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中华航海医学与高气压医学杂志
中华航海医学与高气压医学杂志

褚新奇

双月刊

1009-6906

zhhh@chinajournal.net.cn

021-81883316

200433

上海市翔殷路880号

中华航海医学与高气压医学杂志/Journal Chinese Journal of Nautical Medicine and Hyperbaric MedicineCSCDCSTPCD北大核心
查看更多>>1994年创刊，中国科学技术协会主管，中华医学会主办。本刊是我国航海医学领域、高压氧医学与潜水医学领域唯一的专业性科技核心期刊和统计源期刊。本刊已被美国《化学文摘》（CA）、俄罗斯《文摘杂志》（AJ）、国内各大数据库收录，主要刊发航海环境医学、潜水医学、航海临床医学、高压氧医学、航海医学保障与卫生防疫、航海医学心理学、航海人-机-环系统工程学、医学教育等方面的文章。主要读者对象为从事航海医学与高压氧医学治疗、教学、科研、管理等领域的高、中级人员。
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    高压氧联合地塞米松治疗剖宫产椎管内麻醉后脊神经根损伤62例疗效观察

    李红培李皓姚兰董铭杰...
    1-6页
    查看更多>>摘要：目的 探讨高压氧（HBO）联合地塞米松治疗剖宫产椎管内麻醉后脊神经根损伤的临床疗效。 方法 回顾性分析2017年4月至2023年4月解放军总医院第一医学中心麻醉科收集的109例剖宫产椎管内麻醉后脊神经根损伤患者的临床资料。按照治疗方法将109例患者分为联用组（n=62）和对照组（n=47）。2组患者在穿刺或置管过程中出现下肢触电感且不自主收缩等神经刺激症状，均即刻和术毕分别经硬膜外注射地塞米松5 mg治疗。对照组患者术后第2天继续静脉滴注地塞米松10 mg，联用组在对照组治疗的基础上加用HBO治疗。采用视觉模拟评分（VAS）分别对2组患者术后第2、5、8天疼痛、麻木和感觉异常进行评估，并统计临床疗效。采用酶联免疫吸附法测定患者术后第2、5、8天血清白细胞介素（IL）-8、IL-10及肿瘤坏死因子α（TNF-α）水平；采用散射比浊法测定血清高敏C反应蛋白（hs-CRP）水平。采用匹兹堡睡眠质量指数（PSQI）评分法分别对2组患者术后第2、5、8天睡眠质量进行统计。 结果 联用组术后第8天治疗总有效率（98.4%）明显高于对照组（83.0%），差异有统计学意义（χ2=4.471，P=0.024）。与对照组术后第5、8天比较，联用组相应时点疼痛、麻木及感觉异常评分均明显降低（P<0.05）。与同组术后第2天相比，2组患者术后第5、8天血清TNF-α、hs-CRP、IL-8水平明显降低，IL-10水平明显升高（P<0.01）；与同组术后第5天比较，2组患者第8天血清TNF-α、hs-CRP、IL-8水平明显降低，IL-10水平明显升高（P<0.05）；与对照组术后第5、8天比较，联用组相应时点血清TNF-α、hs-CRP、IL-8水平明显降低，IL-10水平明显升高（P<0.05）。与对照组术后第5、8天比较，联用组相应时点PSQI评分均明显降低（P<0.05）。 结论 HBO联合地塞米松治疗剖宫产椎管内麻醉后脊神经根损伤临床疗效显著，能明显降低患者疼痛、麻木及感觉异常评分，改善睡眠质量。 Objective To investigate the clinical efficacy of hyperbaric oxygen（HBO）combined with dexamethasone in the treatment of spinal nerve root injury after intraspinal anesthesia in patients underwent caesarean section. Methods The clinical data of 109 patients with nerve root injury after intraspinal anesthesia during caesarean section in the Anesthesia Department of the First Medical Center of the PLA General Hospital from April 2017 to April 2023 were retrospectively analyzed. According to the treatment method，109 patients were divided into combination group（n=62）and control group（n=47）. The patients experienced nerve stimulation symptoms，such as lower limb electric shock and involuntary contraction，and were treated with 5 mg dexamethasone through epidural injection upon occurrence and after surgery，respectively. The patients in the control group received 10 mg of intravenous dexamethasone on the second day after surgery，while the patients in the combination group received HBO treatment based on the treatments for the control group. Two groups of patients were evaluated for pain，numbness，and sensory abnormalities on the 2nd，5th，and 8th day after operation using visual analog scale（VAS），and clinical efficacy was analyzed. Enzyme-linked immunosorbent assay was used to measure the levels of serum interleukin-8（IL-8），interleukin-10（IL-10），and tumor necrosis factor-α（TNF-α）on the 2nd，5th，and 8th day after operation. Serum high-sensitivity C-reactive protein（hs-CRP）levels were measured using nephelometric turbidity method. The Pittsburgh sleep quality index（PSQI）scoring method was used to analyze the sleep quality of the patients in the two groups on the 2nd，5th，and 8th day after operation. Results The total effective rate of the combined group on the 8th day after surgery（98.4%）was significantly higher than that of the control group（83.0%），with a statistical difference（χ2=4.471，P=0.024）. Compared with the control group on the 5th and 8th day after surgery，the pain，numbness，and sensory abnormalities scores of the combination group were significantly reduced at the corresponding time points（P<0.05）. Within the same group，compared with the serum levels of TNF-α，hs-CRP，and IL-8 on the 2nd day after surgery，those on the 5th and 8th day after surgery in both groups were significantly reduced，while the levels of IL-10 were significantly increased（P<0.01）. Within the same group，compared with the levels of serum TNF-α and hs-CRP，and IL-8 on the 5th day after surgery，those on the 8th day in both groups were significantly reduced，while the levels of IL-10 were significantly increased（P<0.05）. Compared with the control group on the 5th and 8th day after surgery，the serum levels of TNF-α，hs-CRP，and IL-8 in the combined group were significantly reduced on the 5th and 8th day after surgery，while the levels of IL-10 were significantly increased（P<0.05）. Compared with the control group on the 5th and 8th day after surgery，the PSQI scores of the combination group at the corresponding time points were significantly reduced（P<0.05）. Conclusion HBO combined with dexamethasone has a significant clinical effect on treating nerve root injury after cesarean section intraspinal anesthesia，which can significantly reduce the pain，numbness，and sensory abnormalities scores，and improve sleep quality.

