高压氧辅助STA-MCA搭桥术治疗烟雾病的临床疗效

Curative effect of STA to MCA anastomosis combined by hyperbaric oxygen therapy on Moyamoya disease

目的探讨高压氧治疗（HBOT）辅助颞浅动脉-大脑中动脉（STA-MCA）吻合术治疗烟雾病（MMD）的临床疗效。方法 2009年1月至2014年1月收治MMD患者50例,随机分为HBOT组和对照组,每组各25例;两组均给予开颅STA-MCA搭桥术,术后对照组给予常规综合治疗、HBOT组在对照组基础上加用HBOT,共2个疗程20 d。采用盲法评定两组患者治疗前及治疗后20 d神经功能缺损程度评分（NDS）、洛文斯顿认知评定量表（LOTCA）评分、GCS评分,治疗后6个月采用日常生活能力（ADL）分级评估患者预后。结果 HBOT组总有效率为88%（22/25,NDS评分降低18%以上）,显著高于对照组（64%,16/25;P〈0.05）。治疗后20 d,两组患者NDS评分、LOTCA评分和GCS评分均较治疗前明显改善（P〈0.05）,HBOT组改善情况又明显优于对照组（P〈0.05）。随访6个月,HBOT组预后良好率（80%,20/25;ADL分级Ⅰ~Ⅱ级）明显高于对照组（52%,13/25;P〈0.05）。结论 HBOT辅助STA-MCA搭桥术治疗MMD临床疗效显著,可促进患者神经功能认知功能及意识状态恢复,改善患者预后,提高生活质量。

Objective To observe the clinical effect of superficial temporal artery （STA） to middle cerebral artery （MCA） anastomosis combined with hyperbaric oxygen therapy （HBOT） on Moyamoya disease. Methods Fifty patients with Moyamoya disease underwent STA to MCA anastomosis and then were randomly divided into both the HBOT and the control groups of 25 patients each. The patients in the control group were routinely treated after the STA to MCA anastomosis. The patients in the HBOT group received routinely treatment and HBOT at the same time. The neurological deficiency score （NDS）, Loewenstein Occupational Therapy Cognitive Assessment （LOTCA） and GCS were determined 20 clays after the treatment in both the groups. The prognoses were assessed by activity of daily living （ADL） 6 months after the treatment. Results The effective rate （88%, 22/25） was significantly higher in the HBOT group than that （64%, 16/25） in the control group 20 days after the treatment （P〈0.05）. LOTCA and GCS score were significantly higher, NDS were significantly lower in the HBOT group than those in the control group 20 days after the treatment （P〈0.05）. The rate of good prognosis （80%, 20/25） was significantly higher in HBOT group than that （52%, 13/25） in the control group 6 months after the tredithent （P〈0.05）. Conclusion The rehabilitation of consciousness, the neurological function and cognitive function may be promoted, and prognosis and quality of life may be improved by STA to MCA combined with HBOT in the patients with Moyamoya disease.