高压氧联合重复经颅磁刺激治疗一氧化碳中毒迟发性脑病的临床价值探析

Clinical value of hyperbaric oxygen combined with rTMS in the treatment of DEACMP was investigated

目的研究高压氧联合重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)治疗后,DEACMP患者认知功能及运动功能情况,并分析临床意义。方法选择2017年1月至2022年1月南昌市第一医院收治的一氧化碳中毒迟发性脑病(delayed encephalopathy after acute carbon monoxide poisoning,DEACMP)患者124例,给予高压氧联合rTMS治疗,10d后将其分为长程组(n=64)和短程组(n=60),长程组继续给予联合治疗至满30d,短程组在第11天起停用rTMS,持续行高压氧(hyperbaric oxygen,HBO)治疗至满30d,比较各组治疗前后简易精神状态检查量表(mini-mental state examination,MMSE)、功能独立性评定量表(functional independence measure,FIM)量表评分、事件相关诱发电位(event-related potential,ERP)的P300潜伏期及波幅测定。结果DEACMP患者治疗10d后与治疗前比较,MMSE、P300潜伏期、P300波幅评分,差异无统计学意义(P>0.05),而FIM评分较治疗前差异有统计学意义(P<0.05);长程组30d后与同组10d后、短程组30d后分别比较,各项量表评分比较,差异有统计学意义(P<0.05);短程组30d后与同组10d后比较,各项量表评分比较,差异无统计学意义(P>0.05)。结论高压氧联合rTMS治疗,能够明显改善DEACMP患者认知功能、生活自理能力,且治疗周期越长,患者认知及生活自理能力改善效果越显著。

Objective To study the cognitive function and motor function of delayed encephalopathy after acute carbon monoxide poisoning(DEACMP)patients after hyperbaric oxygen combined with repetitive transcranial magnetic stimulation(rTMS)treatment and to analyze the clinical significance.Methods A total of 124 patients with DEACMP admitted to the Third Affiliated Hospital of Nanchang University from January 2017 to January 2022 were selected and treated with hyperbaric oxygen combined with rTMS,and after 10 days they were divided into a long-term treatment group(n=64)and a short-term treatment group(n=60),and the long-term treatment group continued to give the combined treatment until the completion of 30 days,and the short-term treatment group discontinued rTMS from the 11th day and continued hyperbaric oxygen(HBO)treatment until the completion of 30 days,comparing the mini-mental state examination(MMSE),functional independence measure(FIM)scale score,P300 latency and wave amplitude measurement of ERP before and after treatment in each group.Results There were no significant differences in MMSE,P300 latency,and P300 wave amplitude scores after 10 days of treatment in DEACMP patients compared with before treatment(P>0.05),while there were significant differences in FIM scores compared with before(P<0.05);there were statistically significant differences in the scale scores after 30 days in the long-term treatment group compared with 10 days in the same group and 30 days in the short-term treatment group,respectively(P<0.05);There was no statistically significant difference(P>0.05)between the scores of the scales in the short-term treatment group after 30 days compared with the same group after 10 days.Conclusion Hyperbaric oxygen combined with rTMS treatment can significantly improve the cognitive function and self-care ability of DEACMP patients,and the longer the treatment period,the more significant the improvement of patients’cognitive and self-care ability.