    脊神经根损伤孕妇剖宫产高压氧地塞米松椎管内麻醉

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    核心训练联合高压氧治疗外伤性颈段不完全性脊髓损伤患者的康复效果分析

    曾波王萍芝高敏兰彩琴...
    7-11页
    查看更多>>摘要：目的 探究核心训练联合高压氧（HBO）治疗对外伤性颈段不完全性脊髓损伤（SCI）患者术后康复效果的影响。 方法 选择2018年1月至2022年1月山西白求恩医院康复医学科收治的177例外伤性颈段不完全性SCI患者，按随机数字表法将患者分为核心训练组、HBO组和联合组，每组59例，分别予以核心训练、HBO、核心训练联合HBO治疗。连续治疗4周后采用美国脊髓损伤协会（ASIA）评分评估患者感觉、运动等神经功能，采用改良Barthel指数（MBI）评定量表和功能独立性量表（FIM）评定患者日常活动能力，采用简易McGill疼痛问卷（SF-MPQ）评估患者疼痛程度，采用匹兹堡睡眠质量指数（PSQI）量表评定患者睡眠质量，并记录各组患者脊髓功能恢复时间及不良反应情况。 结果 3组患者治疗后ASIA感觉评分、ASIA运动评分、MBI评分、FIM评分较治疗前升高，SF-MPQ各维度评分及PSQI总分较治疗前降低，且联合组上述指标优于HBO组和核心训练组，差异均有统计学意义（P<0.05）；联合组患者括约肌功能恢复时间、独立下床活动时间及总住院时长短于核心训练组、HBO组，差异均有统计学意义（P<0.05）；3组患者总不良反应发生率比较差异无统计学意义（P>0.05）。 结论 采用核心训练联合HBO治疗外伤性颈段不完全性SCI，不仅能改善患者神经、下肢运动功能，减轻疼痛程度，还能提高患者睡眠质量，加速脊髓功能恢复，且不良反应少，值得临床优先选择。 Objective To investigate the effect of core training combined with hyperbaric oxygen（HBO）in postoperative rehabilitation of patients with traumatic cervical incomplete spinal cord injury（SCI）. Methods A total of 177 patients with traumatic cervical incomplete SCI admitted to the Department of Rehabilitation Medicine of Shanxi Bethune Hospital between January 2018 and January 2022 were selected and divided into three groups，i.e.，core training group（n=59），HBO group（n=59），and combination group（n=59），according to the random number table method. The patients were treated with core training，HBO，and core training combined with HBO，respectively.After 4 weeks of continuous treatment，the patient’s sensory，motor，and other neurological functions were assessed by American Spinal Injury Association（ASIA）scale. The patients’ daily activity ability was assessed using the Modified Barthel Index（MBI）assessment scale and Functional Independence Measure（FIM）. The level of pain in patients was evaluated using the simplified McGill Pain Questionnaire（SF-MPQ）. The sleep quality of patients was assessed by Pittsburgh Sleep Quality Index（PSQI）scale，and the recovery time of spinal cord function and adverse reactions in each group were recorded. Results After treatment，the ASIA sensory and motor scores，MBI scores，and FIM scores of the patients in the three groups were significantly higher than those before treatment（P<0.05）；while each result of the SF-MPQ and the total score of PSQI significantly decreased（P<0.05），and the indicators of the combination group were significantly better than the other two groups（P<0.05），all the differences were statistically significant. The recovery time of sphincter function，the time of getting out of bed independently，and the total length of hospitalization in the combination group were significantly shorter than those in the core training group and the HBO group（P<0.05）. There was no statistically significant difference in the total incidence of adverse reactions among the three groups（P>0.05）. Conclusion The combination of core training and HBO in the treatment of traumatic cervical incomplete SCI can not only improve the neurologic function and lower limbs’ motor functions，reduce the degree of pain，but also improve the quality of sleep and accelerate the recovery of spinal cord function with few adverse reactions，which is worth clinical priority.

