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目的 探讨高压氧联合脑循环电刺激治疗对缺血性脑卒中患者的临床疗效.方法 将152例缺血性脑卒中患者按照治疗方法分为4组,其中联合治疗组38例,脑循环治疗组38例,高压氧组38例,常规药物治疗38例(对照组).应用经颅多普勒超声技术和脑电图分别检测刺激前后的大脑前、中、后动脉及椎动脉、基底动脉的血流速度及各频段脑电波(α、β、δ、θ波)的变化;用美国国立卫生研究院卒中量表(NIHSS)评分及Bathel指数作为疗效标准依据进行疗效对比.结果 脑循环治疗组、高压氧组患者脑血流速度较对照组显著增高,联合治疗组大脑中、前动脉、椎动脉、基底动脉平均流速分别由治疗前的(35.13 ±3.47)、(34.28 ±4.25)、(21.45 ±3.23)、(20.47±3.58) cm/s增至治疗后的(60.23 ±4.32)、(57.48 +5.23)、(36.84±2.75)、(35.47 ±3.17)cm/s,差异均有统计学意义(p＜0.05),联合治疗组脑电图α波由治疗前(56.25±3.86) μV2增加至(90.47±4.35) μV2,θ、δ波分别由(22.23±2.63) μV2、(19.24 ±3.57) μV2降至(10.37±2.31) μY2、(8.19±3.28) μV2,差异有统计学意义(P＜0.05);NIHSS评分在各组治疗后均降低,联合治疗组由治疗前(22.89 ±8.15)分降至(14.53±6.54)分,差异有统计学意义(P＜0.05),脑循环组及高压氧治疗组在治疗后有效率达76.3％和73.4％,与对照组57.9％比较差异有统计学意义(P＜0.05),而联合治疗组为86.8％,组间差异有统计学意义(P＜0.05).联合治疗组Bathel指数由治疗前(28.73 ±6.89)增至(68.28 ±8.17),与治疗前及各组间治疗后比较差异有统计学意义(P＜0.05).结论 高压氧、脑循电刺激治疗均可提高缺血性脑卒中患者的脑血流量,改善脑细胞功能,促使缺血性脑卒中患者早期恢复,二者合用疗效更显著.

Objective To investigate the clinical effects of hyperbaric oxygen (HBO) combined cerebral circular electro-stimulation in the treatment of patients with ischemic stroke.Methods One hundred and fifty-two patients with ischemic stroke were divided by different treatment methods into 4 groups:the combined treatment group,the cerebral circular electro-stimulation group,the HBO group and the drug routine group (the control group),each consisting of 38 patients.Blood flow rates of anterior cerebral artery (ACA),middle cerebral artery (MCA),posterior cerebral artery (PCA),vertebral artery (VA) and basilar artery (BA),and changes in cerebral wave lengths (α,β,δ and θ waves) both before and after stimulation were respectively detected with transcranial Doppler (TCD) and EEG.The National Institute of Health Stroke Scale (NIHSS) and the Bathel Index were used as standards for comparisons of therapeutic effects between groups.Results Cerebral blood flow rates for the patients in the cerebral circular electro-stimulation group and the HBO group were all increased,as compared with that of the control group.For the patients in the combined treatment group,average blood flow rates of MCA (35.13 ±3.47)cm/s,ACA(34.28 ± 4.25)cm/s,VA (21.45 ± 3.23) cm/s and BA (20.47 ± 3.58) cm/s before treatment were respectively increased to the levels of (60.23 ± 4.32) cm/s,(57.48 + 5.23) cm/s,(36.84 ± 2.75) cm/s and (35.47 ± 3.17) cm/s after treatment,with statistical significance(P ＜ 0.05).Statistical significance could be noted,when comparisons were made after treatment between the combined treatment group and the cerebral circular electro-stimulation and the HBO groups(P ＜ 0.05).For the patients in the combined treatment group,EEG o wave length was increased from (56.25 ± 3.86)μV2 before treatment to(90.47 ±4.35)μV2 after treatment,while the wave lengths of θ wave and δ wave lengths were decreased from (22.23 ± 2.63) μV2 and (19.24 ± 3.57) μV2 before treatment to (10.37 ± 2.31) μV2 and 8.19 ± 3.28) μV2 after treatment,with statistical significance (P ＜ 0.05).After treatment,the scores of NIHSS for all the groups were decreased dramatically.The NIHSS scores for the combined treatment group were decreased from 22.89 ± 8.15) before treatment to (14.53 ± 6.54) after treatment,with statistical significance (P ＜ 0.05).Statistical significance could also be noticed,when they were compared with those of the cerebral circular electro-stimulation and the HBO groups (P ＜ 0.05).The therapeutic efficacy achieved following treatment for the cerebral circular electro-stimulation and the HBO groups was respectively 76.3％ and 73.4％,and there was statistical significance,when compared with that of the control group(P ＜ 0.05),while the therapeutic efficacy for the combined treatment group was 86.8％,and statistical significance could also be noted,when comparisons were made between the groups(P ＜ 0.05).The Bathel Index for the combined treatment group was increased from(28.73 ± 6.89)before treatment to(68.28 ± 8.17)after treatment,and statistical significance could be found,when compared with that before treatment and those of other groups after treatment(P ＜ 0.05).Conclusions HBO and cerebral circular electro-stimulation could all increase cerebral blood flow of the patients with ischemic stroke,improve brain cell function and promote early recovery of the patients with ischemic stroke,and combined treatment of HBO and cerebral circular electro-stimulation could achieve much better effects.