基于OPT康复训练联合高压氧治疗对重症病毒性脑炎合并吞咽障碍患儿吞咽功能、脑氧代谢及血清神经损害指标的影响

Effect of OPT Rehabilitation Training Combined with Hyperbaric Oxygen Therapy on Swallowing Function,Cerebral Oxygen Metabolism,and Serum Neurological Damage Indicators in Children with Severe Viral Encephalitis Complicated with Swallowing Disorders

目的:基于口腔定位疗法(OPT)康复训练联合高压氧治疗对重症病毒性脑炎合并吞咽障碍患儿吞咽功能、脑氧代谢及血清神经损害指标的影响。方法:选取2015年1月到2022年8月期间南部战区总医院接收的重症病毒性脑炎合并吞咽障碍患儿80例。采用信封抽签法将患儿分为对照组(常规对症治疗、口腔吞咽康复训练的基础上联合OPT康复训练)和研究组(对照组的基础上联合高压氧治疗),各为40例。对比两组疗效、吞咽功能、脑氧代谢及血清神经损害指标。结果:研究组干预后的临床总有效率高于对照组(P<0.05)。干预后,研究组口腔期、食管期、咽期的吞咽障碍调查表(DDS)评分低于对照组(P<0.05)。干预后,研究组血氧饱和度(SjvO_(2))、脑氧摄取率(CERO_(2))高于对照组,脑动静脉血氧含量差(Da-jvO_(2))低于对照组(P<0.05)。干预后,研究组脑源性神经营养因子(BDNF)高于对照组,髓鞘碱性蛋白(MBP)、中枢神经特异性蛋白(S100β)、神经元特异性烯醇化酶(NSE)、β-内啡肽(β-EP)低于对照组(P<0.05)。结论:重症病毒性脑炎合并吞咽障碍患儿采用OPT康复训练联合高压氧治疗,可显著改善吞咽功能、脑氧代谢、血清神经损害指标水平。

Objective:To investigate the effects of oral positioning therapy(OPT)combined with hyperbaric oxygen rehabilitation training on cerebral oxygen metabolism,swallowing function,and serum neurological damage indicators in children with severe viral encephalitis complicated with swallowing disorders.Methods:80 children with severe viral encephalitis and swallowing disorders who were admitted to Southern Theater Command General Hospital from January 2015 to August 2022 were selected.The children were divided into control group(conventional symptomatic treatment,oral swallowing rehabilitation training combined with OPT rehabilitation training)and study group(control group combined with hyperbaric oxygen treatment)using envelope drawing method,with 40 cases each.The efficacy,swallowing function,cerebral oxygen metabolism,and serum neurological damage indicators between the two groups were compared.Results:The total clinical effective rate of the study group after intervention was higher than that of the control group(P<0.05).After intervention,the swallowing disorders questionnaire(DDS)scores of the study group in Oral stage,esophageal stage and pharyngeal stage were lower than those of the control group(P<0.05).After the intervention,the oxygen saturation(SjvO_(2))and cerebral oxygen uptake rate(CERO_(2))in the study group were higher than those in the control group,and the cerebral arteriovenous oxygen content difference(Da-jvO_(2))was lower than that in the control group(P<0.05).After the intervention,brain derived neurotrophin(BDNF)in the study group was higher than that in the control group,myelin basic protein(MBP),central nervous system specific protein(S100β),neuron specific enolase(NSE),β-Endorphin(β-EP)were lower than those in the control group(P<0.05).Conclusion:The combination of OPT rehabilitation training and hyperbaric oxygen therapy can significantly improve swallowing function,cerebral oxygen metabolism,and serum neurological damage indicator levels in children with severe viral encephalitis complicated with swallowing disorders.