摘要目的:探讨高压氧（HBO）治疗对尿毒症维持性血液透析患者认知功能的影响。方法:选取2020年1月至12月在闸北中心医院肾内科进行维持性血液透析的尿毒症患者143例作为研究对象，采用中文版蒙特利尔认知评估量表（MoCA）进行认知功能评估，根据患者受教育时间和MoCA总分筛选出有认知功能障碍的82例患者，按照随机数字表法分为HBO组和对照组，每组41例。对照组患者给予纠正水电解质紊乱、营养支持和血液透析等治疗，HBO组患者在此基础上给予HBO治疗。比较2组患者的体内毒素清除情况、炎症因子水平、认知功能和生存质量。结果:治疗后，HBO组患者的MoCA总分及各因子得分、肾病与透析相关生存质量量表（KDTA）总均分及各因子得分均显著高于对照组（ P<0.05）。与治疗前相比，治疗后HBO组患者执行能力、抽象、定向力、语言、命名、注意力评分和MoCA总分均显著升高；而对照组患者仅定向力、注意力评分和MoCA总分显著升高（ P<0.05）；除对照组患者肾病影响评分升高不明显外，2组患者其他KDTA各因子及总均分均显著升高（ P<0.05）。血肌酐（Cr）、尿素氮（BUN）、甲状旁腺素（PTH）、β2-微球蛋白（β2-MG）和半胱氨酸蛋白酶抑制剂C（CysC）清除率均显著高于对照组（ P<0.05）。2组患者的血清C反应蛋白（CRP）、白细胞介素（IL）-6、IL-8、肿瘤坏死因子α（TNF-α）、单核细胞趋化蛋白-1（MCP-1）水平均较治疗前明显下降，且HBO组患者炎症因子水平明显低于对照组，差异均有统计学意义（ P<0.05）。 结论:HBO治疗有助于清除维持性血液透析尿毒症患者体内的毒素，减轻炎症反应，对认知功能和生存质量均具有一定的改善作用。

abstractsObjective:To investigate the effect of hyperbaric oxygen（HBO）therapy on the cognitive function in uremic patients with maintenance hemodialysis.Methods:The uremic patients undergoing maintenance hemodialysis in the Department of Nephrology of Zhabei Central Hospital from January 2020 to December 2020 were selected as the research subjects. The Chinese version of Montreal Cognitive Assessment（MoCA）was used to assess the cognitive function of all patients. Eighty-two patients with cognitive dysfunction were identified according to their length of education and MoCA total scores，and were divided into HBO group and control group according to the random number table method，with 41 patients in each group. Patients in the control group were given treatment such as correction of water-electrolyte disturbance，nutritional support，and hemodialysis，while patients in the HBO group were additionally given HBO treatment on the basis of the treatment in the control group. The clearance of toxins，levels of inflammatory factors，cognitive function，and quality of life were compared between the two groups.Results:After treatment，the total scores and factor scores of MoCA，and the total mean scores and factor scores of kidney disease-targeted areas（KDTA）of the HBO group were significantly higher than those of the control group（ P < 0.05）. In the HBO group，the scores of executive ability，abstraction，orientation，language，naming，and attention，and the total scores of MoCA after treatment were significantly increased when compared with those before treatment；in the control group，only the scores of orientation and attention and the total scores of MoCA after treatment were significantly increased（ P < 0.05）. All factor scores and total mean scores of KDTA in both groups were increased significantly（ P < 0.05），except for the score of effects of kidney disease（EKD）in the control group. The clearance rates of blood creatinine（Cr），urea nitrogen（BUN），parathyroid hormone（PTH），β2-microglobulin（β2-MG）and cysteine protease inhibitor C（CysC）in the HBO group were significantly higher than those of the control group（ P<0.05）. And the levels of serum C-reactive protein（CRP），interleukins（IL-6，IL-8），tumor necrosis factor-α（TNF-α），and monocyte chemotactic protein-1（MCP-1）in both groups after treatment were lower than those before treatment，and levels of inflammatory factors in the HBO group were significantly lower than those in the control group，with statistically significant differences（ P < 0.05）. Conclusion:HBO therapy helps remove toxins in uremic patients with maintenance hemodialysis，reduce inflammatory response，and improve the cognitive function and quality of life to a certain extent.