摘要目的:探究高压氧疗法(hyperbaric oxygen therapy，HBOT)联合延续性护理对脊柱骨折合并脊髓损伤(spinal cord injury，SCI)患者神经功能恢复和情绪的影响。方法:选取2016年4月至2018年4月在陆军军医大学附属第一医院接受治疗的脊柱骨折合并SCI患者84例，按随机数字表法将患者分为对照组和观察组，每组42例。2组患者均接受HBOT治疗，观察组在HBOT的基础上联合延续性护理。采用Frankel评分评估患者脊髓功能；记录术后患者并发症的发生情况；采用美国国立卫生研究院卒中量表(National Institutes of Health stroke scale，NIHSS)和功能独立性测量表(functional independence measure，FIM)评估患者神经功能和独立生活能力；采用美国脊髓损伤协会(Americans Spinal Injury Association，ASIA)评分评估患者自身感觉和运动水平；采用焦虑自评量表(Zung-self-rating anxiety scale, SAS)和抑郁自评量表(Zung-self-rating depression scale, SDS)评价患者焦虑和抑郁的负性情绪；干预前、后抽取外周血，通过酶联免疫吸附测定(enzyme-linked immunosorbent assay，ELISA)法检测血清神经生长因子(nerve growth factor, NGF)、neuritin、肿瘤坏死因子(tumor necrosis factor，TNF)-α和白细胞介素(interleukin, IL)-1β水平；护理期间密切关注康复相关并发症发生情况。结果:治疗前2组患者各项指标差异无统计学意义( P>0.05)，具有可比性。治疗后2组患者Frankel评分均较治疗前改善，且观察组改善优于对照组，差异有统计学意义( P<0.05)。治疗后观察组的NIHSS和SAS评分显著低于对照组；FIM评分、ASIA感觉评分、运动评分显著高于对照组，差异均有统计学意义( P<0.05)。治疗后观察组TNF-α、IL-1β显著低于对照组，NGF、Neuritin显著高于对照组，差异均有统计学意义( P<0.05)。观察组手术并发症总发生率(4.76%)显著低于对照组(21.43%)，差异有统计学意义( P<0.05)。 结论:在延续性护理的基础上联合HBOT可显著抑制炎症因子的表达，保护神经功能，促进运动能力的恢复，改善脊柱骨折合并SCI患者的情绪。

abstractsObjective:To investigate the effects of hyperbaric oxygen therapy (HBOT) combined with transitional care on the recovery of nerve function and emotion in the patients with spinal fracture combined with spinal cord injury (SCI).Methods:A total of 84 patients with spinal fracture combined with SCI admitted to the First Affiliated Hospital of the Army Medical University between April 2016 and April 2018 were randomly assigned to observation group ( n=42) or control group ( n=42). The patients in the control group received HBOT, while those in the observation group received HBOT combined with transitional care. The Frankel score was used to assess the patients’ spinal cord function. The post-surgery complications were recorded. National Institutes of Health stroke scale (NIHSS) and functional independence measure (FIM) were used to assess the patients’ nerve function and independent living ability. American Spinal Injury Association (ASIA) score was used to assess their sensation and motor function. Zung-self-rating anxiety scale (SAS) and Zung-self-rating depression scale (SDS) were used to assess their negative emotions, such as anxiety and depression. Blood was drawn before and after intervention to measure the levels of nerve growth factor (NGF), Neuritin, tumor necrosis factor-α(TNF-α) and interleukin-1β(IL-1β). Rehabilitation-related complications were closely observed during nursing care. Results:There was no significant difference in the baseline characteristics between the two groups of patients before treatment, which was comparable ( P>0.05). The Frankel scores showed improvement in both groups after treatment, and the improvement in the observation group being significantly greater than that in the control group ( P<0.05). The incidence of post-surgery complications in the observation group was significantly lower than that in the control group ( P<0.05). The scores of both NIHSS and SAS in the observation group were significantly lower than those in the control group, while the scores of FIM, ASIA sensation, and ASIA motor function in the observation group were significantly higher than those in the control group ( P<0.05). After treatment, the levels of TNF-α and IL-1β in the observation group were significantly lower than those in the control group, while the levels of NGF and Neuritin in the observation group were significantly higher than those in the control group; all differences were statistically significant ( P<0.05). The incidence of complications in the observation group was significantly lower than that in the control group ( P<0.05). Conclusion:HBOT combined with transitional care can protect nerve function by significantly inhibiting the expression of inflammatory factors, promote the recovery of motor function, and improve the emotion of patients with spinal fractures combined with SCI.