    不完全性脊髓损伤核心训练高压氧

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    高压氧联合轻度全身降温模式治疗脑损伤术后患儿56例疗效观察

    刘晓莉刘赵鹤陈海珍吴丽莉...
    12-16页
    查看更多>>摘要：目的 探讨高压氧（HBO）联合轻度全身降温模式治疗脑损伤术后患儿的临床疗效。 方法 选取2019年7月至2022年2月山西省儿童医院小儿重症监护病房收治的脑损伤术后患儿112例作为研究对象。按照随机数字表法分为观察组和对照组，每组56例。2组患儿常规对症支持治疗后，对照组予以头部降温联合HBO治疗，观察组给予轻度全身降温联合HBO治疗。比较2组患儿治疗前后格拉斯哥昏迷评分（GCS）、功能独立性评定（FIM）评分、动脉血氧分压、经皮血氧饱和度的变化。采用简易智力状态检查量表（MMSE）和Loewenstein认知功能评定量表（LOTCA）对2组患儿治疗前后的认知能力进行评定。采用酶联免疫吸附法检测2组患儿治疗前后血清纤维凝胶蛋白（ficolin-3）水平，采用实时荧光定量PCR实验检测2组患儿治疗前后微小RNA-34a（miR-34a）的相对表达量。随访6个月，比较2组患儿的预后良好率。 结果 与治疗前比较，2组患儿治疗后GCS、FIM评分、MMSE评分、LOTCA评分、动脉血氧分压、经皮血氧饱和度及血清ficolin-3水平均明显升高（P<0.01），且观察组患儿治疗后均明显高于对照组（P<0.05或P<0.01）；血清miR-34a相对表达量明显降低（P<0.01），且观察组患儿治疗后miR-34a相对表达量明显低于对照组（P<0.01）。在随访6个月后，观察组患儿预后良好率（52.83%）明显高于对照组（40.74%），差异有统计学意义（P<0.05）。 结论 HBO联合轻度全身降温模式治疗脑损伤术后患儿，能提高其脑组织氧含量，有效改善患儿的昏迷程度和认知功能，进一步提高认知能力和预后良好率。 Objective To investigate the clinical efficacy of hyperbaric oxygen（HBO）combined with mild systemic hypothermia in the treatment of postoperative brain injury in children. Methods A total of 112 children with postoperative brain injury admitted to the Pediatric Intensive Care Unit of Children's Hospital of Shanxi from July 2019 to February 2022 were selected as the research subjects. They were randomly divided into observation group and control group，with 56 cases in each group. After conventional symptomatic supportive treatment，the control group received head cooling combined with HBO therapy，while the observation group received mild systemic hypothermia combined with HBO therapy. The changes in Glasgow Coma Scale（GCS）score，Functional Independence Measure（FIM）score，arterial oxygen partial pressure，and blood oxygen saturation before and after treatment were compared between the two groups. The cognitive abilities of the children of two groups before and after treatment were assessed using the Mini Mental State Examination（MMSE）and Loewenstein Occupational Therapy Cognitive Assessment（LOTCA）Scale. Enzyme-linked immunosorbent assay was used to detect the serum ficolin-3 level，and real-time fluorescence quantitative polymerase chain reaction（RT-PCR）was used to detect the relative expression level of micro-RNA-34a（miR-34a）before and after treatment in both groups. A 6-month follow-up was conducted to compare the rate of favorable prognosis in the two groups. Results Compared with before treatment，the GCS，FIM score，MMSE score，LOTCA score，arterial oxygen partial pressure，and transcutaneous oxygen saturation score in both groups significantly increased after treatment（P<0.01）；and the post-treatment scores in the observation group were significantly higher than those in the control group（P<0.05 or P<0.01）. After treatment，the level of serum ficolin-3 in the observation group was significantly higher than that in the control group，while the relative expression level of miR-34a was significantly lower than that in the control group（P<0.05 or P<0.01）. After the 6-month follow-up，the rate of favorable prognosis in the observation group（52.83%）was significantly higher than that in the control group（40.74%），with a statistically significant difference（P<0.05）. Conclusion HBO combined with mild systemic hypothermia in the treatment of postoperative brain injury in children can increase cerebral tissue oxygen content，effectively improve the severity of coma and enhance functional abilities，thus further promoting cognitive abilities and improving the rate of favorable prognosis.

