早期足疗程高压氧综合治疗对急性不完全性脊髓损伤患者神经电生理的影响

Effect of early and full course of hyperbaric oxygen therapy on neuroelectrophysiology in patients with acute incomplete spinal cord injury

目的探讨早期、足疗程高压氧(HBO)综合治疗对急性不完全性脊髓损伤(SCI)患者临床疗效和神经电生理的影响。方法选取2017年2月至2020年2月烟台山医院骨科和毓璜顶医院脊柱科入住的急性不完全性SCI患者65例为研究对象。按照治疗方法分为观察组(n=42)和对照组(n=23),对照组患者予以常规药物或手术治疗,观察组患者在对照组治疗的基础上予以早期(<48 h)、足疗程的HBO治疗。于治疗前和治疗14、28 d后进行Frankel分级评分和ASIA评分,并评定临床治疗疗效;应用肌电图诱发电位仪检测治疗前和治疗14、28 d后患者下肢运动神经传导速度(MCV)、感觉神经传导速度(SCV)、感觉神经动作电位(SAP)波幅、运动诱发电位(MEP)和体感诱发电位(SEP)。结果治疗4个疗程后,观察组患者治疗总有效率(85.71%)明显高于对照组(69.57%),差异有统计学意义(χ^(2)=6.994,P<0.05)。与治疗前比较,2组患者治疗14 d神经功能、运动功能评分明显提高;与治疗14 d比较,治疗28 d神经功能、运动功能评分明显提高;与对照组治疗后比较,神经功能、运动功能评分均明显提高,差异均有统计学意义(P<0.05)。与治疗前比较,2组患者治疗14 d胫神经和腓总神经SEP、MEP波幅峰值增高,潜伏期缩短;与治疗14 d比较,治疗28 d胫神经和腓总神经SEP、MEP波幅峰值增高,潜伏期缩短。与对照组治疗后比较,胫神经和腓总神经SEP、MEP波幅峰值增高,潜伏期缩短,差异均有统计学意义(P<0.05)。2组患者治疗14 d胫神经和腓总神经的SCV、MCV与治疗前比较明显提高;与治疗14 d比较,治疗28 d胫神经和腓总神经的SCV、MCV明显提高;与对照组治疗后比较,胫、腓总神经SCV、MCV均明显提高,差异均有统计学意义(P<0.05)。结论早期、足疗程HBO综合治疗急性不完全性SCI患者,可显著改善其运动、感觉和诱发电位,并明显提高临床治疗效果,有利于脊神经功能恢复。

Objective To investigate the effect of early and full course of hyperbaric oxygen(HBO)therapy on neuroelectrophysiology in patients with acute incomplete spinal cord injury(iSCI).Methods A total of 65 patients with acute iSCI admitted to the Department of Orthopedics of Yantai Mountain Hospital and the Department of Spine Injury of Yuhuangding Hospital from February 2017 to February 2020 were selected as the research objects.According to the treatment,they were divided into observation group(n=42)and control group(n=23).The patients in the control group were treated with conventional drugs or surgery,while the patients in the observation group were treated with full course of HBO at early stage(<48 h)on the basis of the treatment in the control group.The scores of Frankel scale and American Spinal Injury Association(ASIA)impairment scale were collected before treatment,and 14 and 28 days after treatment;and the clinical efficacy was evaluated.The motor nerve conduction velocity(MCV),sensory nerve conduction velocity(SCV),amplitude of sensory action potential(SAP),motor evoked potential(MEP),and somatosensory evoked potential(SEP)of lower limbs were measured and calculated by electromyography and evoked potential meter before treatment,14 days and 28 days after treatment.Results After four courses of treatment,the total effective rate of the observation group(85.71%)was significantly higher than that of the control group(69.57%)with a statistically significant difference(χ^(2)=6.994,P<0.05).Compared with those before treatment,the scores of neurological and motor functions(ASIA scale and Frankel scale)of the two groups after 14 days of treatment were significantly increased;compared with the scores after 14 days of treatment,the scores of neurological and motor functions after 28 days of treatment were significantly increased;compared with the scores of the control group,the scores of neurological and motor functions of the treatment group were significantly increased;and all of these were statistically significant(P<0.05).Compared with those before treatment,the peak amplitudes of SEP and MEP of tibial nerve and common peroneal nerve in the two groups were increased and the latencies were shortened after 14 days of treatment;compared with those after 14 days of treatment,the peak amplitudes of SEP and MEP of anterior tibial nerve and common peroneal nerve were increased and the latencies were shortened after 28 days of treatment;compared with those in the control group after treatment,the peak amplitudes of SEP and MEP of anterior tibial nerve and common peroneal nerve in the observation group after treatment were increased and the latencies were shortened;and all of these were statistically significant(P<0.05).Compared with those before treatment,the SCV and MCV of tibial nerve and common peroneal nerve in the two groups were significantly increased after 14 days of treatment;compared with those after 14 days of treatment,the SCV and MCV of anterior tibial nerve and common peroneal nerve were significantly increased after 28 days of treatment;compared with those in the control group after treatment,the SCV and MCV of anterior tibial nerve and common peroneal nerve in the observation group after treatment were significantly increased(P<0.05);and all of these were statistically significant(P<0.05).Conclusion For patients with acute iSCI,early and full course of HBO therapy can significantly improve their neuro-bioelectricity such as motor,sensory,and other evoked potentials,improve the clinical efficacy,and facilitate the recovery of spinal nerve function.