Harch Paul G, Fogarty Edward F
Department of Medicine, Section of Emergency Medicine, University Medical Center, Louisiana State University School of Medicine, New Orleans, LA, USA.
Department of Radiology, University of North Dakota School of Medicine, Bismarck, ND, USA.
Med Gas Res. 2017 Jun 30;7(2):144-149. doi: 10.4103/2045-9912.208521. eCollection 2017 Apr-Jun.
A 2-year-old girl experienced cardiac arrest after cold water drowning. Magnetic resonance imaging (MRI) showed deep gray matter injury on day 4 and cerebral atrophy with gray and white matter loss on day 32. Patient had no speech, gait, or responsiveness to commands on day 48 at hospital discharge. She received normobaric 100% oxygen treatment (2 L/minute for 45 minutes by nasal cannula, twice/day) since day 56 and then hyperbaric oxygen treatment (HBOT) at 1.3 atmosphere absolute (131.7 kPa) air/45 minutes, 5 days/week for 40 sessions since day 79; visually apparent and/or physical examination-documented neurological improvement occurred upon initiating each therapy. After HBOT, the patient had normal speech and cognition, assisted gait, residual fine motor and temperament deficits. MRI at 5 months after injury and 27 days after HBOT showed near-normalization of ventricles and reversal of atrophy. Subacute normobaric oxygen and HBOT were able to restore drowning-induced cortical gray matter and white matter loss, as documented by sequential MRI, and simultaneous neurological function, as documented by video and physical examinations.
一名2岁女童在冷水溺水后发生心脏骤停。磁共振成像(MRI)显示第4天出现深部灰质损伤,第32天出现脑萎缩伴灰质和白质丢失。患者在出院时第48天没有言语、步态,对指令也无反应。自第56天起,她接受常压100%氧气治疗(通过鼻导管以2升/分钟的速度吸氧45分钟,每天两次),然后自第79天起接受高压氧治疗(HBOT),在绝对压力1.3个大气压(131.7千帕)的空气环境中吸氧45分钟,每周5天,共40次;每次开始治疗后均出现明显的视觉改善和/或经体格检查记录的神经功能改善。高压氧治疗后,患者言语和认知正常,步态需辅助,存在残留的精细运动和气质缺陷。受伤后5个月和高压氧治疗后27天的MRI显示脑室接近正常,萎缩逆转。如连续MRI所示,亚急性常压氧和高压氧治疗能够恢复溺水导致的皮质灰质和白质丢失,如视频和体格检查所示,同时恢复神经功能。