    脑损伤患儿高压氧轻度全身降温头部降温

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    自我构念对海军航空兵主观幸福感的影响

    王志强李艳王俐钞范硕...
    17-22页
    查看更多>>摘要：目的 探讨海军航空兵某部官兵的自我构念对主观幸福感的影响及其机制。 方法 2021年10月至12月，采用便利抽样法选取海军航空兵某部官兵533名，采用自我构念量表、简易应对方式问卷、UCLA孤独量表、领悟社会支持量表和主观幸福感量表对其进行调查。 结果 （1）海军航空兵自我构念以二元类和边缘类为主，前者主观幸福感最高，差异有统计学意义（P<0.01）。（2）自我构念显著正向预测主观幸福感（P<0.01）。（3）应对倾向与领悟社会支持及孤独感之间存在交互作用（P<0.01）。（4）应对倾向、领悟社会支持和孤独感在互依自我和主观幸福感之间中介作用显著（P<0.01），孤独感在独立自我和主观幸福感之间中介作用显著（P<0.05）。（5）采取积极应对倾向时，社会支持正向预测幸福感（P<0.01），而采取消极应对倾向时，这种预测作用不明显；不管是积极或消极应对倾向，孤独感均负向预测幸福感，但消极时的预测作用更明显（P<0.01）。 结论 海军航空兵某部官兵的自我构念能通过应对方式、社会支持和孤独感的部分中介作用影响主观幸福感，且应对方式还在间接路径中起调节作用。 Objective To analyze the influence of self-construal on subjective well-being and its mechanism. Methods A total of 533 officers and soldiers from a naval aviation unit were investigated by Self-construal Scale，Simplified Coping Style Questionnaire，UCLA Loneliness Scale，Perceived Social Support Scale，and Subjective Well-being Questionnaire. Results （1）The self-construal significantly and positively predicted subjective well-being（P<0.01）.（2）There were interactive effects among coping tendencies，perceived social support，and loneliness（P<0.01）.（3）Coping tendencies，perceived social support，and loneliness played significant mediating roles between interdependent self and subjective well-being（P<0.01）.（4）When adopting positive coping tendencies，social support positively predicted well-being（P<0.01）；when adopting negative coping tendencies，the above predictive function was not obvious（P<0.05）.（5）No matter adopting positive or negative coping tendencies，the loneliness all negatively predicted well-being，and the predictive function was more obvious when adopting negative copping tendencies（P<0.01）. Conclusion The self-construal of officers and soldiers of a naval aviation unit can affect subjective well-being through partial mediating effects of coping style，social support，and loneliness，specifically，coping style played a moderating role in the indirect path.

