高压氧治疗带状疱疹后遗神经痛伴中枢性止痛药依赖1例

近年来,毒麻药物滥用依赖乃至成瘾的问题日趋严重,本文分析我科利用高压氧治疗带状疱疹后遗神经痛(PHN)伴口服中枢性止痛药依赖的1例患者的临床资料,旨在为临床治疗毒麻药依赖或成瘾的研究提供新思路。1临床资料1.1一般资料患者男,64岁。因左头颈背部疼痛3 d,相应部位皮肤起疹1 d来我院就诊。当时查体:除左枕部、颈部及背     

带状疱疹后遗神经痛的治疗现状

带状疱疹后遗神经痛 (posther peticneuralgia ,PHN)是指急性带状疱疹患者疱疹消退后疼痛持续经过3月者[1] 。PHN的临床特征为持续性、自发性灼痛或深在性疼痛、跳痛 ,自发性刀割样疼痛或阵发性灼痛 ,异常性疼痛和感觉过敏及难以忍受的瘙痒。PHN虽可发生在青壮年 ,但常见于中、     

高压氧综合治疗带状疱疹后遗神经痛疗效观察及护理

［摘要］　目的　探讨高压氧综合治疗带状疱疹后遗神经痛（PHN)的疗效及护理特点。方法　将80例PHN患者按随机数字表法分为观察组和对照组各40例,两组均给予常规药物及激光治疗,观察组在此基础上行高压氧治疗并采取相应的护理措施,治疗3个疗程,采用视觉模拟评分法（VAS）进行疼痛评估,比较治疗前、后疼痛情况及疗效。结果　治疗后两组VAS评分均低于治疗前（P<0.05）,且观察组评分明显低于对照组（P<0.01）。观察组总有效率95.0%,对照组总有效率77.5%,两组比较差异有统计学意义（P<0.01）,观察组疗效优于对照组。结论　高压氧综合治疗PHN疗效确切,能明显改善疼痛症状,提高治疗效果,是一种安全可靠的治疗手段。     

带状疱疹后遗神经痛研究进展

带状疱疹是由潜伏于脊髓后根神经节中的水痘-带状疱疹病毒被各种诱发因素再次激活所引起的急性感染性皮肤病。近年来,带状疱疹的发病率呈逐年上升趋势,而神经痛为该病的主要症状之一,其并发症以带状疱疹后遗神经痛(PHN)最常见且难于控制。目前为止,关于PHN尚无统一定义,且发病机制不明,治疗方法有限,这极大影响了患者的生活质量。本文将对PHN的定义、发病机制、危险因素及防治进行综述,以帮助临床医师及时预防本病的发生发展。     

带状疱疹后遗神经痛的治疗与护理现状

带状疱疹后遗神经痛(PHN),是由滞留在人体内的带状疱疹病毒侵蚀破坏神经所致,常规治疗方法如抗病毒、营养神经、止痛虽有一定的效果,但大部分患者疼痛仍不能得到有效缓解。目前临床上对带状疱疹后遗神经痛没有疗效确切的治疗方法,也没有相关的临床指南或诊疗规范,但临床工作者在临床实践中积累了较为丰富的治疗与护理经验。本文就我国近10年来PHN的治疗与护理现状进行了综述。     

局部激光照射治疗带状疱疹后遗肋间神经痛15例

带状疱疹后遗神经痛（PHN）是指带状疱疹皮损消退后,受累区皮肤疼痛持续3个月以上。2008年5月-2009年11月,我们采用半导体激光治疗仪行局部激光照射治疗带状疱疹后遗肋间神经痛15例,效果较好。现报告如下。     

