高压氧治疗在脊髓损伤中的应用

The Application of Hyperbaric Oxygen Therapy in Spinal Cord Injury

目的探讨高压氧综合治疗脊髓损伤的临床疗效及其对患者炎症因子水平的影响。方法 85例确诊为急性脊髓损伤患者按治疗方法分为两组:对照组42例,行椎弓根系统内固定及椎板切除减压手术等常规外科治疗及其他对症治疗;观察组43例,在应用对照组治疗方法的基础上加行高压氧治疗。比较两组患者临床疗效(总有效率);分别于治疗前后应用功能独立性评分表(FIM)、美国脊髓损伤协会(ASIA)评分、改良Barthel指数评分(MBI)对患者康复效果进行评估,并于治疗前后测定血清白细胞介素-6,8(IL-6、8)及肿瘤坏死因子-α(TNF-α)水平。结果观察组总有效率显著高于对照组(97.67 vs 57.14%,P<0.05)。两组患者治疗后ASIA运动、感觉评分,FIM评分及MBI评分较术前均显著提高,且治疗后观察组各项评分均高于对照组(P<0.05)。两组治疗后IL-6、IL-8及TNF-α水平显著低于治疗前,且观察组治疗后IL-6、IL-8、TNF-α水平显著低于对照组(P<0.05)。结论对脊髓损伤患者,应用高压氧治疗可有效抑制炎症因子的生成,有助于降低继发性炎性损伤的发生,从而提高临床疗效,改善脊髓功能。

Objective To investigate the clinical efficacy of hyperbaric oxygen treatment of spinal cord injury and the effect of the levels of inflammatory cytokine. Methods 85 cases with acute spinal cord injury were divided into two groups according to treatment. The control group with 42 cases were treated by conventional surgical treatment of pedicle screw internal fixation, decompression of laminectomy and other symptomatic treatment, and the observation group were treated the same combined modality therapy but plus hyperbaric oxygen therapy. The clinical effect of total effective rate was compared between two groups. The functional independence measure （FIM）, American Spinal injury Association （ASIA） score and modified Barthel index （MBI） were applied to evaluate the spinal cord function of two groups. The levels of interleukin-6, 8 （ IL-6, 8） and tumor necrosis factor-α （TNF-α） of two groups before and after treatment were measured by ELISA. Results The total effective rate of observation group was obviously higher than that of control group （97.67% VS 57.14%, P 〈 0.05）. All the ASIA, FIM and MBI score of post-treatment were improved remarkable than those of pre-treatment in both two groups （P 〈 0.05 ）. All the ASIA, FIM and MBI score of observation group were higher than those of control group after treatment （P 〈0.05）. The levels of inflammatory cytokines of post-treatment were decreased significantly than those of pre-treatment in both two groups （P 〈 0. 05 ）. The levels of IL-6, IL-8, TNF-α of observation group were significantly lower than those of control group after treatment （ P 〈 0.05 ）. Conclusion The hyperbaric oxygen therapy can improve the clinical efficacy and spinal cord function for the patients with spinal core injury by inhibiting the generation of inflammatory factor and decreasing the incidence of secondary inflammatory injury.