中医解毒化瘀疗法联合高压氧治疗一氧化碳中毒迟发性脑病的临床疗效观察

发布时间：2019-06-02 06:40

【摘要】：目的据相关文献报道,一氧化碳中毒迟发性脑病在国内外发病率均较高,一氧化碳中毒迟发性脑病患者给家庭及社会带来沉重的负担,目前其机制尚不完全明确,且缺乏有效的临床治疗方法,目前多采用高压氧治疗,关于疗效文献报道不一。本研究探讨在高压氧治疗基础上,加用中医药配合治疗一氧化碳中毒迟发性脑病,充分发挥中西医结合治疗的优势,为治疗该病提供新的方法和手段。方法研究选用我院2014年11月至2016年12月间收治的一氧化碳中毒迟发性脑病患者,共60例,随机分为中药联合高压氧组与高压氧治疗组,每组30例。中药联合高压氧治疗组中男性24例,女性6例,有吸烟史患者18例,有饮酒史患者15例,有基础疾病史(高血压、糖尿病)患者20例。高压氧治疗组中男性26例,女性4例;有吸烟史患者17例,有饮酒史患者21例,有基础疾病史(高血压、糖尿病)患者22例。纳入研究的患者均符合相应的纳入标准及排除标准。中药联合高压氧治疗组与高压氧治疗组的高压氧治疗方案一致,均行60天高压氧治疗,治疗压力为2.2ATA,每日1次。中药联合高压氧治疗组在高压氧治疗基础上配合中药治疗,以解毒化瘀为原则,方药组成:黄芪25g,川芎30g,制大黄15g,地龙10g,全蝎10g,水蛭10g,天麻10g,石菖蒲25g,红景天20g。根据患者症候特点,在本方基础上进行加味。口服中药疗程与高压氧治疗疗程一致。两组患者分别在治疗前、治疗30天、治疗60天后采用简易智能状态检查表(mini-mental state examination,MMSE)及Barthel指数(Barthel Index,BI)进行评分,并对评分结果进行等级评估。治疗结束后进行临床疗效评定,疗效评定分为:治愈,显效,好转,无效。统计采用SPSS17.0软件,符合正态分布的计量资料使用t检验,计数资料使用χ2检验,P0.05差别无统计学意义,P0.05差别有统计学意义。结果两组患者在性别、年龄、有无吸烟史、有无饮酒史、有无基础疾病史、治疗前认知功能、日常生活自理能力方面差别无统计学意义(P0.05)。组内数据比较:使用χ2检验,对联合治疗组患者治疗前与治疗60后MMSE、BI评分得出的分级数据进行统计分析,显示差别有统计学意义(P0.05);使用χ2检验,对高压氧治疗组患者治疗前与治疗60后MMSE、BI评分得出的分级评估数据进行分析,显示差别有统计学意义(P0.05)。组间数据比较:使用χ2检验,比较两组患者在治疗30后MMSE、BI评分得出的分级数据差别,显示差别无统计学意义(P0.05)。使用χ2检验比较两组患者在治疗60天后MMSE、BI评分得出的分级数据差别,显示差别有统计学意义(P0.05)。比较两组患者临床疗效评定结果差别,得出差别具有统计学意义(P0.05)。结论1.治疗30天后,中医解毒化瘀疗法联合高压氧治疗在改善一氧化碳中毒迟发性脑病(delayed encephalopathy after carbon monoxide poisiong,DEACMP)患者认知功能、日常生活自理能力方面与单独高压氧治疗相比无明显差异。2.治疗60天后,中医解毒化瘀疗法联合高压氧治疗在改善DEACMP患者认知功能、日常生活自理能力方面较单纯使用高压氧治疗存在一定优势。3.中医解毒化瘀疗法联合高压氧治疗DEACMP存在较好疗效,一定程度上提高了DEACMP患者的生活质量。
[Abstract]:Objective According to the relevant literature, the delayed encephalopathy with carbon monoxide poisoning has a high incidence rate at home and abroad, and the delayed encephalopathy patients with carbon monoxide poisoning have a heavy burden on the family and society. At present, the mechanism is not completely clear and the effective clinical treatment method is not available. At present, hyperbaric oxygen therapy is used, and the report on the curative effect is different. This study, on the basis of hyperbaric oxygen therapy, combined with traditional Chinese medicine in the treatment of delayed encephalopathy of carbon monoxide poisoning, and made full use of the advantages of the combination of the traditional Chinese medicine and the western medicine, and provides a new method and means for the treatment of the disease. Methods A total of 60 patients with delayed encephalopathy of carbon monoxide poisoning from November 2014 to December 2016 were randomly divided into two groups: the combined hyperbaric oxygen group and the hyperbaric oxygen treatment group, and 30 cases in each group. There were 24 males,6 females,18 patients with history of smoking,15 patients with history of alcohol, and 20 patients with basic disease history (hypertension, diabetes). There were 26 males and 4 females in the hyperbaric oxygen treatment group,17 patients with a history of smoking,21 patients with a history of drinking history, and 22 patients with basic disease history (hypertension, diabetes). Patients included in the study met the appropriate inclusion criteria and exclusion criteria. In combination with the hyperbaric oxygen therapy in the hyperbaric oxygen treatment group, the hyperbaric oxygen treatment group was treated with hyperbaric oxygen for 60 days, the treatment pressure was 2.2 ATA, and the treatment pressure was once a day. The traditional Chinese medicine combined with the hyperbaric oxygen treatment group is combined with the traditional Chinese medicine on the basis of the hyperbaric oxygen therapy, and the traditional Chinese medicine combined with the hyperbaric oxygen treatment group is composed of the following components