摘要
目的对颅内动脉瘤和脑血管畸形患者氧治疗方案的治疗效果及安全性进行探讨。方法对41例颅内动脉瘤、63例各类脑血管畸形共104例患者采用不同的氧治疗方案。其中25例颅内动脉瘤和脑血管畸形未经手术或血管内治疗的患者，因其本人或家属拒绝高压氧（hyperbaricoxygen，HBO）治疗给予舱外高流量常压氧（normalpressnreoxygen，NPO）治疗。79例采用渐进式HBO治疗：治疗从NPO开始，HBO选择从压力较低开始逐渐升高，加、减压速率相对缓慢的治疗方案（加、减压速率3～4kPa／min，治疗压力0．175MPa，稳压吸氧60rain）。全部患者同时进行生命体征和心电监测分析，疗效评定和治疗安全评定。结果HBO和舱外NPO治疗的有效率分别为97．5％和40．0％，HBO疗效优于NPO，差异有统计学意义（P〈0．05）。生命体征和心电监测分析显示，HBO治疗后心率减慢，吸氧结束时为（83．63±15．80）／min，与NPO比较差异有统计学意义（P〈0．05）。2种治疗方案脉搏氧饱和度均升高，差异无统计学意义。HBO治疗时收缩压、舒张压较加压前均升高（P〈0．01），NPO治疗时变化不大，两者比较差异有统计学意义（P〈0．01）。HBO治疗时，呼吸频率在加压阶段[（22．02±3．15）次]加快，与进舱前[（18．63±4．02）次]比较差异有统计学意义（P〈0．01）；HBO治疗结束后[（19．20±4．01）次]下降，但与进舱前比较差异无统计学意义。104例患者治疗期间无明显不良反应发生。结论脑动脉瘤和脑血管畸形患者接受HBO治疗或NPO治疗均有效，但HBO治疗可引起患者血压、心率波动，必须根据患者具体病情选择不同的治疗方案，确保治疗安全。
Objective To observe the therapeutic effects of different oxygen therapy protocols in the treatment of patients with intracranial aneurysm and cerebral vascular malformations. Methods Forty-one cases of intraeranial aneurysm and 63 cases of various cerebral vascular malformations （with a total of 104 cases） were treated with different oxygen therapy protocols. High-flow normal pressure oxygen （NPO） therapy outside the chamber was given to 25 patients either with intracranial aneurysm or cerebral vascular malformation, who failed to receive surgical operation or endovascular treatment, or their family members refused to accept hyperbaric oxygen （HBO） therapy. Seventy-nine cases were treated with progressive HBO therapy protocol, i.e. treatment started with high-flow oxygen therapy outside the chamber, HBO therapy started from a lower pressure to a higher pressure, and a therapy protocol with relatively slower compression and decompression rates was adopted （with compression and decompression rates of 3-4 kPa/min, the therapeutic pressure of 0. 175 MPa and oxygen breathing for 60 min at stable pressure）. At the same time, vital signs and ECG were analyzed, therapeutic effects and safety of the protocols were evaluated. Results Total effective rate for HBO therapy and high-flow NPO therapy outside the chamber was 97.5% and 40.0%. The therapeutic effectiveness of HBO therapy was superior to that of the high-flow NPO therapy outside the chamber, with statistical signifiqance （ P 〈 0. 05 ）. Vital signs and ECG monitoring indicated that heart rate decreased [ （83.63 ±15.80）/mini following HBO therapy, and statistical difference could be noted, when it was compared with those of the patients treated with high-flow NPO therapy outside the chamber. Arterial oxygen saturation all elevated for the two therapy protocols, but without statistical significance. As compared with those before compression, systolic and diastolic pressures all increased, when HBO therapy was implemented （P 〈 0. 01 ）. Nevertheless, no obvious changes in the above data could be seen, when high-flow NPO therapy outside the chamber was administered. There was statistical significance, when a comparison was made between the two （P 〈0.01 ）. With HBO therapy, respiratory rate [ （22.02 ±3. 15） times ] increased during the stage of compression, with statistical significance, when compared with that of before compression[ （18.63 ± 4.02） times ] （P 〈 0. 01 ）. Thereafter, respiratory rate decreased, but without statistical difference, when compared with that before compression （P 〈 0.01 ）. No obvious changes in patient conditions and adverse reactions were noted in all the 104 cases during treatment. Conclusions HBO therapy and high-flow NPO therapy outside the chamber were all effective to patients with cerebral aneurysms and cerebral vascular malformations, though HBO exposure might induce fluctuation of blood pressure and heart rate. Different protocols should be adopted, depending on the patient conditions, so as to ensure treatment safety.
出处
《中华航海医学与高气压医学杂志》
CAS
CSCD
北大核心
2012年第1期40-43,共4页
Chinese Journal of Nautical Medicine and Hyperbaric Medicine
关键词
高压氧
高流量常压氧
颅内动脉瘤
中枢神经系统血管畸形
Hyperbaric oxygen
Normal pressure oxygen
Intracranial aneurysm
Central nervous system
Vascular malformation
