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.

Clinical study of early hyperbaric oxygen therapy for cerebral resuscitation

Objective To observe the effect of early hyperbaric oxygen (HBO) therapy on cerebral resuscitation and to provide good evidence and method for the treatment of cerebral resuscitation.Methods The patients responded to cardiac pulmonary resuscitation (CPR) were divided into 2 groups,the early HBO group( within one week of onset) and the delayed HBO group (after 1 week of onset).All the patients were given routine medicinal treatment coupled with HBO therapy.The exposure pressure of HBO and the course of treatment were all the same,only the time point of HBO intervention was different.Evaluation was made by using "the Revised 2001 PVS Criteria for Diagnosis and Treatment" ( the Nanjing Criteria).Consciousness of the patients was evaluated both before HBO therapy and 6 months after onset.Results Of the 18 patients who received early HBO therapy,4 patients recovered and returned to normal life (effective),5 patients became fully conscious,but with minor disability (effective),and 9 patients became vegetable (ineffective),with a total effective rate of 50.0％.Of the 53 patients with delayed HBO therapy,9 patients recovered and returned to normal life (effective),15 patients became fully conscious,but with minor disability (effective),and 29 patients became vegetable (ineffective),with a total effective rate of 45.3％.No significant differences could be seen in effective rates between the 2 groups (P ＞0.05).However,statistical significance could be noted,when effective rates of the 2 groups were compared with those presented in domestic and international reports (2％-10％ ) ( P ＜ 0.05 ).Conclusions In-time HBO therapy could improve prognosis of some patients following cardiac resuscitation,protect neural cells,and improve the intelligence of patients,however,early and ultra-early HBO therapy could not increase the effective rate of cerebral resuscitation.