    主观幸福感自我构念社会支持孤独感应对方式

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    特种作战医学领域基础研究态势分析

    胡甜甜贾乂扬王伟张阵阵...
    23-28页
    查看更多>>摘要：目的 从特种作战医学领域论文发表趋势、研究方向、研究主题、研究路线及发表来源等方面探讨特种作战医学领域研究态势。 方法 对Web of Science（WOS）核心合集进行检索，检索时间为2019年11月，检索策略包含WOS医学相关学科，从论文发表趋势、研究方向、研究主题、研究路线等方面检索统计分析，检索涉及到的学科方向采用WOS分类标准。 结果 共计检索到相关文献1 211篇。从相关论文发表趋势来看，20世纪初期至20世纪80年代末，该领域文献发表数量较少，近5年来该领域的论文年均发表量超过70篇。发表论文数量较多的研究方向主要有普通内科、公共卫生、环境与职业健康等，研究的重要方向包括特种作战医疗危险因素、地区战争健康问题相关研究、战场伤病员医疗保健。从相关论文区域分布来看，发文量最大的国家为美国，占全球发文总量的76%，其次依次为英国、中国、德国、日本、荷兰等国家。从研究方向来看，除德国外，其他国家都将公共卫生、环境和职业健康作为主要研究方向。 结论 通过对主要因素的检索研究，可基本了解国外特种作战医学研究态势和脉络。 Objective To analyze the general status of research in the field of special operations medicine from the perspectives of publication trend，research direction，research topic，research pathway，and publication source. Methods The retrieval were conducted on the Web of Science（WOS）Core Collection，with the retrieval time of November 2019. The retrieval field focused on medicine and its related areas. The retrieval results were statistically analyzed from the perspectives of publication trend，research direction，research topic，and research pathway. The classification of research field used the Web of Science classification standards. Results A total of 1 211 related literatures were retrieved. From the perspective of the publication trend，the number of papers published in this field was relatively small from the beginning of the 20th century to the end of the 1980s，and the average annual number of papers published in this field in the past five years was more than 70. The research directions with many published papers were internal medicine，public health，and environment and occupational health. The key research directions are medical risk factors in special operations，health issues in regional wars，and battlefield casualty care，and so on. From the perspective of the country distribution of the papers’ origin，the country with the largest number of published paper is the United States，accounting for 76% of the total global publications，followed by the United Kingdom，China，Germany，Japan，the Netherlands，and others. From the perspective of research direction，except Germany，all the countries took public health and environment and occupational health as the main research directions. Conclusion Through studying on the main factors of the publication，the general status of the research in the field of special operations medicine in foreign countries can be outlined.

    特种作战特战队空中突击队蛙人

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    高压氧治疗相关指南和专家共识的质量分析与优化建议

    张良孙强范丹峰张敦晓...
    29-35页
    查看更多>>摘要：目的 评价高压氧治疗相关指南和专家共识的质量并提出优化建议。 方法 检索万方数据知识服务平台、维普中文期刊知识服务平台、中国知网、中国生物医学文献数据库和中华医学期刊网等5个中文数据库，筛选高压氧治疗相关的指南和共识，提取标题、主要责任者、疾病分类、领域类型、证据质量、推荐强度分级、发表年份、核心观点等信息，确定入选文献。检索时限为2017年1月1日至2022年12月31日。采用中国临床实践指南评价体系（AGREE-China）对入选文献进行评分，并对制订主要责任专家为高压氧和非高压氧专家的2组总分与各领域得分进行比较。 结果 总计有40篇文献纳入本研究，其中共识35篇，占比87.5%；高压氧医学专家为主要责任者9篇，全部为共识。AGREE-China评分平均分仅28.58分。高压氧医学专家为主要责任作者制订的共识，在总分及各领域得分与对照组比较差异无统计学意义（P>0.05），但总体上分数偏低，除入围排名前10位的1篇外，其余8篇总分均低于平均值。 结论 高压氧治疗相关指南和共识的质量评分总体不高，尤其是在注册、文献检索、证据质量分级、推荐意见的形成和等级、推荐方案的有效性和安全性等方面需要加强。高压氧医学工作者需要努力进行高质量的临床研究，积极主持或参与相关指南和共识的制订。 Objective To evaluate the guidelines and expert consensuses on hyperbaric oxygen therapy and provide recommendations for its optimization. Methods The guidelines and consensuses related to hyperbaric oxygen therapy were retrieved from five Chinese databases，including Wanfang Data，Chinese Science and Technology Periodicals（VIP）database，National Knowledge Infrastructure（CNKI），Chinese Biomedical Literatures database（CBM），and National Medical Journal of China，with the search period set from January 1st 2017 to December 31st 2022. Based on the extracted information，such as title，main responsible author，classification of disease，type of domain，evidence quality，recommendation rating，year of publication，and key points，to determine the inclusion of the literature. The AGREE-China was used to score the included literatures，and the total scores of the two groups with hyperbaric oxygen and non-hyperbaric oxygen experts as the main responsible authors were compared with the scores in each field. Results A total of 40 articles were included，among which 35 were consensuses，accounting for 87.5%. Nine literatures with hyperbaric oxygen medicine experts as the main responsible authors were all consensuses. The average rating of AGREE-China is only 28.58. As for the guidelines and consensuses formulated by hyperbaric oxygen medicine experts as the main responsible authors，although there was no statistical significance in the total scores and scores in various fields compared with the control group（P>0.05），the scores were generally low. Except one article ranked in the top 10，the total scores of the remaining 8 articles were lower than the average. Conclusion The quality scores of the guidelines and consensuses on hyperbaric oxygen therapy are generally not high，especially in the areas of registration，literature retrieval，grading of evidence quality，formation and grading of recommendation，effectiveness and safety of recommended programs，and other aspects. The hyperbaric oxygen medicine experts need to strive to conduct high-quality clinical studies and actively lead or participate in the development of the guidelines and consensus in this field.

