高压氧辅助治疗重症脑创伤恢复期患者的临床疗效及对脑氧代谢的影响

摘要

目的：探讨高压氧辅助治疗重症脑创伤恢复期患者的临床效果及对脑氧代谢的影响。方法选取2011年2月—2014年2月湖北医药学院附属东风医院神经外科收治的重症脑创伤恢复期患者120例，随机分为治疗组和对照组，各60例。对照组患者给予常规治疗及对症治疗，治疗组患者在对照组基础上联合高压氧治疗；两组患者均治疗14 d。比较两组患者临床疗效，治疗前后炎性因子〔血清白介素6（ IL-6）和肿瘤坏死因子α（ TNF-α）水平〕、认知功能〔简易精神状况检查表（ MMSE ）评分、数字广度测验（ DST ）评分〕及脑氧代谢指标〔动脉血氧含量（ CaO2）和颈内静脉球部血氧含量（ CjvO2）〕。结果治疗组显效20例、有效38例、无效2例；对照组显效16例、有效34例、无效10例；治疗组患者临床疗效优于对照组（ P<0.05）。治疗前两组患者血清IL-6、TNF-α水平及MMSE评分、DST评分比较，差异无统计学意义（ P>0.05）；治疗后治疗组患者血清IL-6、TNF-α水平均低于对照组，MMSE评分、DST评分均高于对照组（ P<0.05）。治疗前后两组患者CaO2、CjvO2比较，差异无统计学意义（ P%Objective To investigate the clinical effect of hyperbaric oxygenation on severe brain trauma at recovery phase and its impact on cerebral oxygen metabolism. Methods From February 2011 to February 2014,a total of 120 patients with severe brain trauma at recovery phase were selected in the Department of Neurosurgery,Dongfeng Hospital Affiliated to Hubei University of Medicine,and they were randomly divided into treatment group and control group,each of 60 cases. Patients of control group were given conventional treatment and symptomatic treatment,while patients of treatment group were given extra hyperbaric oxygenation based on conventional and symptomatic treatment,both groups treated for 14 days. Clinical effect,serum levels of IL-6 and TNF-α,MMSE score and DST score,cerebral oxygen metabolism index including CaO2 ,CjvO2 before and after treatment were compared between the two groups. Results In treatment group,20 cases got excellent effect,38 cases got good effect,2 cases were invalid;in control group,16 cases got excellent effect,34 cases got good effect,10 cases were invalid;the clinical effect of treatment group was statistically significantly better than that of control group ( P <0. 05 ). No statistically significant differences of serum levels of IL-6 or TNF-α,MMSE score or DST score was found between the two groups before treatment ( P >0. 05 );while after treatment, serum levels of IL -6 and TNF - α of treatment group were statistically significantly lower than those of control group,MMSE score and DST score of treatment group were statistically significantly higher than those of control group(P<0. 05). No statistically significant differences of CaO2 or CjvO2 was found between the two groups before or after treatment(P>0. 05). Conclusion Hyperbaric oxygenation can effectively improve the clinical effect of patients with severe brain trauma at recovery phase,inhibit the expression of inflammatory cytokines,is helpful to maintain stable cerebral oxygen metabolism and promote the recovery of neurological function.