in parts by weight:25 g of yellow chrysanthemum,30 g of Sichuan aconite root,15 g of rhubarb,10 g of earthworm,10 g of scorpion,10 g of leech,10 g of gastrodia elata,25 g of cattail pollen and 20 g of rhodiola rosea. According to the symptom of the symptom of the patient, and is modified on the basis of the recipe. the course of oral administration of the traditional Chinese medicine is consistent with the treatment course of the hyperbaric oxygen The two groups were treated with mini-mental state examination (MMSE) and Barthel Index (BI) for 30 days before and after treatment for 30 days. The clinical curative effect evaluation after the treatment is completed, the curative effect evaluation is divided into the following steps of: healing, obvious effect, improvement and ineffectiveness. The software of SPSS17.0 was used, and the t-test was used to measure the data of the normal distribution. The difference of the counting data was not statistically significant, but the difference of P05 was not significant. Results There was no significant difference between the two groups in the history of sex, age, the history of smoking, the history of alcohol consumption, the history of underlying disease, the cognitive function before treatment and the self-adjusting ability of daily life (P0.05). The data in the group were compared: the results of the statistical analysis of the grading data obtained by the MMSE and BI scores before and after the treatment in the combined treatment group were statistically significant (P0.05). The results showed that the difference was of statistical significance (P0.05); after the treatment of the hyperbaric oxygen treatment group, the patients with the hyperbaric oxygen treatment group were treated with MMSE before and after treatment 60 days after the treatment. The data of the grading assessment from the BI score were analyzed, and the difference was statistically significant (P0.05). The data of the two groups were compared between the two groups: the difference of the grading data obtained by the MMSE and BI scores after 30 days after the treatment was compared between the two groups, and the difference was not statistically significant (P0.05). The difference of the grading data between the two groups after 60 days of treatment was compared with the other two groups, and the difference was statistically significant (P0.05). The difference of the results of clinical curative effect was compared between the two groups, and the difference was statistically significant (P0.05). Conclusion 1. The effect of hyperbaric oxygen therapy combined with hyperbaric oxygen therapy in the treatment of delayed encephalopathy (DEACMP) in the treatment of delayed encephalopathy (DEACMP) in the treatment of delayed encephalopathy (DEACMP) in the treatment of delayed encephalopathy (DEACMP) after 30 days has no significant difference with the hyperbaric oxygen therapy alone. After 60 days of treatment, the combination of the traditional Chinese medicine and the blood stasis therapy combined with the hyperbaric oxygen therapy in the improvement of the cognitive function of the DEACMP and the self-adjusting ability of daily life have a certain advantage in the simple use of the hyperbaric oxygen therapy. The treatment of DEACMP with the combination of the traditional Chinese medicine detoxication and the blood stasis therapy combined with the hyperbaric oxygen has a good curative effect, and the quality of life of the DEACMP patient is improved to a certain extent.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R595.1;R747.9

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