CAJ | 학술논문

目的观察不同时间窗高压氧治疗对脑性瘫痪患儿疗效的影响.方法共选取3月龄脑瘫患儿60例,将其按数字表法随机分为1、2、3、4共4个组,每组15例.4组均给予常规康复治疗,1组患儿在月龄3～4月内开始高压氧治疗,2组患儿在月龄4～6个月进行高压氧治疗,3组患儿在月龄6个月以上进行高压氧治疗,4组患儿未给予高压氧治疗.共给予40次HBO治疗.常规康复治疗持续到1岁.分别在治疗前及1岁时应用粗大运动功能测试量表(gross motor function measure,GMFM)评定患儿粗大运动发育情况,用Gesell发育量表进行智能评估,计算粗大运动、精细运动、适应性、语言、个人社会、发育商及总发育商.结果 1岁时,4组患儿GMFM、粗大运动、精细运动、适应性、语言、个人社会、发育商及总发育商均较治疗前显著改善,其中1组[(30.55±8.44)分]的改善幅度显著优于2组[(26.43±7.52)分]、3组[(20.88±6.69)分]、4组[(19.14±4.38)分],差异具有统计学意义(P＜0.05)；2组患儿的改善幅度显著优于3、4组,差异亦有统计学意义(P＜0.05)；3、4组间疗效差异无统计学意义(P＞0.05).4组患儿在治疗期间均未发生严重不良反应.结论高压氧治疗时间窗对脑性瘫痪患儿疗效具有重要影响.开始治疗时间越早疗效越佳,3～4个月内进行高压氧治疗疗效最佳,4～6个月疗效次之,超过6个月则无显著疗效.
목적 관찰불동시간창고압양치료대뇌성탄탄환인료효적영향.방법 공선취3월령뇌탄환인60례,장기안수자표법수궤분위1、2、3、4공4개조,매조15례.4조균급여상규강복치료,1조환인재월령3～4월내개시고압양치료,2조환인재월령4～6개월진행고압양치료,3조환인재월령6개월이상진행고압양치료,4조환인미급여고압양치료.공급여40차HBO치료.상규강복치료지속도1세.분별재치료전급1세시응용조대운동공능측시량표(gross motor function measure,GMFM)평정환인조대운동발육정황,용Gesell발육량표진행지능평고,계산조대운동、정세운동、괄응성、어언、개인사회、발육상급총발육상.결과 1세시,4조환인GMFM、조대운동、정세운동、괄응성、어언、개인사회、발육상급총발육상균교치료전현저개선,기중1조[(30.55±8.44)분]적개선폭도현저우우2조[(26.43±7.52)분]、3조[(20.88±6.69)분]、4조[(19.14±4.38)분],차이구유통계학의의(P＜0.05)；2조환인적개선폭도현저우우3、4조,차이역유통계학의의(P＜0.05)；3、4조간료효차이무통계학의의(P＞0.05).4조환인재치료기간균미발생엄중불량반응.결론 고압양치료시간창대뇌성탄탄환인료효구유중요영향.개시치료시간월조료효월가,3～4개월내진행고압양치료료효최가,4～6개월료효차지,초과6개월칙무현저료효.
Objective To observe the therapeutic effects of hyperbaric oxygen (HBO) at different time points in infants with cerebral palsy.Methods Sixty cases of cerebral palsy with an age of 3 months were randomly divided into 4 groups:group 1,2,3,4,each consisting of 15 cases.All the infants of the 4 groups were given routine rehabilitation treatment until they were 1 year old.The sick infants in group 1,2 and 3started HBO therapy at the following ages:3 to 4 months old,4 to 6 months old and over 6 months old respectively,with a treatment course of 8 weeks and a total of 40 sessions.The infants in groups 4 were not treated with HBO.Gross motor function was evaluated with Gross Motor Function Measure (GMFM).Intelligence was evaluated with Gesell Development Scale.Then,developmental quotient and total developmental quotient in gross motor,fine motor,adaptation,language and individual-social domains were calculated.Results At one year old,GMFM,developmental quotients in the above five domains and total developmental quotients of all the sick infants in the 4 groups improved significantly,when compared with those before treatment.Of all the patients in the 4 groups,the patients in groups 1 improved more significantly than those in group 2,3 and 4,with statistical significance (P ＜ 0.05).The patients in groups B improved more significantly than those in group 3 and 4,also with statistical significance (P ＜ 0.05).No statistical significance could be noted in therapeutic effects,when a comparison was made between group 3 and 4 (P ＞0.05).No serious adverse reactions could be noticed in the patients of the 4 groups during treatment.Conclusions Therapeutic time points of HBO therapy played an important role in the treatment of cerebral palsy in infants.The earlier the HBO therapy was implemented,the better the treatment.Optimal therapeutic effects could be achieved,if HBO therapy was started within 3 to 4 months after onset of the disease.Less optimal therapeutic results could be achieved,if HBO intervention was given within 4 to 6 months.And there would be no significant effects,if HBO therapy was started 6 months after the onset of disease.