    高压氧指南共识质量评价评价标准

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    高压氧辅助治疗对糖尿病患者血糖影响的Meta分析

    代艳芬董安华仲蓓万金娥...
    36-40页
    查看更多>>摘要：目的 分析高压氧（HBO）辅助治疗糖尿病时对血糖的影响。 方法 检索PubMed、Embase、CBM、CNKI、VIP和万方数据库（WAN-FANG DATA）等数据库，时间限定为自建库至2022年1月。收集高压氧联合常规药物治疗糖尿病的随机对照试验（RCTs）。3名研究者独立筛选收集到的RCTs，提取相关数据、评估文献质量。应用RevMan 5.3软件进行Meta分析。 结果 本研究共纳入8个RCTs，Meta分析结果显示，与对照组相比，高压氧联合常规治疗组患者的空腹血糖、餐后2 h血糖、糖化血红蛋白明显降低（P≤0.01）。 结论 高压氧辅助治疗糖尿病可降低患者的血糖水平，为高压氧的临床应用提供证据。 Objective To analyze the effect of hyperbaric oxygen（HBO）therapy on blood glucose in the treatment of diabetes mellitus. Methods The articles were retrieved from PubMed，Embase，CBM，CNKI，VIP，and WANFANG DATA with the publishment time from the establishment of the database to January 2022. The randomized controlled trials（RCTs）of hyperbaric oxygen combined with conventional medication treatment of diabetes mellitus were collected. Three researchers independently screened the RCTs，extracted relevant data，and evaluated the quality of the trial. Meta-analysis was performed using RevMan 5.3. Results A total of eight RCTs were included in this study. The results of meta-analysis showed that fasting blood glucose（FBG），2-hour postprandial blood glucose（PBG），and HbA1c in the observation group were significantly decreased compared to those in control group（P≤0.01）. Conclusion Hyperbaric oxygen can reduce blood glucose level in patients with diabetes mellitus，providing evidence for clinical application of hyperbaric oxygen.

    糖尿病高压氧Meta分析

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    高压氧治疗对创伤性蛛网膜下腔出血患儿神经功能、脑微循环及血清miR-143水平的影响

    王琪邵启国张丽娜何卫东...
    41-45页
    查看更多>>摘要：目的 探讨高压氧治疗对创伤性蛛网膜下腔出血患儿神经功能、脑微循环和血清miR-143水平的影响。 方法 前瞻性选取2015年2月至2020年5月商丘市第一人民医院儿科重症监护室收治的50例创伤性蛛网膜下腔出血患儿作为研究对象，根据治疗方法分为对照组（n=24）和观察组（n=26）。对照组患儿采用常规药物治疗，观察组患儿在对照组治疗基础上的采用高压氧治疗。比较治疗前后2组患儿的格拉斯哥昏迷量表（GCS）评分、脑微循环指标、颅内压、血清miR-143水平及预后情况。 结果 观察组患儿治疗1、2个疗程后的颅内压明显低于对照组，GCS评分、血清miR-143水平高于对照组，差异均有统计学意义（P<0.001）；观察组患儿治疗2个疗程后的平均通过时间（MTT）、脑血流量（CBF）、脑血容量（CBV）、平均动脉压（MAP）较对照组明显改善，差异均有统计学意义（P<0.001）；观察组患儿预后良好率明显高于对照组，差异有统计学意义（P<0.05）。 结论 高压氧治疗创伤性蛛网膜下腔出血患儿，可提高患儿的血清miR-143水平，降低颅内压，改善脑微循环及预后。 Objective To explore the effect of hyperbaric oxygen on neurological function，cerebral microcirculation，and serum miR-143 level in children with traumatic subarachnoid hemorrhage. Methods A total of 50 children with traumatic subarachnoid hemorrhage admitted to the pediatric intensive care unit of Shangqiu First People’s Hospital from February 2015 to May 2020 were prospectively selected as the research objects and divided them into control group（n=24）and observation group（n=26），according to the random number table method. The children in the control group received conventional medical treatment，and the children in the observation group were treated with hyperbaric oxygen on the basis of the treatment in the control group. The Glasgow Coma Scale（GCS）score，cerebral microcirculation index，intracranial pressure，serum miR-143 level，and prognosis were compared between the two groups before and after treatment. Results After one course of treatment and two courses of treatment，the intracranial pressure of children in the observation group were all lower than that in the control group，and the GCS score and serum miR-143 level were all higher than those in the control group，with statistically significant differences（P<0.05）；the mean transit time（MTT），cerebral blood flow（CBF），cerebral blood volume（CBV），and mean arterial pressure（MAP）of the children in the observation group after two courses of treatment were all significantly improved compared with those in the control group，with statistically significant differences（P<0.05）；the good prognosis rate of the observation group was higher than that of the control group，with statistically significant differences（P<0.05）. Conclusion Hyperbaric oxygen for children with traumatic subarachnoid hemorrhage can elevate the level of serum miR-143，reduce intracranial pressure，and improve cerebral microcirculation and prognosis.

