸入纯氧60min（30min2次，中间间歇10min吸舱内空气），加、减压各25mirt，1次／d，10d为1个疗程，疗程间隔3—5d，共3个疗程。对照组按照病程亦分为〈6h．6—48h、〉48h3个亚组。对所有患者分别于治疗前及疗程结束后进行美国国立卫生研究院卒中量表（NIHSS）评分和Barthel指数（BI）评分，并与常规治疗的ACI患者（对照组）进行比较。结果治疗后HBO各亚组的总有效率（97．3％、90．0％、80．7％）显著高于常规治疗各亚组（85．7％、77．1％、57．1％）（均为P〈0．01）；HBO组中〈6h亚组的有效率明显高于6～48h和〉48h亚组（P〈0．05），各亚组NIHSS评分明显低于常规治疗组，BI评分明显高于常规治疗组各亚组（均为P〈0．01）；HBO组中〈6h亚组明显优于6～48h和〉48h亚组（P〈0．05）。结论HBO治疗ACI的疗效显著，并且在发病6h内开始治疗为最佳。

Objective To compare the curative effects of hyperbaric oxygen （HBO） and conventional therapy on acute cerebral infarction （ACI）, and to study the best therapeutic time window of HBO therapy on ACI. Methods One hundred and ninety-six patients with ACI admitted into the hospital from June 2006 to December 2010 were divided into the HBO group （ n = 98 ） and the control group （ n = 98 ）. The HBO group was subdivided into the 〈 6 h therapy group, the 6-48 h therapy group and the 〉 48 h therapy group, in accordance with the duration of HBO exposure. In addition to HBO therapy, the HBO group also received conventional therapy. The patients received HBO therapy once a day, 10 days as one therapeutic course, totaling 3 courses. The time used for compression and decompression was 60 min. In the chamber, the patients were exposed to a pressure of 0.25 MPa for a duration of 120 min and breathed pure oxygen with masks for 60 min （30 minutes of oxygen ,breathing, at a time, and a 10 min interval）. All the patients were assessed with National Institute of Health Stroke Scale （NIHSS） and Barthel Index （BI） both before treatment and after termination of the treatment courses. Then, they were compared with those ACI patients （the control group ） receiving conventional therapy. Results After treatment, total effective rates for each HBO therapy sub-group were 97.3% ,90.0% and 80.7% , which were significantly higher than those of the conventional therapy subgroups with effective rates of 85.7% ,77.1% and 57.1% respectively （P 〈 0.01 ）. In the HBO group, the effective rate for the 〈 6 h sub-group was significantly higher than those of the 6-48 h and the 〉 48 h subgroups （P 〈 0. 05 ）. NIHSS scores in each HBO sub-group were significantly lower than those of the conventional therapy group, and BI cores were significantly higher than those of all the sub-groups in the conventional group （P 〈 0.01 ）. In the HBO group, the score for the ≤6 h sub-group were obviously superior to those of the 6 - 48 h and the 348 h sub - groups （ P 〈 0.05 ）. Conclusions HBO therapy could produce a significant result for the treatment of ACI and the best therapeutic time was within 6 hours after the onset of ACI.