高压氧在放射性下颌骨骨髓炎治疗中的应用

放射性下颌骨骨髓炎患者８例，采用单人纯氧舱高压氧治疗机，最高治疗压力为０．１Ｍｐａ，每次治疗８０ｍｉｎ，每天治疗１次，１２天为１个疗程。６例治疗了２个疗程，２例１个疗程。治疗完成后１周左右，行死骨病灶清除术，术后５例创口Ⅰ期愈合；３例曾行２个疗程高压氧治疗者创口未全愈合，再予１个疗程治疗后创口Ⅱ期愈合。随访８个月至２年无１例复发。简要讨论适应证的选择，治疗的时机及疗程的确定。     

高压氧在放射性下颌骨骨髓炎治疗中的应用

放射性下颌骨骨髓炎患者８例，采用单人纯氧舱高压氧治疗机，最高治疗压力为０．１Ｍｐａ，每次治疗８０ｍｉｎ，每天治疗１次，１２天为１个疗程，６例治疗了２个疗程，治疗完成后１周左右，行死骨病灶清除术，术后５例创口Ⅰ期愈合；３例曾行２个疗程高压氧治疗者创口未全愈合，再予１个疗程治疗后创口Ⅱ期愈合，随访８个月至２年无１例复发。简要讨论适应证的选择，治疗的时机及疗程的确定。     

皮肤慢性溃疡的高压氧治疗

目的 探讨皮肤慢性溃疡的治疗方法。方法 回顾自1987年2月～2000年12月，采用高压氧综合治疗皮肤慢性溃疡80例，高压氧治疗压力0．2MPa，面罩吸氧60min，间歇10min。1次／d，10次为一疗程。本组平均治疗16次。常规用抗生素、血管扩张剂及局部用药。糖尿病者加用降糖药。必要时需外科手术植皮。结果 溃疡愈合61例(愈合率76．2％)，好转19例(占23．8％)，总有效率100％。结论 高压氧治疗可明显提高皮肤慢性溃疡的治愈率，缩短病程，提高患者生活质量。     

耐瑞霜治疗酒渣鼻40例疗效观察

使用耐瑞霜（山东德美克制药有限公司生产）对４０例酒渣鼻患者进行治疗，取得了较满意的疗效，现报告如下。１资料和方法临床资料４０例均为临床症状典型，颜面中部有红斑、痤疮样丘疹、脓疱和毛细血管扩张的Ⅰ期和Ⅱ期酒渣鼻患者，男１５例，女２５例，年龄１７～５５岁。治疗方法先用清水清洗患处，然后取耐瑞霜薄涂患处，每日１次，疗程８周，不加用其他任何药物。每２周观察１次并记录面部症状变化，８周后评定疗效。疗效标准痊愈：皮损消退９０％以上；显效：皮损消退６０％～８９％；有效：皮损消退２０％～５９％；无效：皮损消退不…     

高压氧治疗突发性耳聋468例分析

应用高压氧治疗突发性耳聋４６８例。治疗方法：０．２ＭＰａ下吸氧８０ｍｉｎ，每日１次，１２日为１个疗程。治疗结果：显效１４３例，占３０．５％；好转２７３例，占５８．３％；无效５２例，占１１．１％；总有效率８８．９％。对突发性耳聋的发病机理、运用高压氧治疗的原理、疗效与病程及年龄的关系等进行了分析探讨。     

高压氧治疗下肢皮肤慢性溃疡33例

目的探讨高压氧治疗下肢慢性溃疡的适宜时间,方法及其疗效.方法采用单人氧舱纯氧加压治疗,加压、减压、稳压时间均为20min.每日1次,12次为1疗程,溃疡面在1cm×1cm者一般3个疗程治愈.结果经高压氧治疗后,临床症状消失,溃疡面缩小直至愈合.结论高压氧治疗皮肤慢性溃疡疗效显著,值得推广.     