口服糖皮质激素对带状疱疹后遗神经痛患者的临床疗效观察

目的观察口服糖皮质激素对带状疱疹后遗神经痛的临床疗效。方法将2018-12～2019-10该院90例带状疱疹后遗神经痛患者随机分为观察组和对照组各45例,两组患者均给予维生素B1及腺苷钴胺肌肉注射,同时给予红光照射治疗,观察组加用醋酸泼尼松片口服治疗2周。采用视觉模拟量表(Visual Analogue Scale,VAS)评分法评价疼痛程度及临床疗效。结果治疗前两组VAS评分比较差异无统计学意义(P0.05)。观察组治疗后1周和2周VAS评分均低于对照组(P均0.05)。观察组总有效率明显高于对照组(95.6%vs 80.0%,P 0.05)。两组未见严重不良反应。结论口服糖皮质激素对带状疱疹后遗神经痛患者疗效明确,可以有效减少疼痛程度,短期使用不良反应较少。     

“从心胆论治”治疗老年人带状疱疹后遗神经痛的疗效

<正>带状疱疹后遗神经痛是一种顽固性疼痛病,也是针灸科临床较常见的疾病。近年来,带状疱疹发病率为人群的1.4‰⁴.8‰,并且有增加的趋势;带状疱疹急性期约80%以上患者伴有疼痛,其中约10%可并发带状疱疹后遗神经痛,以60岁以上的老年患者发病率较高。本文采用"从心胆论治"治疗老年人带状疱疹后遗神经痛21例,疗效显著。1资料与方法1.1对象选择2012年6月至2013年12月我院门诊带状疱     

带状疱疹后遗神经痛与白介素2水平的相关研究

带状疱疹后遗神经痛(PHN)多见于老年患者,常见症状为疼痛剧烈、难以忍受,夜间不能入睡,有时皮损已完全消失,但神经痛可持续数月至2～3年;其原因可能与机体免疫低下有关~([1]).血清白介素2(IL-2)的水平是评价机体免疫功能的重要指标之一.本文研究PHN与IL-2水平的关系,为PHN的诊疗提供临床依据.     

饮食护理干预对带状疱疹后遗神经痛治疗效果的作用

目的：观察饮食护理干预对带状疱疹后遗神经痛治疗效果的作用.方法：将100例带状疱疹后遗神经痛患者随机分成观察组50例和对照组50例,对照组给予带状疱疹后遗神经痛患者常规护理;观察组在对照组基础上实施饮食护理干预.结果：观察组饮食干预后疼痛、疗效与对照组比较差异有统计学意义（P〈0.05）.结论：饮食干预能减少带状疱疹后遗神经痛患者反复加重,减轻患者疼痛程度,有利于康复.     

高压氧治疗糖尿病足的疗效研究

目的 探讨高压氧治疗糖尿病足的临床疗效.方法 选取100例糖尿病足患者按照区组随机化分为高压氧组,对照组,各50例.对照组给予糖尿病饮食、降血糖、局部创面处理、抗感染等常规治疗,高压氧组在常规治疗基础之上同时予以高压氧治疗,高压氧治疗压力为0.20 ～0.25MPa,患者吸纯氧60 min,每天1次,共6个疗程.观察治疗前、后空腹血糖、血液流变学、患侧下肢动脉血流峰值的变化情况.结果 治疗后,与对照组相比,高压氧组空腹血糖较低[(5.1±0.8)mmol/L vs.(7.2±0.7)mmol/L,P=0.011];血液流变学得到改善(t=2.381 ～3.854,P均＜0.05);患侧下肢动脉血流峰值较低(t=3.169 ～9.899,P均＜0.05);糖尿病足皮损明显改善[(2.11±1.34) cm2vs.(3.65±1.65)Cm2,P=0.021].高压氧组总有效率和治愈率分别为98％和78％;对照组总有效率和治愈率为76％和48％,差异有统计学意义(P＜0.05).结论 高压氧治疗糖尿病足疗效优于常规治疗,是糖尿病足治疗的有效途径.     

