高压氧综合治疗一氧化碳中毒迟发性脑病患者一年期内疗效观察

Effect of hyperbaric oxygen coupled with rehabilitation therapy on patients with delayed encephalopathy after acute carbon monoxide poisoning in one year

目的研究1年期内一氧化碳中毒迟发性脑病（delayed encephalopathy after acute carbon monoxide poisoning，DEACMP）患者高压氧（hyperbaric oxygen，HBO）加药物治疗对Et常生活能力及肌张力的影响，探讨联合康复治疗能否进一步提高疗效。方法经患者知情同意并签署知情同意书后，将100例DEACMP患者分为HBO组、康复＋HBO组，每组50例。HBO组患者采用HBO＋药物治疗，康复＋HBO组患者在HBO＋药物治疗的同时开展康复治疗。HBO治疗压力为0．20MPa，升压25min，稳压吸纯氧60min，减压30min。1次／d，15d为1个疗程，休息10～15d继续下一个疗程。药物治疗采用抗血小板聚集、改善脑循环、改善脑细胞代谢等药物。康复治疗采用中医针灸及按摩和康复训练。用巴氏指数（BarthelIndex，BI）对治疗后患者日常生活能力进行评定，用改良的Ashworth量表评定患者肌张力。每3个月随访1次，共随访1年。其中完成1年期随访的患者每组各46例。结果（1）2组患者1年期内的BI较前一时间点均有显著提高，如：治疗前，HBO组35．9±4．0，康复＋HBO组34．4±3．8；治疗3个月，HBO组48．5±4．1，康复＋HBO组49．2±3．8（P〈0．01）。（2）2组间3个月时BI差异无统计学意义（P〉0．05），6—12个月时差异有统计学意义（P〈0．05或P〈0．01）；（3）2组12个月时改良的Ashworth评级较人组时均明显降低（P〈0．01），2组改良的Ashworth评级在3—12个月时差异均有统计学意义（P〈0．05）。结论（1）1年随访期内，HBO治疗能持续提高DEACMP患者的日常生活活动能力；（2）HBO联合康复治疗可以进一步降低患者的肌张力，并在6～12个月内进一步提高患者的日常生活能力。提示不应过早终止HBO及康复治疗。

Objective To investigate the effect of hyperbaric oxygen （HBO） on patients with delayed encephalopathy after acute carbon monoxide poisoning （DEACMP） in one year, and also to explore if HBO therapy coupled with rehabilitation therapy could result in better therapeutic effects. Methods One hundred patients with DEACMP were randomly divided into 2 groups： the HBO group （n = 50） and the rehabilitation ＋ HBO group （n = 50）. Barthel Index （BI） was used to assess daily life activities of the patients, and Modified Ashworth Rating Scale was used to assess the muscular tension of the patients after treatment. The patients had clinical follow-ups every 3 months in one year, and 46 patients in each group had clinical follow- ups as required. Results （ 1 ） BI data for the patients of the 2 groups within the period of one year were significantly higher than those detected at the previous time point. （2） At month 3, no statistical significancecould be noted in BI, when comparisons were made between the 2 groups （ P 〉 0.05 ）. However, at month 6 to 12, statistical significance＂ could be noticed in BI（P 〈0.05 or P 〈 0.01 ）. （3） Compared with the baseline, the Modified Ashworth scores of both groups at month 12 all improved significantly（P 〈 0.01 ）, and statistical significance could be noted in the Modified Ashworth scores at month 3 to 12, when comparisons were made between the 2 groups （ P 〈 0.05 ）. Conclusions （ 1 ） During 1-year follow-up, HBO therapy could improve daily life activities of DEACMP patients. （2） HBO therapy coupled with rehabilitation therapy could further decrease muscular tension of the patients and further improve their daily life activities within the period of 6 months to 12 months, indicating that HBO therapy ＋ rehabilitation therapy should not be terminated too early.