高压氧治疗婴幼儿脑瘫的疗效分析

目的探讨高压氧治疗婴幼儿脑瘫的效果。方法选择90例脑瘫患儿随机分为治疗组及对照组,各45例;对照组采用常规药物治疗,治疗组在对照组基础上加用高压氧治疗。结果治疗组治疗前后发育商评分和运动功能评分显著高于对照组(P<0.05);治疗组总有效率为91.1%,显著高于对照组的71.1%(P<0.05);治疗组在高压氧舱治疗过程中未发现眼型、肺型氧中毒的不良反应。结论使用高压氧治疗婴幼儿脑瘫能使患儿运动、言语、智力等功能达到最佳功能状态,且方法简便、不良反应少,是减轻残疾的有效手段之一。     

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.     

高压氧综合治疗急性脑梗死一年期内疗效分析

目的 探讨脑梗死急性期行高压氧治疗对患者1年内神经功能恢复的影响.方法 急性脑梗死患者192例分为高压氧组和非高压氧组,分别于治疗前、治疗20 d、3个月、6个月、12个月时进行神经功能缺损评分对比.根据治疗前神经功能缺损评分,每组患者冉被分为轻、中、重3个亚组进行分析.结果 (1)神经功能缺损轻型组:治疗后各评分时间高压氧组均较非高压氧组有显著改善(P<0.01或P<0.05).(2)神经功能缺损中型组:高压氧20 d组、12个月组较同期非高压氧组有明显改善,差异有统计学意义(P<0.05).(3)神经功能缺损重型组:高压氧6个月组、12个月组较同期非高压氧组有明显改善,差异有统计学意义(P<0.05).(4)高压氧组1年死亡率较非高压氧组有明显降低,差异有统计学意义(P<0.01).高压氧组1年复发率较非高压氧组有明显降低,差异有统计学意义(P<0.05).结论 脑梗死患者急性期行高压氧治疗不仪可以改善患者急性期神经缺损,而且在1年内仍可使患者受益,改善神经功能,降低死亡率及复发率.     

Complications and side effects of hyperbaric oxygen therapy

BACKGROUND: Despite ongoing controversy, hyperbaric oxygen (HBO) therapy is frequently administered in various clinical situations. Probably because of the unique atmospheric conditions to which the patient is exposed, there are concerns about the safety aspects of this therapy. Possible complications during HBO therapy include barotraumatic lesions (middle ear, nasal sinuses, inner ear, lung, teeth), oxygen toxicity (central nervous system, lung), confinement anxiety, and ocular effects (myopia, cataract growth). METHODS: To analyze the medical safety of HBO therapy, this report reviewed complications and side effects of 782 patients treated for various indications with a total of 11,376 HBO therapy sessions within a multiplace chamber. The absolute treatment pressure was 240 or 250 kPa 114 or 15 msw). The compression was performed in a linear manner with 14 to 15 kPa (1.4 to 1.5 msw) x min(-1). All data were gathered prospectively within a special database. RESULTS: More than 17% of all patients experienced ear pain or discomfort as an expression of problems in equalizing the middle ear pressure. Most episodes were not related to a persistent eustachian tube dysfunction since they only occurred once. Barotraumatic lesions on visual otological examinations (ear microscopy) were verified in 3.8% of all patients. Patients with sensory deficits involving the ear region need special attention, because they seem to be at risk for rupture of the tympanic membrane (three cases documented). A barotrauma of the nasal sinuses occurred rarely and no barotraumatic lesions of the inner ear, lung, or teeth were noted. Oxygen toxicity of the CNS manifested by generalized seizures affected four patients without any recognizable risk factors or prodromes. None of the patients suffered recurrences or sequelae. Regular checks of the blood glucose in diabetics failed to reveal episodes of hypoglycemia as a cause for seizures. Lung function tests of patients undergoing prolonged treatment (average 52.8 sessions) did not deteriorate. CONCLUSION: Patients scheduled for HBO therapy need a careful pre-examination and monitoring. If safety guidelines are strictly followed, HBO therapy is a modality with an acceptable rate of complications. The predominant complication is represented by pressure equalization problems within the middle ear. Serious complications rarely occur.     