高压氧治疗脑梗死临床疗效分析

观察了５５３例经头颅ＣＴ检查确诊的脑梗死患者，其中治疗组３６０例，除常规治疗外每日行高压氧治疗１次，对照组１９３例，只进行常规治疗。结果显示；治疗组的疗效明显高于对照组；高压氧治疗的最佳疗程为第２－３疗程。     

高压氧配合中西药治疗慢性疲劳综合征

高压氧医学是一门新兴的临床学科,在现代医学中起着重要的作用。笔者近年来应用高压氧配合中、西药治疗慢性疲劳综合征（ＣＦＳ）,取得了很好的疗效,现报告如下。１　临床资料 选择１９９８年４月～１９９９年８月急症、门诊观察的ＣＦＳ患者３２例,男１４例,女１８例;年龄２８～５２岁,平均４０．２岁;病程９个月～３年,平均１８．５个月。诊断标准符合美国疾病控制中心（ＣＤＣ）的标准［１］。２治疗方法２．１高压氧治疗　采用０．２５Ｍｐａ压力,吸氧６０ ｍｉｎ,每日治疗１次,１０次为１个疗程。一般治疗不少于２个疗程。…     

新敏乐、甲氰咪胍和潘生丁联合治疗慢性荨麻疹疗效观察

我科自１９９７年８月至１９９８年４月应用新敏乐、甲氰咪胍和潘生丁联合治疗８９例慢性荨麻疹患者取得满意疗效,现报道如下。１　临床资料８９例患者中男性５６例,女性３３例,年龄１２～６５岁,病程２个月～５年,均有风团反复发作伴瘙痒史,治疗前３ｄ停用一切抗组胺类药物、镇静药及皮质类固醇激素。８９例患者随机分为２组：第１组３１例,单用新敏乐８ｍｇ,每日２次,连用１～４周;第２组５８例为联合用药组,新敏乐８ｍｇ＋甲氰咪胍２０ｍｇ＋潘生丁５０ｍｇ,每日２次,连用１～４周,全部病例均不再用其他抗组胺类药物和辅助…     

针药并用治疗外伤性截瘫

现代医学研究表明，各种脊柱外伤引起的截瘫，凡持续２４小时以上，几乎无自行恢复的希望。西医在脊髓损伤急性期除采用手术治疗外，对本病无理想的治疗方法［１］。我们利用自制中药“治瘫丸”加针刺治疗，效果满意，现将结果报道如下。１　临床资料本组中，男性８例，女性３例；年龄２０岁～５０岁；病程２０天～１８０天；所有病例经Ｘ光片显示脊椎有压缩、移位及粉碎性骨折。受伤部位：胸腰段８例，腰骶段３例；其中脊髓完全断裂３例，不完全断裂８例；行手术治疗３例，保守治疗８例。２　治疗方法２．１　针刺方法取穴：百会，受伤平面…     

PNF技术联合综合疗法治疗脊柱外伤并不全瘫疗效观察

目的观察早期神经肌肉本体感觉促进疗法（PNF）联合常规运动疗法、高压氧、针灸治疗胸腰段脊柱外伤并不全瘫的临床效果。方法胸腰段脊柱外伤合并不全瘫患者30例,均手术解除脊髓压迫后,随机分为A组和B组,每组15例。A组采用PNF联合常规运动疗法、高压氧及针灸治疗;B组采用常规运动疗法、高压氧及针灸治疗,两组均治疗6个月。观察两组康复治疗前后感觉评分,运动评分和日常生活能力量表（Barthel指数）评分的差异。结果两组康复治疗后感觉评分、运动评分、Barthel指数均较治疗前明显升高（P〈0.05）。A组康复治疗后感觉评分、运动评分、Barthel指数比B组升高更明显（P〈0.05）。结论 PNF联合常规运动疗法、高压氧、针灸治疗脊柱外伤并不全瘫患者有助于脊髓功能的恢复,提高患者的运动能力,改善患者的生活自理能力。     