    创伤性蛛网膜下腔出血高压氧脑微循环miR⁃143颅内压

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    海军飞行人员高尿酸血症患病状况及影响因素分析

    宋平范茂丹李峰苟昊林...
    46-50页
    查看更多>>摘要：目的 了解海军飞行人员血尿酸水平及高尿酸血症检出情况，调查分析高尿酸血症发病影响因素。 方法 收集717例海军飞行人员人口学信息、生活方式资料，并回顾性分析其年度体检数据，根据血尿酸水平分为正常组及高尿酸血症组，计算海军飞行人员高尿酸血症检出率，了解发病特征。通过χ2检验、Logistic回归分析高尿酸血症飞行人员发病影响因素。 结果 717名海军飞行人员中，共检出高尿酸血症195例（195/717，27.20%），纳入高尿酸血症组，血尿酸水平（473.70±48.35）µmol/L；血尿酸正常522例（522/717，72.80%），纳入正常尿酸组，血尿酸水平（350.10±42.73）µmol/L。χ2检验结果显示，正常尿酸组和高尿酸血症组在饮食、运动、吸烟、饮酒、睡眠等生活习惯，职业累计时间、体重指数、丙氨酸转氨酶、天冬氨酸转氨酶、三酰甘油、胆固醇、低密度脂蛋白胆固醇、空腹血糖等方面的检出率差异有统计学意义（P<0.05）。进一步多因素Logistic回归分析发现，饮食、运动、饮酒、睡眠、三酰甘油、低密度脂蛋白胆固醇是高尿酸血症发病的独立影响因素（P<0.05）。 结论 海军飞行人员高尿酸血症检出率较高，其发病主要与不良生活习惯、三酰甘油升高、低密度脂蛋白胆固醇升高有关。在进行健康宣教时，应指导其养成少食用海鲜、多食新鲜蔬菜、保持规律运动、戒酒、改善睡眠等良好生活习惯，控制三酰甘油、低密度脂蛋白胆固醇水平，降低高尿酸血症发病率，提高海军飞行人员健康水平。 Objective To investigate the level of serum uric acid and the prevalence of hyperuricemia in naval aviation personnel，and analyze the influencing factors of hyperuricemia. Methods The demographic information and lifestyle data of 717 naval aviation personnel were collected，and their annual physical examination data were analyzed retrospectively. According to the blood uric acid level，they were divided into normal group and hyperuricemia group. The detection rate of hyperuricemia in naval aviation personnel was calculated to investigate the characteristics of the prevalence of the disease. The influencing factors of hyperuricemia in naval aviation personnel were analyzed by chi-square test and logistic regression. Results Among the 717 naval aviation personnel，195（195/717，27.20%）were detected as hyperuricemia and were assigned in the hyperuricemia group，with blood uric acid level of（473.70 ± 48.35）μmol/L. A total of 522 cases（522/717，72.80%）with normal blood uric acid were assigned in the normal uric acid group，with blood uric acid level of（350.10 ± 42.73）μmol/L. The results of chi-square test showed that there were statistically significant differences between the normal uric acid group and the hyperuricemia group in the factors of living habits，such as diet，physical exercise，smoking，drinking alcohol，and sleep quality，and cumulated occupational time，body mass index，alanine aminotransferase，aspartate aminotransferase，triacylglycerol，cholesterol，low density lipoprotein cholesterol，and fasting blood glucose（P<0.05）. Multivariate logistic regression analysis showed that diet，physical exercise，alcohol drinking，sleep quality，triglyceride，and low-density lipoprotein cholesterol were independent influential factors of hyperuricemia（P<0.05）. Conclusion The detection rate of hyperuricemia in naval aviation personnel is high，and its occurrence is mainly related to unhealthy living habits，elevated triacylglycerol，and elevated low density lipoprotein cholesterol. It is recommended to emphasize forging good living habits such as eating less seafood，eating more fresh vegetables，keeping regular physical exercise，quitting alcohol drinking，and improving sleep quality，and controlling the levels of triglyceride and low-density lipoprotein cholesterol in health education，so as to reduce the incidence of hyperuricemia and improve the health of naval aviation personnel.