脑梗死患者高压氧治疗再出血分析

脑梗死是中老年人一种常见病、多发病.其发病在脑血管病中约占75%,病死率高,常遗留有不同程度的后遗症,致残率更高.临床常规约物治疗虽有一定疗效,但治疗时间长,症状体征消失较慢.近年来,国内外广泛采用高压氧综合治疗,取得了较好的疗效.脑梗死患者存进行高压氧综合治疗的同时,有部分患者出现了再出血,亦可称为脑梗死出血性转化(HT),系指脑动脉或其分支栓塞,或血栓形成,发生脑梗塞后,出现动脉再开通,血液从病变的血管漏出,或穿破血管进入脑组织而形成.患者症状和体征均有加重,也有少数患者因起病急而死亡.本文回顾性分析和讨论了我院脑梗死患者高压氧治疗发生再出血的原因,并提出了防治措施.     

高压氧综合治疗对小儿脑瘫运动功能的影响

目的评价高压氧(HBO)综合治疗对小儿脑瘫运动功能的影响。方法采用随机区组配对的统计学方法,将57例小儿脑瘫患者(平均年龄2.3±1.3岁)分为两组:HBO治疗+常规治疗组(HBO组,n=31,0.16～0.20MPa)和常规治疗组(n=26)。评价治疗前、治疗1,2,3个疗程后肌张力(Ashworth指数)、总运动功能评分(GMF评分)。所有首次HBO治疗的患儿在3个月内接受30次(3个疗程)的HBO治疗。通过SPSS12.0统计软件对组内、组间数据进行Wilcoxon符号秩检验。结果HBO组:1个疗程后,Ashworth指数降低(P<0.05);2个疗程后,GMF评分降低(P<0.05)。其中<1岁组患儿的上述两个指标变化较其他两组明显(P<0.001)。结论HBO对轻症、早期(<1岁)脑瘫患儿的治疗效果最佳,对重症、病程长的患儿(>3岁)需要进行长疗程的HBO治疗。     

高压氧早期综合治疗急性脑梗死的临床疗效观察

目的 探讨高压氧早期治疗急性脑梗死的临床疗效.方法 132例急性脑梗死患者,按照高压氧治疗时期分为早期治疗组(发病后7 d内)及晚期治疗组(发病14 d后).高压氧治疗30次后采用改良的爱丁堡-斯堪的纳维亚量表进行神经功能缺损评分(NFD),用改良的Barthel指数(MBI)进行患者的日常生活活动能力评分(ADL).结果 2组患者治疗后的NFD、MBI评分比较差异有统计学意义(P<0.05).结论 高压氧早期治疗对急性脑梗死患者的神经功能恢复、日常生活活动能力均有良好的促进作用,对急性脑梗死的患者应尽早进行高压氧治疗.     

早期应用高压氧进行脑复苏的临床研究

目的 观察早期高压氧( hyperbaric oxygen,HBO)治疗对脑复苏成功率的影响,为临床脑复苏治疗提供依据和方法.方法 将心肺复苏成功的患者分成早期HBO治疗组(发病l周内)和晚期HBO治疗组(发病1周后),在内科治疗的基础上加用HBO治疗,2组的HBO治疗压力、疗程均相同,但HBO治疗的介入时间不同.评定标准采用“2001年中国重新修订的PVS诊断和疗效评分标准(南京标准)”,在HBO治疗前和发病后的第6个月进行意识状态评定.结果 早期HBO治疗组18人,清醒、恢复正常生活4人(有效),清醒、轻残但可自理生活5人(有效),最低意识状态2人(无效),植物状态生存7人(无效),有效率50.0％:晚期HBO治疗组53人,清醒、恢复正常生活9人(有效),清醒、轻残但可自理生活15人(有效),最低意识状态4人(无效),植物状态生存25人(无效),有效率为45.3％.2组有效率比较差异无统计学意义(P＞0.05),但2组有效率与国内外报道的脑复苏成功率(2％～10％)比较,差异有统计学意义(P＜0.05).结论适时的HBO治疗可改善部分心肺复苏患者的预后,保护残存神经细胞,提高智能水平,但早期、超早期HBO治疗不能提高脑复苏成功率.     