高压氧治疗肝肺综合征大鼠的实验研究

目的 研究高压氧治疗对大鼠肝肺综合征(HPS)的作用.方法 采用胆总管结扎术(CBDL)制备HIS动物模型.44只雄性SD大鼠随机分为4组:假手术对照组(Sham组)8只、单纯造模组(CBDL5w组)12只、治疗1周组(HBOT1w组)12只、治疗2周组(HBOT2w组)12只.两治疗组在造模成功后送入高压氧舱治疗,分别治疗1周和2周.Sham组和CBDL5w组大鼠在术后5周,HBOT1w组和HBOT2w组在治疗结束后,进行血气分析、肝功能以及血清一氧化氮(NO)、内皮素-1(ET-1)浓度检测,肝、肺病理检查,并使用激光多普勒血流仪检测肝、肺微循环.结果 CBDL5w组大鼠肝功能检测中ALB降低,ALT、AST、ALP、γ-GT、TBIL及TBA均升高,血气分析中PaO2降低,PA-aO2增大,与Sham组相比均有显著差异(P＜0.01),且病理检查CBDL5w组大鼠的肝脏组织可见胆汁性肝纤维化表现,肺组织可见肺毛细血管扩张、充血,证实HPS大鼠模型制成;同时与Sham组相比,CBDL5w组大鼠血清NO及ET-1浓度均升高(P＜0.01),肝脏毛细血管血流量降低(P＜0.01),肺脏毛细血管血流量增大(P＜0.01).经高压氧治疗后,HBOT1w组大鼠与CBDL5w组相比,以上指标均好转(P＜0.01).HBOT2w组大鼠与CBDL5w组相比,除血清NO水平和肺脏毛细血管血流量无统计学差异(P＞0.05)外,其余指标的差异有显著性意义(P＜0.01).结论 高压氧治疗大鼠HPS可通过降低血清NO、ET-1浓度,提高组织氧含量及改善肝、肺微循环等,有效改善肝、肺功能及病理,且治疗前期效果更好.     

糖尿病足高压氧与非高压氧治疗的疗效对比观察

目的探讨高压氧综合治疗糖尿病足的疗效。方法选择糖尿病病人68例,随机分为高压氧治疗组和对照组各34例,均采用控制血糖、营养末梢神经血管、改善循环、全身应用有效抗生素、局部清创处理等治疗措施。高压氧治疗组在上述治疗的基础上加用高压氧治疗。疗效依据Wagner分级下降情况及自觉症状改善程度评价疗效。结果高压氧治疗组总有效率91.1%,对照组总有效率67.6%,差异有统计学意义(P<0.05)。结论高压氧治疗对糖尿病足有较好的康复价值。     

Treatment of diabetic foot ulcers: a comparative study of extracorporeal shockwave therapy and hyperbaric oxygen therapy

Objective

This study compared the effectiveness of extracorporeal shockwave therapy (ESWT) and hyperbaric oxygen therapy (HBOT) in chronic diabetic foot ulcers.

Patients and methods

The ESWT group (39 patients/44 feet) received shockwave therapy twice per week for total six treatments. The HBOT group (38 patients/40 feet) received hyperbaric oxygen therapy daily for total 20 treatments. Evaluations included clinical assessment, blood flow perfusion scan and histopathological examination.

Results

The overall clinical results showed completely healed ulcers in 57% and 25% (P = 0.003); ≥50% improved ulcers in 32% and 15% (P = 0.071); unchanged ulcers in 11% and 60% (P < 0.001) and none worsened for the ESWT and the HBOT group respectively. The blood flow perfusion rates were comparable between the two groups before treatment (P = 0.245), however, significant differences were noted after treatment favoring the ESWT group (P = 0.002). Histopathological examination revealed considerable increases in cell proliferation and decreases in cell apoptosis in the ESWT group as compared to the HBOT group.

Conclusion

ESWT is more effective than HBOT in chronic diabetic foot ulcers. ESWT-treated ulcers showed significant improvement in blood flow perfusion rate and cell activity leading to better healing of the ulcers relative to HBOT in chronic diabetic foot ulcers.     

