高压氧联合颈椎硬膜外神经阻滞对脊髓型颈椎病患者神经功能的恢复作用  

Effect of hyperbaric oxygen combined with cervical epidural nerve block on nerve function recovery in patients with cervical spondylotic myelopathy

作　　者：吕剑敏[1] 蓝远青 程月梅 Lyu Jianmin;Lan Yuanqing;Cheng Yuemei(Operating Room,Lishui Municipal Central Hospital,Lishui 323000,China;Operating Room,Wenzhou People’s Hospital,Wenzhou 325000,China)

机构地区：[1]丽水市中心医院手术室,丽水323000 [2]温州市人民医院手术室,温州325000

出　　处：《中华航海医学与高气压医学杂志》2023年第5期572-576,共5页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

基　　金：浙江省自然科学基金(LY20H180156)。

摘　　要：目的探讨高压氧(HBO)联合颈椎硬膜外神经阻滞对脊髓型颈椎病(CSM)患者神经功能的恢复作用。方法选取2019年3月至2021年3月丽水市中心医院收治的84例CSM患者作为研究对象,以随机数字表法分为观察组及对照组,各42例。对照组患者接受HBO治疗,观察组患者在对照组患者基础上联合颈椎硬膜外神经阻滞治疗。比较2组患者临床疗效、治疗前后的神经功能恢复情况以及治疗后的生活质量。结果观察组患者临床疗效总有效率(85.71%)明显优于对照组(66.67%)患者,差异有统计学意义(P=0.040)。治疗前,2组患者日本骨科协会(JOA)评分及N1波、P1波水平比较,差异均无统计学意义(均P>0.05);治疗1个疗程后观察组JOA评分[(11.12±1.61)分]及N1波[(14.64±3.88)ms]、P1波[(7.88±0.81)ms]均明显高于治疗前和对照组,治疗后6个月观察组JOA评分[(13.93±1.64)分]及N1波[(15.71±2.16)ms]、P1波[(8.21±0.92)ms]均明显高于治疗前和对照组(均P<0.05)。观察组患者精神健康、生理功能、社会功能、躯体疼痛、情感职能、精力、生理职能、总体健康等生活质量维度评分均明显高于对照组患者(均P<0.001)。结论HBO联合颈椎硬膜外神经阻滞相比单纯的HBO在治疗CSM患者上效果更优。Objective To discuss the effect of hyperbaric oxygen(HBO)combined with cervical epidural nerve block on nerve function recovery in patients with cervical spondylotic myelopathy(CSM).Methods A total of 84 patients with CSM treated in Lishui Municipal Central Hospital from March 2019 to March 2021 were selected as research subjects and divided into observation group and control group by random number table method,with 42 cases in each group.The patients in the control group received HBO therapy,while the patients in the observation group were treated with cervical epidural nerve block on the basis of the treatment in the control group.The clinical efficacy,neurological recovery before and after treatment,and quality of life after treatment were compared between the two groups.Results The total effective rate of clinical efficacy in the observation group(85.71%)was significantly better than that in the control group(66.67%),with a statistically significant difference(P=0.040).Before treatment,there was no statistically significant differences in Japanese Orthopaedic Association(JOA)scores and the levels of N1 wave and P1 wave between the two groups(all P>0.05);after one course of treatment,the JOA score(11.12±1.61),N1 wave[(14.64±3.88)ms],and P1 wave[(7.88±0.81)ms]in the observation group were significantly higher than those before treatment and those of the control group;six months after treatment,the JOA score(13.93±1.64),N1 wave[(15.71±2.16)ms],and P1 wave[(8.21±0.92)ms]in the observation group were significantly higher than those before treatment and those of the control group(all P<0.05).The scores of quality of life,i.e.,mental health,physiological function,social function,physical pain,emotional function,energy,physiological function,and overall health,in the observation group were significantly higher than those in the control group(all P<0.001).Conclusion HBO combined with cervical epidural nerve block is more effective in the treatment of CSM patients than HBO alone.

关 键 词：高压氧 颈椎硬膜外神经阻滞 脊髓型颈椎病 神经功能 

分 类 号：R681.55[医药卫生—骨科学]