高压氧综合治疗小儿脑瘫144例疗效分析

小儿性瘫痪是指从妊娠到新生儿期，以各种原因所致的脑组织非进行性病变为基础，形成永存的运动和姿势异常的脑功能障碍综合征。临床上对小儿脑性瘫痪无特效方法，一般采取综合治疗（功能锻炼、针炙、药物及加强营养等）。我院自1999年开始采用高压氧综合治疗小儿脑性瘫痪144例。现报告如下。     

高压氧综合治疗格林-巴利综合征一例

我院2004年收治1名患格林．巴利综合征的3岁男童，予以高压氧（HBO）治疗，疗效良好。现报道如下。     

高压氧综合治疗慢性格林巴利22例

慢性格林巴利又称慢性炎症性脱髓鞘性多发性神经病(CIDP)，病程缓慢易复发，本文选择我院1996年以来收治的CIDP22例应用高压氧(HBO)综合治疗，取得较满意疗效，结果报道如下。     

高压氧综合治疗急性一氧化碳中毒1260例分析

急性一氧化碳中毒（ACOP）是冬季我国北方的高寒地区的常见急诊之一，目前的治疗措施主要是一方面尽快促使中毒者体内的碳氧血红蛋白（HbCO）解离，恢复正常血红蛋白的携氧和供氧功能；另一方面尽快恢复因缺氧造成的器官组织功能损伤。我院自1996年引进高压氧（HBO）治疗以来，收治了1260例ACOP患者，经临床联合HBO治疗，取得了较好效果，现报告如下。     

高压氧综合治疗中老年脑梗死患者的疗效观察

脑梗死是中、老年人常见病和多发病之一，其致残率高，严重影响患者的生命质量，给家庭、社会造成沉重负担。2000年2月至2004年2月我院对63例中、老年脑梗死患者进行高压氧（HBO）治疗，并对其疗效进行对比分析。     

告知制度在高压氧治疗中的实施与作用

由于高压氧（HBO）治疗环境的特殊性，医疗安全不容忽视。我科2003年1月至2006年3月对接受HBO治疗的18631人次患者实施告知制度，效果满意。现报告如下。     

高压氧治疗急性天然气中毒五例

家用天然气为经过脱硫处理后的净化天然气，毒性极低，临床上因家用天然气导致中毒的病例较为少见。2004年12月，我科相继收治5例因家用天然气中毒患者，经高压氧（HBO）治疗疗效显著。现报告如下。     

高压氧综合治疗脑外伤并迟发性尿崩症一例

患儿，男，7岁。因车祸致伤头部，伤后即昏迷，呼吸停止。以重型颅脑损伤急送我院。经抢救呼吸恢复，伴呕吐、四肢抽搐，CT示：脑干见小结节状高密度影（IM4），左额颞顶部头皮血肿；体检：T38℃，P130／min，R30次／min，BP130／84mmHg，昏迷，双侧瞳孔等大等圆，光反射迟钝，收神经外科重症ICU病房。1周后行高压氧（HBO）治疗，采用宁波产DYC／750AK型单人纯氧舱。     

高压氧治疗阴道炎症20例观察

阴道炎症是妇科门诊的常见病、多发病。目前,临床上多采用局部或全身性药物治疗,部分患者疗效不理想。我科应用高压氧(HB0)治疗阴道炎症,疗效满意。现报告如下。一、临床资料1．一般资料:全部病例20例,均来自我院妇科门诊,符     

脑血栓患者高压氧治疗前后的体外血栓变化(论著)

目的：观测高压氧（ＨＢＯ）治疗前后脑血栓患者的体外血栓变化情况。方法：选择２０例脑血栓形成的患者在ＨＢＯ治疗前及治疗１５次后抽静脉血检测在体外血栓形成的长度和湿重并进行比较分析。结果：２０例患者ＨＢＯ治疗前体外血栓平均长度为２２．５５ｍｍ，治疗后为１３．０５ｍｍ；血栓湿重治疗前平均为５４．１ｍｇ，治疗后为３２．３ｍｇ，两者前后相差均非常显著（Ｐ＜０．０１）。结论：ＨＢＯ治疗有明显减小脑血栓患者体外血栓形成的作用     

高压氧联合奥美拉唑治疗十二指肠溃疡60例

目的 探讨高压氧（HBO）联合奥美拉唑对十二指肠溃疡（DU）的治疗作用。方法 选择门诊十二指肠溃疡患者60例给予HBO加奥美拉唑治疗（HBO组），另选择同类患者30例仅给予奥美拉唑治疗（对照组），比较治疗前和治疗2周后溃疡情况及幽门螺杆菌检出率。结果 治疗2周后，两组患者溃疡的长征，短径和深度均较治疗前有显著减小（P＜0．001），HBO组溃疡的长征，短径和深度的减少较对照组显著（P＜0．001）；两组幽门螺杆菌的阳性率治疗后显著低于治疗前（P＜0．001），治疗后HBO组幽门螺杆菌菌的阳性率显著低于对照组（P＜0．001）。结论 HBO联合奥美拉唑对十二指肠溃疡有良好的治疗作用。     