Assessment of myocardial injury in the emergency department independently predicts the short-term poor outcome in patients with severe carbon monoxide poisoning receiving mechanical ventilation and hyperbaric oxygen therapy

ObjectivesPatients with severe carbon monoxide (CO) poisoning are often prone to unconsciousness and respiratory distress and as a result will receive mechanical ventilation and hyperbaric oxygen (MV-HBO) therapy. Factors associated with poor outcome at discharge are less defined in this patient population. This study was conducted to identify the prognostic predictors of short-term poor outcome in severely CO-poisoned patients receiving MV-HBO therapy.MethodsThe departmental database and the medical records of 81 patients treated with MV-HBO therapy were reviewed. Demographic and clinical data were extracted for analysis. HBO therapy with 2.5 or 2.8 atmosphere absolute (ATA) was administered to these patients. Short-term poor outcome was defined as an in-hospital death or neurologic sequelae at discharge. All patients were divided into two groups: those with a poor outcome and those without a poor outcome.ResultsNine patients died while in the hospital, 32 patients had neurologic sequelae at discharge, and the incidence of poor outcome was 50.6%. Parameters that were assessed in the emergency department (ED) and highly associated with patients with a poor outcome included myocardial injury, typical findings on brain computed tomography related to CO poisoning, and higher serum levels of alanine transaminase, aspartate aminotransferase, blood urea nitrogen, creatinine, creatine kinase, creatine kinase-myocardial band, troponin-I, and C-reactive protein. These poor outcomes were also correlated with prolonged lag times from the end of CO exposure to ED arrival and from ED arrival to HBO therapy. In a multivariate analysis, myocardial injury was the only independent predictor of poor outcome (odds ratio, 8.2; 95% confidence interval, 1.012–67.610; p = 0.049).ConclusionsThe results of this study indicate that myocardial injury assessed at ED arrival independently predicts the short-term poor outcome in severely CO-poisoned patients who receive MV-HBO therapy. Emergency physicians could use this objective marker to identify patients with an increased risk of poor outcome at discharge and refine the treatment protocol by shortening the time of patient transport and administering HBO therapy as soon as possible.     

Effect of growth hormone,hyperbaric oxygen and combined therapy on the gastric serosa

AIM:To investigate the role of growth hormone(GH),hyperbaric oxygen therapy(HBOT) and combined therapy on the intestinal neomucosa formation of the gastric serosa.METHODS:Forty-eight male Wistar-albino rats,weighing 250-280 g,were used in this study.The rats were divided into four groups(n = 12):Group 1,control,gastric serosal patch;Group 2,gastric serosal patch + GH;Group 3,gastric serosal patch + HBOT;and Group 4,gastric serosal patch + GH + HBOT.Abdominal access was achieved through a midline incision,and after the 1-cm-long defect was created in the jejunum,a 1 cm × 1 cm patch of the gastric corpus was anastomosed to the jejunal defect.Venous blood samples were taken to determine the insulin-like growth factor 1(IGF-1) and insulin-like growth factor binding protein 3(IGFBP-3) basal levels.HBOT was performed in Groups 3 and 4.In Groups 2 and 4,human GH was given subcutaneously at a dose of 2 mg per kg/d for 28 d,beginning on the operation day.All animals were sacrificed 60 d after surgery.The jejunal segment and the gastric anastomotic area were excised for histological examination.The inflammatory process,granulation,collagen deposition and fibroblast activity at the neomucosa formation were studied and scored.Additionally,the villus density,villus height,and crypt depth were counted and recorded.The measurements of villus height and crypt depth were calculated with an ocular micrometer.New vessel growth was determined by calculatingeach new vessel in a 1 mm 2 area.RESULTS:In the histological comparison of groups,no significant differences were observed between the control group and Groups 2 and 3 with respect to epithelialization,granulation,fibroblastic activity and the inflammatory process,but significant differences were present between the control group and all others groups(Groups 2-4) with respect to angiogenesis(P < 0.01) and collagen deposition(P < 0.05,P < 0.01).Significant differences between the control group and Group 4 were also observed with respect to epithelialization and fibroblas     