重复高压氧预处理对大鼠脊髓缺血再灌注损伤时糖调节蛋白78表达的影响

目的探讨重复高压氧预处理对大鼠脊髓缺血再灌注损伤保护中糖调节蛋白78(GRP78)表达的影响。方法雄性SD大鼠36只,体重250～300g,采用随机数字表法,将其随机分为3组(n=12)假手术组(S组)、脊髓缺血再灌注组(I/R组)和重复高压氧预处理(HOP组)。HOP组采用高压氧预处理[1000ml/L O2,2.5 atmosphere absolute(ATA),1h/d,5天],最后一次处理后24h,I/R组和HOP组采用Zivin法制备脊髓缺血再灌注模型(缺血15min,再灌注1h),24、48、72h后分别评价后肢运动功能,然后处死大鼠,取L5～7节段脊髓组织,测定GRP78的mRNA及其蛋白表达水平,光镜下观察病理学结果。结果与S组比较,I/R组和HOP组后肢运动功能和脊髓前角正常运动神经元计数降低,脊髓组织GRP78 mRNA及蛋白表达水平上调(P<0.05);与I/R组比较,HOP组后肢运动功能和脊髓前角正常运动神经元计数升高,脊髓组织GRP78 mRNA及蛋白表达水平上调(P<0.05)。HOP组脊髓组织病理学损伤程度轻于I/R组。结论重复高压氧预处理可上调大鼠脊髓缺血再灌注时GRP78表达,从而减轻大鼠脊髓缺血再灌注损伤。     

超早期高压氧治疗对脊髓全横断大鼠脊髓水肿及后肢运动功能的影响

目的 探讨超早期高压氧治疗对脊髓全横断损伤大鼠脊髓水肿及后肢运动功能的影响.方法 (1)55只3月龄健康雌性SD大鼠随机分为假手术组(Sham组,15只)、模型组(CSCT组,20只)及高压氧组(HBO组,20只).Sham组仅行椎板切除术,其余2组均行T10椎板水平脊髓完全横向切断术.(2)HBO组于术后第3小时置于动物舱内开始高压氧治疗,10天1疗程,共3疗程,其中第1疗程每天2次,第2、3疗程均每天1次,每疗程休息6 d.(3)分别于建模型后第1～6周末.采用BBB运动功能评分法评价并比较两组大鼠后肢运动功能恢复程度;术后6周末取材,观察各组受损脊髓节段组织含水量变化.结果 CSCT组及HBO组大鼠术后第1-6周末BBB运动功能评分逐渐增高,HBO组在2～6周末的BBB运动功能评分均明显高于CSCT组(P<0.05);术后6周末,CSCT组受损脊髓节段组织含水量较Sham组明显增加(P<0.01),HBO组受损脊髓节段组织含水蛩较CSCT组有所减少(P<0.05).结论 超早期高压氧治疗可可减轻脊髓全横断损伤大鼠脊髓组织水肿,促进后肢运动功能的部分恢复,对脊髓有保护作用.

Abstract：

Objective To evaluate the effect of ultra-early hyperbaric oxygenation on spinal edema and hind limb motor function in rats with complete spinal cord transection. Methods Fifty-five healthy 3-month-old female SD rats were randomly divided into sham-operated group (n=15), complete spinal cord transection group (CSCT group, n=20) and hyperbaric oxygen group (HBO group, n=20). The rats in the sham-operated group underwent only laminectomy, while those in the other 2 groups underwent CSCT at the T10 level. The rats in HBO group were placed in an oxygen chamber 3 h after the operation for 10 days as a treatment course, and 3 treatment courses were administered at the interval of 6 days. In the first treatment course, 2 hyperbaric oxygenation sessions were given daily, and in the following 2 course, only 1 session was given daily. The recovery of hindlimb motor function was evaluated using the open-field Basso-Beattie-Bresnahan (BBB) scoring system once a week for 6 weeks. All the rats were sacrificed 6 weeks after the operation to measure the water content in the injured tissues. Results The BBB scores of CSCT group and HBO group gradually increased with the passage of time after the operation, and from week 2 to week 6, HBO group had significantly higher scores than CSCT group (P<0.05). The water content was markedly increased in CSCT group at 6 weeks after the operation as compared with that in the sham-operated group (P<0.01), and significantly reduced in HBO group in comparison with that in the CSCT group (P<0.05). Conclusion Ultra-early HBO can suppress spinal cord edema and promote hindlimb locomotor recovery in rats with complete spinal cord transection.     

