【摘要】 目的观测小骨窗直视下清除血肿和高压氧(HBO)治疗对基底节区脑出血肢体运动功能障碍的治疗效果,并探讨其作用机制。方法分别检测治疗组(手术+HBO,n=152)和对照组(手术,n=109)术后当时、15 d、30 d三个时点的血管外周阻力(R)和动态阻力(DR),于术后当时、30 d、6个月三个时点观测两组患者肢体运动功能,用脑出血病损评分(SIAS)积分定量评定肢体运动功能障碍程度。结果两组患者术后当时的R值及DR值均较高,差异无统计意义(P>0.05),15 d及30 d后治疗组及对照组的R值及DR值逐渐下降低,但治疗组下降更为明显,差异显著(P<0.01或P<0.05);两组患者术后当时上、下肢体SIAS积分均较低,差异无统计意义(P>0.05),30 d及6个月后有所增加,但治疗组增加更加明显,差异显著(P<0.01或P<0.05)。结论小骨窗直视下清除血肿为基底节区脑出血的肢体运动功能恢复创造了条件,术后HBO治疗能够明显改善出血灶周围脑组织的微循环障碍,促进肢体运动功能的恢复。更多还原

【Abstract】 Objective To observe the therapeutic efficacy of ossicle fenestration operation and hyperbaric oxygenation(HBO) on the limbs motor dysfunction in the patients with basal ganglion hemorrhage and investigate its mechanism.Methods The vascular peripheral resistance(R) and dynamic resistance(DR) were detected in the therapeutic group(operation + HBO,n=152) and the control group(operation,n=109) at the time finishing the operation,in 15 d and 30 d after operation,respectively.The recovery conditions of all patients’ limbs motor function were observed at the time just finishing the operation,in 30 d and 180 d after operation and the degree of limbs motor dysfunction with stroke impairment assessment set(SIAS) was also evaluated.Results The values of R and DR in each group were higher,but no significant difference was found between two groups(P>0.05).The values of R and DR decreased gradually at 15 d and 30 d after operation in two groups,and the decrease of the therapeutic group was more obvious than that of the control group(P<0.01 or P<0.05).The SIAS values in two groups were lower,and the difference between two groups was not significant at the time just finishing the operation(P>0.05).The patients’ stroke impairment assessment set(SIAS) values in two groups increased gradually after operation.In 30 d and 180 d after operation,the increase of SIAS values in therapeutic group was more obvious than in the control group(P<0.01 or P<0.05).Conclusion The ossicle fenestration operation provides a good condition for the recovery of limbs function with basal ganglion hemorrhage.The HBO treatment can obviously improve microcirculation disturbance and promote limbs functional recovery.更多还原