高压氧辅助治疗小儿急性氟乙酰胺中毒的疗效

目的探讨高压氧(HBO)辅助治疗小儿急性中、重度氟乙酰胺中毒的疗效.方法71例患者随机分成两组对照组36例,采用常规治疗(洗胃、使用特效解毒剂乙酰胺、抗感染、止痉、能量合剂等);HBO组35例,在上述治疗基础上辅以HBO治疗,即将患儿置于加压舱内停留100min,治疗压力0.2MPa(2ATA),家长助其戴面罩吸纯氧50min,中间休息吸空气10min,每日1次,10次为1个疗程,一般只需治疗5～10次.结果HBO组昏迷清醒时间(h)明显快于对照组,有非常显著性差异(52.66±19.02vs71.03±34.04,t=2.79,P＜0.01);HBO组治愈天数比对照组明显缩短,有显著性差异(9.1±2.1vs12.8±4.1,t=2.57,P＜0.05);HBO组治愈率88.6%高于对照组69.4%,有显著性差异(x2=3.89P＜0.05).结论HBO辅助治疗小儿急性氟乙酰胺中毒,对促使昏迷患儿尽快清醒、缩短病程和提高疗效作用显著,值得临床推广应用.     

高压氧对脑梗死患者脑电图和诱发电位的影响

目的研究高压氧（HBO）对急性脑梗死患者脑电图（EEG）和脑干听觉诱发电位（BAEP）的影响。方法94例急性脑梗死患者分为HBO治疗组和对照组各47例，疗程2周；治疗前后检查EEG和BAEP等。结果HBO组总有效率96．3％，对照组66．0％（P〈0．01）；HBO治疗后EEG和BAEP均比治疗前明显改善（P〈0．05，P〈0．01）；对照组虽亦改善，但不如HBO组明显。结论HBO治疗可以有效改善急性脑梗死患者脑功能。     

不同时间窗高压氧治疗对脑性瘫痪患儿疗效的影响

目的 观察不同时间窗高压氧治疗对脑性瘫痪患儿疗效的影响.方法 共选取3月龄脑瘫患儿60例,将其按数字表法随机分为1、2、3、4共4个组,每组15例.4组均给予常规康复治疗,1组患儿在月龄3～4月内开始高压氧治疗,2组患儿在月龄4～6个月进行高压氧治疗,3组患儿在月龄6个月以上进行高压氧治疗,4组患儿未给予高压氧治疗.共给予40次HBO治疗.常规康复治疗持续到1岁.分别在治疗前及1岁时应用粗大运动功能测试量表(gross motor function measure,GMFM)评定患儿粗大运动发育情况,用Gesell发育量表进行智能评估,计算粗大运动、精细运动、适应性、语言、个人社会、发育商及总发育商.结果 1岁时,4组患儿GMFM、粗大运动、精细运动、适应性、语言、个人社会、发育商及总发育商均较治疗前显著改善,其中1组[(30.55±8.44)分]的改善幅度显著优于2组[(26.43±7.52)分]、3组[(20.88±6.69)分]、4组[(19.14±4.38)分],差异具有统计学意义(P＜0.05);2组患儿的改善幅度显著优于3、4组,差异亦有统计学意义(P＜0.05);3、4组间疗效差异无统计学意义(P＞0.05).4组患儿在治疗期间均未发生严重不良反应.结论 高压氧治疗时间窗对脑性瘫痪患儿疗效具有重要影响.开始治疗时间越早疗效越佳,3～4个月内进行高压氧治疗疗效最佳,4～6个月疗效次之,超过6个月则无显著疗效.     

高压氧综合治疗对脑挫裂伤患者免疫功能的影响

目的 研究高压氧治疗脑挫裂伤前后患者免疫功能的变化.方法 采用免疫速率散射比浊法检测114例脑挫裂伤患者治疗前后血浆中C3、C4、IgG、IgA、IgM的变化,采用GCS评分标准判断疗效.结果 GCS评分:高压氧治疗组(12.95±1.96)分,对照组(9.67±2.82)分,两组比较差异有统计学意义(P＜0.01).补体水平:高压氧组治疗前C3、C4分别为(0.97±0.28)g/L和(0.31±0.27)g/L;治疗后C3、C4分别为(1.20±0.23)g/L和(0.43±0.27)g/L;治疗前后结果比较差异有统计学意义(P＜0.01),与对照组比较差异无统计学意义(P＞0.05).免疫球蛋白水平:高压氧治疗前IgG(10.47±2.89)g/L,治疗后(9.83±3.2)g/L,治疗前后比较差异有统计学意义(P＜0.05);IgA治疗前(1.45±0.65)g/L,治疗后(1.53±0.84)g/L,治疗前后比较差异无统计学意义(P＞0.05);IgM治疗前(2.04±0.87)g/L,治疗后(1.86±0.94)g/L,治疗前后比较差异有统计学意义(P＜0.01).结论 高压氧治疗脑挫裂伤能明显增强机体的免疫机能.     

