反复潜水后急性脊髓减压病临床分析  

Clinical characterization and treatment of acute spinal cord decompression sickness after repeated dives

作　　者：李雁[1] 黄烽[1] 韩涛[1] 周宝英[1] 林侃[1] 张天强[1] 

机构地区：[1]福建省立医院省心血管病研究所心外科高压氧室,福州市350001

出　　处：《中华劳动卫生职业病杂志》2015年第6期461-465,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

摘　　要：目的 分析急性脊髓减压病患者临床发病及治疗特点,探讨其疗效影响因素.方法 急性脊髓减压病患者77例,根据再加压治疗方案的不同以及是否采取正规药物治疗分成Ⅰ、Ⅱ、Ⅲ、Ⅳ4个组,同时给予高压氧和其他治疗.比较各组治愈率、Frankel功能分级、截瘫指数及其影响因素.结果 77例急性脊髓减压病患者早期治愈率57.14％（44/77）,晚期（1年）治愈率74.03％（57/77）,两者间差异有统计学意义（P＜0.05）;治疗3个月,Ⅲ组（85.71％）和Ⅳ组（95.24％）治愈率明显高于Ⅰ组（6.25％）和Ⅱ组（26.32％）治愈率,且差异有统计学意义（P＜0.05）;治疗1年,Ⅱ组（68.42％）、Ⅲ组（100％）和Ⅳ组（100％）治愈率明显高于Ⅰ组（12.50％）,差异均有统计学意义（P＜0.05）;Ⅲ组和Ⅳ组治愈率均明显高于Ⅱ组,差异有统计学意义（P＜0.05）.治疗3个月和1年各组Frankel功能分级分别较治疗前提高,截瘫指数分别较治疗前降低,差异有统计学意义（P＜0.05）;Ⅱ、Ⅲ和Ⅳ组的截瘫指数明显低于Ⅰ组,差异均有统计学意义（P＜0.05）;Ⅲ、Ⅳ组与Ⅱ组的Frankel功能分级和截瘫指数比较,差异有统计学意义（P＜0.05）,但Ⅲ和Ⅳ组间Frankel功能分级和截瘫指数差异无统计学意义（P＞0.05）影响治疗效果的17个因素中有9个因素所占比例较大.结论 急性脊髓减压病患者应首选iii组方案,同时给予高压氧治疗、针灸、康复训练、心理干预等.治疗方案、年龄、潜水深度、水下逗留时间、连续工作天数、水面间隔时间、治疗前Frankel功能分级、脊髓损伤部位、反复发潜水次数对急性潜水减压病疗效影响所占比例较大,在临床治疗过程中值得关注.Objective To analyze and summarize the characteristics and treatment of acute spinal cord decompression sickness.To explore the factors that influence the treatment effect.Methods 77 cases of acute spinal cord decompression sickness patients should be divided into 4 groups according to the pressurized treatment and drug treatment options.They were group Ⅰ,group Ⅱ,group Ⅲ and group Ⅳ.At the same time they were get hyperbaric oxygen therapy and other treatment.The evaluation index were Frankel function classification and paraplegia index.There were 17 factors that affected the treatment effect.Results The rate of early cure was 57.14% （44/77）.The rate of late cure was 74.03% （57/77）.Their difference was statistically significant （P〈0.05）.In 3 months and 1 year the cure rate of group Ⅳ and group Ⅲ were the highest.But there was no difference between them（P〉0.05）.They were higher than group ii and group Ⅰ （P〈0.05）.The Frankel function classification in 3months and 1 year in each group was higher than before treatment （P〈0.05）.The paraplegia index in 3 months and 1 year in each group was lower than before treatment （P〈0.05）.In 3 months and 1 year the Frankel function classification was increased gradually and the paraplegia index was decreased gradually in group Ⅰ,group Ⅱ,group Ⅲ （P〈0.05）.In group Ⅳ and group Ⅲ tne Frankel function and the paraplegia index had not significant difference （P〉0.05）.Among the 17 factors that affect the treatment effect there are 9 factors that affect the proportion of the large.Conclusions The first choice of treatment method for the patients with acute spinal cord decompression sickness would be group Ⅲ.Drug therapy was also imporpant.At the same time the hyperbaric oxygen therapy and other treatments were taken.Although the cure rate was not high in this article.But most of the cure is within 3 months.Within 1 year the cure rate still could be improved.9 factors that affect the efficacy of acute spinal cord deco

关 键 词：潜水 急性脊髓减压病 临床方案 

分 类 号：R687.3[医药卫生—骨科学]