高压氧和尼莫地平对缺血再灌注小鼠脑的作用

目的观察高压氧(HBO)和尼莫地平对小鼠脑缺血再灌注的保护治疗作用。方法用昆明种小鼠,结扎双侧颈总动脉,阻断血流30min后恢复血流灌注,同时给予单纯HBO、高压空气和HBO+尼莫地平治疗,检测血小板选择素CD62p、IECa2+、DI和血粘度(WBV),断头取脑作形态学观察并与假手术组对比。结果脑缺血再灌注后手术组CD62p、IECa2+、WBV增高,DI下降明显,与综合治疗组及假手术组相比差异有显著性(P<0.05,P<0.01)。综合治疗组术后第1、2天CD62p、IECa2+明显高于假手术组(P<0.05);但随着治疗天数的增加,CD62p、IECa2+下降,与假手术组比差异无显著性(P>0.05),与手术组比差异有显著性(P<0.05)。高气压组术后CD62p、IECa2+、WBV升高,DI值下降,随着治疗天数增加更显著,与假手术组、手术组及综合治疗组比差异有显著性(P<0.01)。脑组织形态学改变:假手术组小鼠脑片神经元形态正常;手术组脑组织神经细胞数量明显减少,残存的细胞大部分肿胀、固缩或者变性、崩解;高气压组神经细胞广泛肿胀、固缩、变性、崩解明显;综合治疗组仅见少数散在神经细胞肿胀、固缩、变性。结论尼莫地平配合HBO治疗对缺血再灌注小鼠脑有保护作用。     

高压氧治疗对缺血性脑卒中患者凝血-纤溶系统的影响

目的 研究高压氧(HBO)治疗对缺血性脑卒中患者凝血-纤溶系统的影响.方法 将137例急性脑梗死患者分成常规治疗组(常规组)和高压氧治疗组(HBO组),另有健康志愿者27例为对照组.分别于入院第1天、第11天空腹采集静脉血,检测血浆抗凝血酶(AT-Ⅲ)、血栓调节蛋白(TM)、尿激酶型纤溶酶原激活物(uPA)及其受体(uPAR)含量.结果 常规组第1天、第11天血浆AT-Ⅲ低于对照组;TM、uPAR含量高于对照组(P＜0.05).HBO组第1天AT-Ⅲ低于对照组;第1天、第11天TM、uPAR含量均高于对照组(P＜0.05);第11天AT-Ⅲ高于常规组,TM、uPAR含量低于常规组(P＜0.05).常规治疗后AT-Ⅲ升高(P＜0.01);HBO治疗后AT-Ⅲ升高(P＜0.01),TM水平下降(P＜0.05).结论 急性缺血性脑卒中时,HBO治疗可使AT-Ⅲ水平升高、TM和uPAR含量降低,对uPA影响不大,HBO可减轻因缺血、缺氧、血管内皮细胞损伤引起的凝血-纤溶系统异常,加强机体抗凝作用,促进血栓溶解,从而可能改善临床疗效.     

高压氧治疗急性脑梗塞的临床分析

目的观察高压氧（HBO）治疗急性脑梗塞患者的疗效并进行临床分析。方法回顾性研究我院2000年1月至2005年2月急性脑梗塞住院病例共466例。其中高压氧＋药物治疗组（HBO组）303例；单纯药物治疗组（对照组）163例。根据“欧洲卒中量表”（ESS）对HBO组于HBO治疗前、后，对照组于入、出院时分别进行评分并观察疗效。结果HBO组治疗重、中度脑梗塞患者与对照组相比，ESS评分分别有非常显著性差异（P〈0．01）、显著性差异（P〈0．05）；HBO组治疗椎一基底动脉系统脑梗塞与对照组相比，差异有显著性意义（P〈0．05）。HBO治疗次数超过10次组与对照组相比，ESS评分有显著性差异（P〈0．05）。结论重、中度急性脑梗塞和椎一基底动脉系统脑梗塞HBO综合治疗好于单纯药物治疗。HBO治疗次数超过10次组的疗效优于HBO治疗次数不足10次组。     

早期高压氧治疗对急性颅脑外伤患者失语症的疗效观察

目的 研究早期高压氧(HBO)治疗对急性颅脑外伤患者失语症的疗效.方法 将2004年1月至2007年8月在我院住院的62例急性颅脑外伤患者分为HBO治疔组和常规治疗组,常规治疗组采用临床常规治疗,HBO治疗组在常规治疗的基础上,实施24～48次HBO治疗,并且在治疗结束后1年内每3个月进行1次随访.在治疗前、后分别采用西方失语成套测试法(western aphasia,WAB)检测并进行CT检查,对他们的语言功能和恢复情况进行评价和比较.结果 HBO治疗组显效率(83.8%)显著高于常规治疗组(54.8%),经x2检验P＜0.05;CT检查证实患者病变部位阻塞的血管已经恢复冉通或已获得重建.结论 早期HBO治疗有利于促进或恢复患者的语言功能.     

