脑梗死急性期高压氧治疗对卒中后认知功能的影响

Effects of hyperbaric oxygen on the cognition of the patients with stroke during the acute stage of cerebral infarction

目的 探讨脑梗死急性期高压氧治疗对卒中后认知功能的影响.方法 采用随机对照研究,收集本院2017年1-3月在南通大学第二附属医院神经外科住院的初发急性脑梗死患者94例,按照知情同意原则并签署知情同意书,经医院伦理委员会批准,分成2组,治疗组于住院期间除常规脑梗死治疗外并予高压氧治疗,对照组予以脑梗死常规治疗入院时行NIHSS评分、MoCA评分.随访6个月,剔除再发脑梗死、死亡、失访病例4例,共纳入研究90例,每组45例,再次行NIHSS评分、MoCA评分,并行mRS评分.2组一般资料及各项评分进行组间比较.利用Logistic回归分析明确卒中后认知功能障碍的独立影响因子.结果 2组一般资料及入院时的各项评分差异无统计学意义,病后6个月治疗组NIHSS洋分、转归良好率与对照组差异无统计学意义,而卒中后认知障碍发病率显著低于对照组（26.7％vs 48.9％,P＜0.05）、病后6个月的MoCA评分显著高于对照组且差异有统计学意义（27.3±1.52 vs26.2 ±1.95,P＜0.05）.高压氧治疗组患者脑梗死6个月后视空间/执行功能与记忆力分值显著高于对照组[4（4,5）vs 4（4,4）,P＜0.05;4（4,4）vs 4（3,4）,P＜0.05].Logistic回归分析发现教育年限（OR=0.711,95％ CI0.556 ～0.910,P=0.007）、同型半胱氨酸（OR=1.271,95％ CI1.015 ～ 1.591,P=0.037）及脑白质疏松（OR=2.854,95％ CI 1.327 ～6.147,P=0.007）是卒中后认知障碍的独立影响因素,而是否选择高压氧治疗并非卒中后认知障碍的独立影响因素.结论 脑梗死急性期高压氧治疗对病后6个月的转归影响不大,但能显著降低卒中后认知功能障碍的发病率,提高视空间/执行功能与记忆力.

Objective To investigate the effects of hyperbaric oxygen （HBO） on the cognition of the patients with stroke during the acute stage of cerebral infarction.Methods Ninety-four patients with acute cerebral infarction hospitalized in the department of the hospital from January to March,2017 were enrolled for the study.A randomized controlled study was performed and the patients were randomly divided into 2 groups.During hospitalization,the treatment group was treated with HBO in addition to conventional treatment for cerebral infarction,while the control group was just given conventional therapy for cerebral infarction.National Institutes of Health Stroke Scale （NIHSS） scores and MoCA scores were assessed at time of admission.After 6 months of follow-ups,4 patients with recurrent cerebral infarction or death or without medical follow-ups were excluded from the study,and the remaining 90 were included in the study.NIHSS scores,MoCA scores and mRS scores were calculated once again for the study.General medical data and scores were compared between the groups.Logistic regression was used to identify independent influential factors of cognitive impairment after stroke.Results There was no statistical significance in general medical data and various scores detected at the time of admission,when comparisons were made between the 2 groups.Six months after onset,statistical significance could neither be seen in NIHSS scores and the rate of good outcome,as compared with those of the control group.However,incidence of cognitive impairment after stroke was significantly lower than that of the control group（26.7％ vs 48.9％） （P ＜ 0.05）.Six months after onset,the MoCA scores were significantly lower than those of the control group,with statistical significance （27.3 ± 1.52 vs 26.2 ± 1.95） （P ＜ 0.05）.Six months after onset of cerebral infarction,the scores of visual space/executive function and memory in the HBO group were considerably higher than those in the control group [4 （4,5） vs 4 （4,4）] （P ＜ 0.05）.Logistic regression analysis revealed that education background （OR =0.711,95％ CI 0.556-0.910） （P =0.007）,homocysteine （OR =1.271,95 ％ CI 1.015-1.591） （P =0.037） and leukoaraiosis （OR =2.854,95％ CI 1.327-6.147） （P =0.007） were independent factors of cognitive impairment after stroke,and whether not to choose HBO therapy was not an independent factor of cognitive impairment after stroke.Conclusion HBO therapy during the acute stage of cerebral infarction seemed to have little effect on the prognosis of the impairment 6 months after onset.However,it could significantly reduce the incidence of cognitive impairment after stroke and improve the visual spatial/executive function and memory.