早期高压氧治疗热射病中枢性损害的疗效分析

Early hyperbaric oxygen therapy for central lesion in heat stroke

目的观察早期高压氧治疗热射病中枢性损害的临床疗效。方法选取2017年6月至2019年6月在合肥市第二人民医院重症医学科住院治疗的热射病患者46例,采用随机数字表法将46例热射病患者分为高压氧治疗组及对照组,每组23例,对照组给予吸氧、降温、维持呼吸、循环功能稳定、防治脑水肿及补液纠正水、电解质酸碱平衡紊乱等常规治疗,高压氧治疗组在对照组基础上配合高压氧治疗。治疗2个疗程,每个疗程10 d。于治疗前、治疗2个疗程后比较两组患者格拉斯昏迷评分(GCS评分)、神经功能缺损程度量表(NFDS)评分、小脑功能障碍发生率;治疗后1、3、6个月对两组患者进行随访,每次随访分别进行标准日常生活能力Barthel指数(BI)比较两组患者日常生活质量。结果经过2个疗程治疗后,高压氧治疗组NFDS评分[(14.70±6.38)分]明显低于对照组[(20.39±7.77)分],GCS评分[(12.52±2.06)分]明显高于对照组[(10.43±2.76)分],差异均有统计学意义(t=2.718、2.904,均P<0.05);高压氧治疗组小脑功能障碍发生率(4.3%)低于对照组(13.0%),差异无统计学意义(χ^(2)=1.10,P>0.05);治疗后1、3、6个月两组患者BI指数比较,高压氧治疗组均高于对照组,差异均有统计学意义(t=3.87、3.77、3.72,均P<0.05)。结论早期高压氧治疗能够改善热射病患者神经功能及日常生活能力,提高患者远期生活质量。

Objective To investigate the clinical effect of early hyperbaric oxygen therapy on central lesion in heat stroke.Methods Forty-six patients with heat shock who received treatment in the Second People's Hospital of Hefei from June 2017 to June 2019 were included in this study.These patients were randomly divided into a treatment group and a control group,with 23 patients in each group.The control group was given routine treatments,including oxygen inhalation,cooling,maintenance of stable respiratory and circulatory function,prevention and treatment of brain edema,and fluid replacement to correct water,electrolyte,and acid-base imbalance.The treatment group was given hyperbaric oxygen treatment based on the treatment given in the control group.Each group was treated for two courses of 10-day treatment.Before treatment and after two courses of treatment,the Glasgow Coma Scale score,National Institutes of Health Stroke Scale score,and the incidence of cerebellar dysfunction were compared between the treatment and control groups.At 1,3 and 6 months after treatment,quality of life measured by Barthel index,was compared between the treatment and control groups.Results After two courses of treatment,the National Institutes of Health Stroke Scale score in the treatment group was significantly lower than that in the control group[(14.70±6.38)points vs.(20.39±7.77)points,t=2.718,P<0.05],and the Glasgow Coma Scale score in the treatment group was significantly higher than that in the control group[(12.52±2.06)points vs.(10.43±2.76)points,t=2.904,P<0.05].At the same time,the incidence of cerebellar dysfunction in the treatment group was significantly lower than that in the control group(4.3%vs.13.0%,χ^(2)=1.10,P>0.05).At 1,3 and 6 months after treatment,and Barthel index in the treatment group was significantly higher than that in the control group(t=3.87,3.77 and 3.72,all P<0.05).Conclusion Early hyperbaric oxygen therapy can improve the neurological function and activities of daily living of patients with heat stroke,and improve long-term quality of life.