一氧化碳中毒不同时段高压氧治疗的疗效分析

目的探讨对一氧化碳中毒患者采用高压氧治疗的不同时机对治疗效果的影响。方法对我院2011年1月至2013年4月收治的84例一氧化碳中毒患者随机分为观察组和对照组各42例,两组采用常规的抗感染、水电解质平衡、呼吸道护理措施进行治疗,观察组在一氧化碳中毒12 h内就进行高压氧治疗,对照组在一氧化碳中毒12 h后进行高压氧治疗。比较两组患者治疗20天后的临床疗效、超氧化物歧化酶(SOD)、碳氧血红蛋白(HBCO)、TNF-ɑ、IL-6及治疗后相关后遗症发生率的差异。结果治疗前两组患者的SOD、HBCO、TNF-ɑ、IL-6比较不具有统计学意义(P0.05);治疗后两组的SOD、HBCO、TNF-ɑ、IL-6与治疗前进行组内比较差异具有统计学意义(P0.05),治疗后两组各种临床指标均显著好转;治疗后两组间SOD、HBCO、TNF-ɑ、IL-6比较差异具有统计学意义(P0.05)。治疗后两组患者的疗效分布、总有效率比较差异均不具有统计学意义(P0.05)。治疗过程中,观察组的平均昏迷时间、迟发性脑病发生率显著低于对照组且差异具有统计学意义(P0.05);两组病死率比较差异不具有统计学意义(P0.05)。结论本研究发现在发生一氧化碳中毒后12 h内进行高压氧治疗能够有效降低治疗后迟发型脑病的发生率。     

高压氧治疗对无症状冠心病早期心功能减退者血流动力学的影响

目的通过监测无症状冠心病早期心功能减退患者在接受高压氧(hyperbaricoxygen,HBO)治疗或扩冠治疗前后的血流动力学参数变化,为预防冠心病心衰的发生提供新的思路。方法将80例符合入选标准的患者随机分成HBO治疗+扩冠治疗(联合治疗)组和单纯扩冠治疗(对照)组,分别监测两组治疗前、治疗10、20d及停止治疗60d后的血流动力学参数,然后将其相对应的结果进行比较。结果①治疗前两组的血流动力学参数明显高于正常值(P(0.05),但两组间比较无统计学意义(P0.05);②治疗10d后,联合治疗组的CO、CI、SV、SI、LVSWI、LCWI、VI明显高于对照组(P0.05),③治疗20d后,两组上述血流动力学参数无显著差异(P0.05);④停止治疗60d后,联合治疗组的各项指标仍高于对照组(P0.05)。结论在冠心病早期心功能减退的治疗中,HBO有协同、加速及延长扩冠药物疗效,改善和保护心脏功能的作用。     

舍曲林联合高压氧治疗脑卒中后抑郁的日常生活能力的临床观察

目的明确舍曲林联合高压氧治疗脑卒中后抑郁（PSD）的日常生活能力的临床疗效。 方法选取苏州瑞盛康复医院神经康复科自2016年10月至2018年10月收治的80例PSD患者为研究对象,采用随机数字法将其分为观察组与对照组,每组40例。2组均给予舍曲林治疗,观察组在服用舍曲林的基础上给予高压氧治疗,比较2组患者治疗前后日常生活能力量表（ADL）评分、功能独立程度评定量表（FIM）评分。 结果治疗前2组患者ADL、FIM评分比较差异无统计学意义（P>0.05）,治疗后观察组ADL、FIM评分优于对照组,差异具有统计学意义（P<0.05）。治疗后观察组总有效率（90%）高于对照组（73%）,差异具有统计学意义（P<0.05）。 结论在PSD患者的临床治疗中,应用舍曲林联合高压氧治疗方案,可显著改善患者抑郁等不良情绪,提高日常生活能力及生活质量,值得临床推广。