The effects of dual tasks on gait in children with cerebral palsy

AimTo assess the gait and cognitive performances of children with cerebral palsy (CP) during dual tasks (DT) in comparison to typically developing (TD) children.MethodThis prospective, observational, case-control study included 18 children with CP (7 girls, 11 boys; median age 12 [10:13] years and 19 controls (9 girls, 10 boys; median age 12 [10:13y6mo] years). Performances were recorded during a simple walking task, 5 DT (walking + cognitive tasks with increasing cognitive load), and 5 simple cognitive tasks (while sitting). Gait parameters were computed using an optoelectronic system during walking tasks. Six parameters were selected for analysis by a principal component analysis. Cognitive performance was measured for each cognitive task. The dual-task cost (DTC) was calculated for each DT.ResultsGait performance decreased in both groups as DT cognitive load increased (e.g., walking speed normalized by leg length, in simple task: 1.25 [1.15:1.46] s⁻¹ for CP, 1.53 [1.38:1.62] s⁻¹ for TD; DT with highest load: 0.64 [0.53:0.80] s⁻¹ for CP, 0.95 [0.75:1.08] s⁻¹ for TD). The CP group performed significantly worse than TD group in every task (including the simple task), but DTC were similar in both groups. A task effect was found for the majority of the gait parameters.InterpretationThe reduced gait performance induced by DT may generate underestimated difficulties for children with CP in daily-life situations, where DT are common. This should be considered in clinical assessments.     

Gait initiation in children with cerebral palsy

The task of gait initiation (GI), or taking a first step from a static standing position requires the development of forward momentum while maintaining dynamic balance as the body's center of mass (COM) moves forward and outside the base of support. The dynamics of GI in children (aged 7-12 years) with hemiplegic cerebral palsy (CP), diplegic CP and children with typical development (TD) were compared to characterize the mechanics and control of this task. Ground reaction forces (GRFs) and muscle activity were collected during GI at three different self-selected speeds (slow, moderate and fast). Movement of a sacral marker was also tracked to estimate downward shifting of the body during the GI task. Results demonstrate the presence of a motor sequence characterized by increased forward momentum development with increased GI speed for all groups of children. Anticipatory movements of children with CP were different when compared to children with TD. Children with hemiplegic CP demonstrated decreased lateral shifting while children with diplegic CP demonstrated a trend of decreased downward shifting of the body compared to children of TD. Analysis of the GI motor sequence in children provides a means to characterize coordination and motor control of a functional ambulatory task in children with CP compared to children with TD.     

脑性瘫痪儿童的影像学特征

目的脑性瘫痪的诊断主要靠临床表现，而影像学检查（头颅CT及MRI）对脑瘫的诊断及脑病变的判定起重要作用。痉挛型双瘫以脑室周围白质软化症（PVL）为主，不随意运动型表现为基底病变或PVL，失调型表现为先天性小脑发育不良，偏瘫型主要突出在对侧单侧脑损伤。利用影像学检查（头颅CT及MRI）有助于脑瘫的诊断及脑病变的判定，为脑瘫儿童的治疗或改善预后提供可靠依据。     

高压氧综合治疗对脑外伤后脑缺血缺氧及脑水肿的疗效分析

随着人们对脑外伤治疗上认识的不断提高,对外伤后脑缺血缺氧对脑组织的损伤也越来越重视[1-4].我科对2001年以来的80例中重型颅脑损伤患者实施了高压氧(hyperbaric oxygen,HBO)综合治疗,以防止脑缺血缺氧的发生,取得一定疗效.     

Clinical and MR correlates in children with extrapyramidal cerebral palsy.

PURPOSETo identify the characteristic MR findings in extrapyramidal cerebral palsy.METHODSix patients who had suffered intrapartum asphyxia and who subsequently developed extrapyramidal cerebral palsy were identified. Asphyxia was evidenced by severe neonatal systemic acidosis as documented by a venous cord pH of less than 7.0 whenever available, or acidosis in subsequent arterial blood gas samples, and clinical signs of an acute hypoxic-ischemic encephalopathy during the neonatal period. In addition, 1- and 5-minute Apgar scores were 3 or less, and there had been need for intubation or vigorous resuscitation in the delivery room. There were three boys and three girls, all born at term, with birth weight appropriate for gestational age, and without a history of bilirubin levels above 15 mg/dL. MR imaging at 1.5 T was performed between 1 and 19 years of age.RESULTSIn all subjects focal high signal abnormality was demonstrated in the posterior putamen and the anterior or posterior thalamus. There were no other findings in most cases.CONCLUSIONMR demonstrated lesions in the putamen and thalamus in all of our six patients with severe extrapyramidal cerebral palsy who had suffered intrapartum asphyxia.