脊髓电刺激术治疗不可手术的慢性严重肢体缺血1例

Peripheral arterial disease is one part of systematic atherosclerosis, becoming a heavy burden of human health. Patients in end stage of peripheral arterial disease manifest critical limb ischemia with severe rest pain and refractory ulcer. Surgical revascularization is the optimal option for patients with critical limb ischemia to avoid major amputation and improve quality of life. However, some of them contraindicate surgical revascularizations owing to coexisting morbidities. Spinal cord stimulation is reported to be effective and minimally invasive in pain relief and limb salvage for patients with limb ischemia. Here, we reported one case with chronic critical limb ischemia and gangrene of foot who underwent spinal cord stimulation, which was, as we knew, the first case in China. He was diagnosed with Burger disease and accompanied with history of stroke, chronic obstructive pulmonary disease and Castleman’s disease. It showed totally occlusive lesions of external iliac and femoropopliteal artery and no outflows below the knee in the computed tomography angiography. Given the complexity of lesions and weakness of the patient, spinal cord stimulation was indicated for control of rest pain and limb salvage. As specified, we implanted the temporary neurostimulator as the first step. After 2 weeks from temporary neurostimulator implantation, the patient achieved significant relief in intensity of pain, and acquired 20% improvement of transcutaneous oxygen pressure. The satisfactory results indicated probable effectiveness of spinal cord stimulation, thus we performed the permanent neurostimulator implantation 1 month later. During 2 months of follow-up, the patients stabilized at Fountain Ⅲ with pain relief with one kind of nonsteroidal anti-inflammatory drug. In our case, we confirmed the significant validity of spinal cord stimulation for pain control and consequent improvement of quality of life in non-reconstructable chronic critical limb ischemia. Furthermore, we reviewed that a number of published studies suggested that spinal cord stimulation be a reasonable option for patients with critical rest pain, especially who contraindicated surgical revascularization. The application of spinal cord stimulation in pain relief for non-reconstructable chronic critical limb ischemia was approved by related guidelines released by European Society of Cardiology and Trans-Atlantic Inter-Society Consensus. Further investigations are required for assessing the long-term outcome in limb salvage.     

Hyperbaric oxygen therapy in clinical application. A report of a 12-year experience

Hyperbaric oxygen (HBO) has become a useful treatment in clinical diseases. All the treatment profiles (Death/Time) were performed under the safe limit of unit pulmonary toxicity dose (UPTD). Between June 1976 and December 1987, we had treated 1288 cases with HBO. The effective rates (cure or improvement) were 97.5% for decompression sickness, 96.3% for chronic osteomylitis, 90% for chronic skin ulcer, 89.4% for crush injury, 81.3% for gas intoxication, 76.1% for burn injury, 73.3% for cerebrovascular accident, 57.1% for gas gangrene, 50% for retinal artery insufficiency, and 45.5% for head or spinal cord injury. Only 3 patients suffered from oxygen toxicity and relieved immediately. To the serious decompression sickness, the comparative study between the conventional treatment table and our modified table revealed increased cure rate(25.8% versus 50.0%, P less than 0.05), and decreased recurrence rate (16.1% versus 4.1%, P less than 0.05). In burn patients with 35-70% area involved and 15-45 years of age, the comparative analysis showed a reduced mortality rate of 6.8% for the HBO treated group as opposed to 14.8% for the non-HBO treated group, P less than 0.05.     

高压氧结合电针治疗对脊髓损伤后大鼠膀胱功能的影响

目的观察高压氧结合电针治疗对脊髓损伤(SCI)后大鼠神经源性膀胱功能的影响及机制分析。方法将雌性SD大鼠60只,随机分为对照组、高压氧组及高压氧结合电针组(结合电针组),每组20只。所有大鼠用Allen′s重物撞击法制造SCI模型,其中对照组不接受任何治疗,高压氧组及结合电针组在造模成功12h后每天接受高压氧治疗或高压氧结合电针治疗1次。各组大鼠分别于术后24h,3、7、14d在乌拉坦麻醉下尿道置管行尿流动力学检查后处死。观察比较3组大鼠脊髓中及膀胱组织中神经型一氧化氮合酶(nNOS)表达及尿流动力学指标。结果在各时间点上,高压氧组及结合电针组脊髓及膀胱组织中nNOS表达明显高于对照组(P<0.01),结合电针组脊髓及膀胱组织中nNOS表达明显高于高压氧组(P<0.05);尿流动力学结果结合电针组显著优于高压氧组及对照组(P<0.05)。结论高压氧结合电针治疗对SCI后大鼠的神经元具有保护作用,并能很好改善大鼠的膀胱功能。     

