發(fā)布時間：2019-06-02 06:40

【摘要】：目的據(jù)相關文獻報道,一氧化碳中毒遲發(fā)性腦病在國內(nèi)外發(fā)病率均較高,一氧化碳中毒遲發(fā)性腦病患者給家庭及社會帶來沉重的負擔,目前其機制尚不完全明確,且缺乏有效的臨床治療方法,目前多采用高壓氧治療,關于療效文獻報道不一。本研究探討在高壓氧治療基礎上,加用中醫(yī)藥配合治療一氧化碳中毒遲發(fā)性腦病,充分發(fā)揮中西醫(yī)結合治療的優(yōu)勢,為治療該病提供新的方法和手段。方法研究選用我院2014年11月至2016年12月間收治的一氧化碳中毒遲發(fā)性腦病患者,共60例,隨機分為中藥聯(lián)合高壓氧組與高壓氧治療組,每組30例。中藥聯(lián)合高壓氧治療組中男性24例,女性6例,有吸煙史患者18例,有飲酒史患者15例,有基礎疾病史(高血壓、糖尿病)患者20例。高壓氧治療組中男性26例,女性4例;有吸煙史患者17例,有飲酒史患者21例,有基礎疾病史(高血壓、糖尿病)患者22例。納入研究的患者均符合相應的納入標準及排除標準。中藥聯(lián)合高壓氧治療組與高壓氧治療組的高壓氧治療方案一致,均行60天高壓氧治療,治療壓力為2.2ATA,每日1次。中藥聯(lián)合高壓氧治療組在高壓氧治療基礎上配合中藥治療,以解毒化瘀為原則,方藥組成:黃芪25g,川芎30g,制大黃15g,地龍10g,全蝎10g,水蛭10g,天麻10g,石菖蒲25g,紅景天20g。根據(jù)患者癥候特點,在本方基礎上進行加味�？诜兴幆煶膛c高壓氧治療療程一致。兩組患者分別在治療前、治療30天、治療60天后采用簡易智能狀態(tài)檢查表(mini-mental state examination,MMSE)及Barthel指數(shù)(Barthel Index,BI)進行評分,并對評分結果進行等級評估。治療結束后進行臨床療效評定,療效評定分為:治愈,顯效,好轉,無效。統(tǒng)計采用SPSS17.0軟件,符合正態(tài)分布的計量資料使用t檢驗,計數(shù)資料使用χ2檢驗,P0.05差別無統(tǒng)計學意義,P0.05差別有統(tǒng)計學意義。結果兩組患者在性別、年齡、有無吸煙史、有無飲酒史、有無基礎疾病史、治療前認知功能、日常生活自理能力方面差別無統(tǒng)計學意義(P0.05)。組內(nèi)數(shù)據(jù)比較:使用χ2檢驗,對聯(lián)合治療組患者治療前與治療60后MMSE、BI評分得出的分級數(shù)據(jù)進行統(tǒng)計分析,顯示差別有統(tǒng)計學意義(P0.05);使用χ2檢驗,對高壓氧治療組患者治療前與治療60后MMSE、BI評分得出的分級評估數(shù)據(jù)進行分析,顯示差別有統(tǒng)計學意義(P0.05)。組間數(shù)據(jù)比較:使用χ2檢驗,比較兩組患者在治療30后MMSE、BI評分得出的分級數(shù)據(jù)差別,顯示差別無統(tǒng)計學意義(P0.05)。使用χ2檢驗比較兩組患者在治療60天后MMSE、BI評分得出的分級數(shù)據(jù)差別,顯示差別有統(tǒng)計學意義(P0.05)。比較兩組患者臨床療效評定結果差別,得出差別具有統(tǒng)計學意義(P0.05)。結論1.治療30天后,中醫(yī)解毒化瘀療法聯(lián)合高壓氧治療在改善一氧化碳中毒遲發(fā)性腦病(delayed encephalopathy after carbon monoxide poisiong,DEACMP)患者認知功能、日常生活自理能力方面與單獨高壓氧治療相比無明顯差異。2.治療60天后,中醫(yī)解毒化瘀療法聯(lián)合高壓氧治療在改善DEACMP患者認知功能、日常生活自理能力方面較單純使用高壓氧治療存在一定優(yōu)勢。3.中醫(yī)解毒化瘀療法聯(lián)合高壓氧治療DEACMP存在較好療效,一定程度上提高了DEACMP患者的生活質量。
[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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R595.1;R747.9

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