    高尿酸血症尿酸检出率横断面研究影响因素

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    高压氧联合泼尼松治疗无听力变化耳鸣的临床疗效及其作用机制

    邱艾嘉张微微叶晓玲王映红...
    51-54页
    查看更多>>摘要：目的 探讨高压氧（HBO）联合泼尼松治疗无听力变化耳鸣的临床疗效及其作用机制。 方法 选取2020年8月至2022年4月在台州恩泽医院耳鼻咽喉科就诊的150例无听力变化耳鸣患者作为研究对象。按照随机数字表法分为对照组（n=75）和研究组（n=75）。对照组患者口服泼尼松，研究组在对照组的基础上给予HBO治疗。评估2组患者治疗后的临床疗效，检测2组患者治疗前后耳鸣程度、气导听力及听力障碍的变化。采用高效液相色谱荧光法和荧光分光光度法检测2组患者治疗前后静脉血中γ-氨基丁酸（GABA）和5-羟色胺（5-HT）水平，采用硝酸还原酶法酶联免疫吸附法测定血清一氧化氮（NO）水平、采用血清连接子蛋白26（connexin 26）水平。 结果 研究组患者治疗后总有效率（93.33%）明显高于对照组（81.33%），差异有统计学意义（P<0.05）。与治疗前比较，2组患者治疗后耳鸣程度、气导听力水平、听力障碍评分均明显降低（P<0.01），且研究组患者治疗后明显低于对照组（P<0.01）。研究组患者治疗后GABA水平明显高于对照组，5-HT水平明显低于对照组（P<0.05或P<0.01）。与治疗前比较，2组患者治疗后血清NO和connexin 26水平均明显升高（P<0.01），且研究组患者治疗后明显高于对照组（P<0.01）。 结论 HBO联合泼尼松治疗无听力变化耳鸣取得较好临床疗效，主要是通过调节中枢神经递质水平和内耳微环境平衡实现的。 Objective To investigate the clinical efficacy and mechanism of action of hyperbaric oxygen（HBO）therapy combined with prednisone in the treatment of tinnitus without hearing loss. Methods A total of 150 patients with tinnitus without hearing loss treated at the Department of Otorhinolaryngology of Enze Hospital of Taizhou Enze Medical Center from August 2020 to April 2022 were selected as the study subjects. They were randomly divided into control group（n=75）and study group（n=75）. The patients in the control group were given prednisone orally，while the patients in the study group were given HBO therapy on the basis of treatments in the control group. After treatment，the clinical therapeutic effects of the two groups were evaluated，and the changes in the severity of tinnitus，air-conduction hearing level，and hearing impairment were measured before and after treatment in both groups. The levels of gamma-aminobutyric acid（GABA）and 5-hydroxytryptamine（5-HT）in venous blood were determined using high-performance liquid chromatography-fluorescence detection and fluorescence spectrophotometry. The level of serum nitric oxide（NO）was measured by nitrate reductase assay，and the level of connexin 26（Cx26）in serum was determined by enzyme-linked immunosorbent assay. Results The overall effective rate in the study group（93.33%）was significantly higher than that in the control group（81.33%），with a statistically significant difference（P<0.05）. Compared with before treatment，the severity of tinnitus，air-conduction hearing level，and hearing impairment score in both groups were significantly decreased after treatment（P<0.01），and the scores in the study group were significantly lower than those in the control group（P<0.01）. The post-treatment level of GABA in the study group was significantly higher，and the level of 5-HT in the study group was significantly lower，compared with the control group（P<0.01）. Compared with before treatment，the post-treatment levels of serum NO and Cx26 were significantly increased in both groups（P<0.01），and the study group had significantly higher levels than the control group（P<0.01）. Conclusion HBO therapy combined with prednisone shows good clinical efficacy in the treatment of tinnitus without hearing loss，which is mainly achieved through regulating central neurotransmitter levels and maintaining inner ear microenvironment balance.

    无听力变化耳鸣高压氧泼尼松中枢神经递质

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