高压氧治疗在重型颅脑损伤的临床效果及多方机制综合分析

摘要

Objective To investigate the effect of hyperbaric oxygen therapy on the clinical effect and the mechanism of hyperbaric oxygen therapy in patients with severe craniocerebral injury. Methods According to the order of admission, the patient will 87 cases of severe traumatic brain injury were divided into hyperbaric oxygen group(44 cases)and conventional group(43 cases), two groups of patients after admission were treated with operation, reduce the intracranial pressure, brain cell nutrition, anti infection etc. Conventional therapy, hyperbaric oxygen group in the patients with stable disease after given hyperbaric oxygen therapy and observed after one day of treatment 1 day after injury, five days , 10d serum interleukin -6(IL-6), tumor necrosis factor(TNF-ɑ), C-reactive protein(CRP), MDA(MDA), superoxide dismutase -1(SOD-1), changes in intracranial pressure(ICP)and other indicators. Results fter injury 5d, with hyperbaric oxygen therapy, the patients in the hyperbaric oxygen group of serum inflammatory markers(IL-6,TNF alpha, CRP), antioxidant index(MDA, SOD-1), intracranial pressure(ICP)were better than that of routine group patients(P<0.05). The Vs and Vm values of middle cerebral artery in patients with 5d and 10d after injury were superior to those of conventional group(P<0.05). After treatment, the GCS score of the two groups were significantly improved compared with the treatment(P<0.05), the patients with hyperbaric oxygen group were significantly improved(P<0.05). After 63.64% months of treatment, the prognosis of patients with hyperbaric oxygen group was 41.86% higher than that of conventional group(P<0.05), 6 months after treatment. Conclusion Severe craniocerebral injury patients on conventional therapy plus treatment with hyperbaric oxygen can significantly improve the patient's inflammatory reaction,improve the brain blood flow and hypoxia, antioxidant levels, so as to improve the therapeutic effect.%目的：探讨重型颅脑损伤患者在常规治疗基础上加用高压氧（HBO）治疗对临床效果的影响，并分析其作用机制。方法根据患者的入院顺序将87例重型颅脑损伤患者分为 HBO 组44例和常规组43例，两组患者入院后均给予手术、降低颅内压、营养脑细胞、抗感染等常规治疗，HBO 组在患者病情稳定后给予 HBO 治疗，观察两组患者治疗后伤后第1、5、10天血清白介素-6（IL-6）、肿瘤坏死因子（TNF-ɑ）、C 反应蛋白（CRP）、丙二醛（MDA）、超氧化物歧化酶-1（SOD-1）、颅内压（ICP）等指标的变化情况。结果伤后第5、10天，随着 HBO 治疗作用，HBO 组患者的血清炎症指标（IL-6、TNF-ɑ、CRP）、抗氧化指标（MDA、SOD-1）、颅内压（ICP）水平均优于常规组患者（P<0.05）。伤后第5、10天 HBO 组患者的大脑中动脉 Vs、Vm 检测值均优于常规组患者（P<0.05）。治疗后，两组患者的 GCS 评分与治疗前比较，（P<0.05），HBO 组患者提高更加显著（P<0.05）。治疗结束6个月后，HBO 组患者的预后良好率63.64%高于常规组的41.86%（P<0.05）。结论重型颅脑损伤患者在常规治疗基础上加用 HBO 治疗可以显著改善患者的炎症反应、大脑血流状态、机体低氧状态、抗氧化水平，从而改善治疗效果。