随访干预对脊髓损伤患者康复的影响

目的探讨随访干预对脊髓损伤患者生活质量的影响。方法36例随机分为对照组（A组）和干预组（B组）,对照组仅在患者出院时按照常规出院指导,干预组进行6个月的随访干预,对患者进行家庭护理干预。出院6个月后评价两组并发症,日常生活能力,患肢运动功能等情况。结果出院6个月后干预组并发症、日常生活能力、患肢运动功能恢复等效果显著优于对照组（P〈0.01）。结论随访干预可增进脊髓损伤患者的生活质量。     

颈椎术后神经根麻痹的原因分析

目的:通过分析8例颈椎术后发生神经根麻痹患者的临床及影像学资料,探讨颈椎术后神经根麻痹产生的原因。方法:回顾性分析接受手术治疗的颈椎病及颈椎后纵韧带骨化症患者术前、术后MRI观察脊髓高信号的变化情况及脊髓后移的程度。结果:发生神经根麻痹的8例患者中,术前伴有神经根麻痹现象的患者2例,术后神经根麻痹的侧别与术前一致;神经根麻痹均为单侧发生,其中左侧3例,右侧5例;术前5例患者存在脊髓高信号,术后1例患者高信号的范围扩大,余4例患者未见明显变化。术后1年随访时,6例患者均获得Ⅱ级以上的肌力改善。结论:颈椎术后神经根麻痹的发生与术前脊髓高信号、术后脊髓后移引起的栓系效应以及术前是否存在轻度的神经根麻痹有关,重视术前对脊髓功能评估对于预测术后神经根麻痹的发生具有重要的参考意义。     

颈椎脊髓损伤的急救及早期处理

目的:总结颈椎脊髓损伤急救和早期处理的经验,探讨其处理原则及特点。方法:分析对216例颈椎脊髓损伤患者的急救处理方法,评价并发症和预后情况。结果:现场死亡18例(8.3%),颈椎脊髓损伤并发症致死亡10例,休克、脑出血等其他合并伤致死亡8例;转运途中无死亡。现场急救及入院后评估对比,无一例出现继发性损伤;198例患者均获得随访,12例脊髓损伤后期并发症死亡;入院治疗后,Frankel分级B~D级患者178例,神经功能有1~2级的改善,A级患者20例中,6例神经功能有1~2级改善,14例无明显改善。结论:正确的院前救治和早期处理能减少脊髓继发性损伤,对改善患者预后起重要作用。     

髓鞘碱性蛋白与脊髓损伤预后的关系

目的 研究急性脊髓损伤后血清、脑脊液髓鞘碱性蛋白（ＭＢＰ）变化与脊髓损伤程度、预后情况之间的关系。方法 ＥＬＩＳＡ法检测５１例不同程度脊髓损伤患者伤后２４ｈ内血清和脑脊液ＭＢＰ含量,结合预后程度进行分析。结果 脊髓完全性损伤患者伤后２４ｈ内即出现脑脊液ＭＢＰ显著增高,较重的脊髓不完全性损伤（ＡＳＩＡ分级Ｂ或Ｃ级）伤后２４ｈ内也出现脑脊液ＭＢＰ增高,但各时间点增高幅度完全性损伤组小;较轻的脊髓不完全性损伤（ＡＳＩＡ分级Ｄ级）和脊髓震荡不出现脑脊液ＭＢＰ增高;各组血清检测结果与脑脊液结果一致变化。结论 受伤后２４ｈ内血清或脑脊液ＭＢＰ检测对于判断脊髓损伤程度以及估计预后具有积极的意义。