Selective motor control correlates with gait abnormality in children with cerebral palsy

Children with bilateral cerebral palsy (CP) commonly have limited selective motor control (SMC). This affects their ability to complete functional tasks. The impact of impaired SMC on walking has yet to be fully understood. Measures of SMC have been shown to correlate with specific characteristics of gait, however the impact of SMC on overall gait pattern has not been reported. This study explored SMC data collected as part of routine gait analysis in children with bilateral CP.As part of their clinical assessment, SMC was measured with the Selective Control Assessment of the Lower Extremities (SCALE) in 194 patients with bilateral cerebral palsy attending for clinical gait analysis at a single centre. Their summed SCALE score was compared with overall gait impairment, as measured by Gait Profile Score (GPS).Score on SCALE showed a significant negative correlation with GPS (r_s = −0.603, p < 0.001). Cerebral injuries in CP result in damage to the motor tracts responsible for SMC. Our results indicate that this damage is also associated with changes in the development of walking pattern in children with CP.     

高压氧对兔眼视网膜血流量的影响

目的　研究正常兔眼在高压氧 (HBO)治疗结束时及其后不同时程视网膜血流量的变化 ,为 HBO在眼科的应用提供基础数据。方法　采用放射微球标记法分别测在 HBO治疗结束时、出氧舱后1,2 ,4,2 0 h时的视网膜血流量 ,并与对照组比较。结果　 HBO治疗结束时 ,平均视网膜血流量由 (16 .87± 4.86 ) m l· min- 1 · g- 1 (对照组值 )降为 (0 .2 1± 0 .0 8) ml· m in- 1 · g- 1 (P<0 .0 1) ;出氧舱后 1h,平均血流量较 HBO治疗结束时明显升高 ,之后持续升高 ,至 4h时恢复正常 (P>0 .0 5 )。结论　 HBO治疗后兔眼视网膜血流量明显减少 ,出氧舱后持续 4h的低血流量状态 ,有可能影响视功能。     

Virtual motor training to improve the activities of daily living,hand grip,and gross motor function among children with cerebral palsy: Meta-regression analysis

BackgroundGiven that cerebral palsy is a lifelong condition, continuous motor training is necessary to correct abnormal posture and patterns to improve functional performance.ObjectiveTo explore the essential features of virtual motor training and identify its effects on the activities of daily living, hand grip function, and gross motor function among children with cerebral palsy.MethodsTen databases were systematically searched for randomized controlled trials from inception until October 15, 2019. Studies with a randomized controlled trials design, children with cerebral palsy, comparisons of virtual motor training with other interventions, and activities of daily living, hand grip, and gross motor function outcomes were included. Subgroup analyses and meta-regression were performed. The effect size was assessed using random-effects meta-analysis and evaluated by using Hedges’ g. Random effects univariate meta-regression model was used to examine the association of covariates with intervention effectiveness.ResultsSeventeen randomized controlled trials with 853 participants were included. Meta-analysis indicated that the virtual motor training had significant positive effects on activities of daily living (g = 0.31, 95% confidence interval, CI = 0.10, 0.51), grip (g = 0.40, 95% CI = 0.08, 0.71), and gross motor (g = 0.71, 95% CI = 0.43, 0.99) function. Univariate random-effects meta-regression analysis indicated an increase in activities of daily living scores for motion capture systems that used depth imaging compared with those that used digital imaging.SignificanceOur systematic review indicated that virtual motor function may significantly improve ADLs, hand grip, and gross motor functions among children with cerebral palsy.     

Reliability and validity of Edinburgh visual gait score as an evaluation tool for children with cerebral palsy

Assessment of gait abnormalities in cerebral palsy (CP) is challenging, and access to instrumented gait analysis is not always feasible. Therefore, many observational gait analysis scales have been devised. This study aimed to evaluate the interobserver reliability, intraobserver reliability, and validity of Edinburgh visual gait score (EVGS). Video of 30 children with spastic CP were reviewed by 7 raters (10 children each in GMFCS levels I, II, and III, age 6–12 years). Three observers had high level of experience in gait analysis (10+ years), two had medium level (2–5 years) and two had no previous experience (orthopedic fellows). Interobserver reliability was evaluated using percentage of complete agreement and kappa values. Criterion validity was evaluated by comparing EVGS scores with 3DGA data taken from the same video visit. Interobserver agreement was 60–90% and Kappa values were 0.18–0.85 for the 17 items in EVGS. Reliability was higher for distal segments (foot/ankle/knee 63–90%; trunk/pelvis/hip 60–76%), with greater experience (high 66–91%, medium 62–90%, no-experience 41–87%), with more EVGS practice (1st 10 videos 52–88%, last 10 videos 64–97%) and when used with higher functioning children (GMFCS I 65–96%, II 58-90%, III 35–65%). Intraobserver agreement was 64–92%. Agreement between EVGS and 3DGA was 52–73%. We believe that having EVGS as part of the standardized gait evaluation is helpful in optimizing the visual scoring. EVGS can be a supportive tool that adds quantitative data instead of only qualitative assessment to a video only gait evaluation.