高压氧治疗一氧化碳中毒迟发性脑病的疗效观察

The effect of hyperbaric oxygen therapy on delayed encephalopathy after carbon monoxide poisoning

目的 探讨高压氧治疗一氧化碳中毒迟发性脑病（DEACMP）的疗效.方法 选取DEACMP患者60例,按照随机数字表法将其分为高压氧组（32例）和对照组（28例）.2组患者均给予改善微循环及康复治疗,高压氧组在此基础上辅以高压氧治疗.治疗前、治疗35 d、治疗70 d,采用简易智能状态检查量表（MMSE）、BI评分（BI）、年龄相关的白质改变量表（ARWMC）对2组患者的认知功能、运动功能及脑白质损伤程度进行评定.结果 治疗前,高压氧组和对照组MMSE、BI、ARWMC评分之间比较,差异无统计学意义（P＞0.05）.与组内治疗前比较,高压氧组治疗35 d及70 d后MMSE、BI评分均有显著变化,差异有统计学意义（P＜0.05）.高压氧组治疗70 d后ARWMC评分较治疗前显著降低,差异有统计学意义（P＜0.05）.治疗35 d后,高压氧组MMSE评分[（10.78±4.41）分]高于对照组[（2.54±1.50）分]（P＜ 0.05）,BI评分[（48.75±11.85）分]高于对照组BI评分[（9.46±6.43）分]（P＜0.05）,其ARWMC评分与对照组ARWMC评分之间比较,差异无统计学意义（P＞0.05）.治疗70 d后,高压氧组MMSE评分[（23.69±3.79）分]高于对照组[（2.89±1.64）分]（P＜0.05）,BI评分[（75.78 ±16.37）分]高于对照组BI评分[（12.14±8.65）分]（P＜0.05）,其ARWMC评分[（7.13±3.22）分]低于对照组[（15.79±4.70）分]（P＜0.05）.结论 在改善微循环治疗及康复训练基础上,高压氧能够改善DEACMP患者的认知功能及运动功能,治疗70 d后可显著减轻患者脑白质的损伤程度.

Objective To investigate effect of hyperbaric oxygen therapy （HBOT） on delayed encephalopathy after carbon monoxide poisoning （DEACMP）.Methods This was a prospective random study of 60 patients with DEACMP admitted to Beijing Tiantan Hospital.Among them,32 constituted the HBOT group and 28 were controls.All of the patients in both groups were given drugs to improve microcirculation and rehabilitation treatment.Additionally,the patients in the HBOT group were given hyperbaric oxygen therapy.The Mini-Mental State Examination （MMSE）,the Barthel index and an index of age-related white matter changes （ARWMC） were used assess the patients＇ cognition,motor function and cerebral white matter lesions on the day of enrollment and on the 35th and 70th day after treatment.Results Before treatment there was no significant difference in average MMSE,Barthel index or ARWMC scores between the groups.In the HBOT group the average MMSE and Barthel index scores on the 35th and 70th day after enrollment were significantly higher than on the day of enrollment and the average ARWMC score on the 70th day was significantly lower than at enrollment.On the 35th day the average MMSE and Barthel index scores of the HBOT group were significantly higher than those of the control group,but there was no significant difference in the groups＇ average ARWMC scores.On the 70th day after enrollment the HBOT group＇s average MMSE and Barthel index scores were still significantly higher than those of the control group,but its average ARWMC score was significantly lower.Conclusion HBOT can help improve cognitive and notor function and also alleviate cerebral white matter lesions of DEACMP patients.