高压氧联合神经节苷脂治疗弥漫性轴索损伤的疗效及其对血清相关指标和预后的影响

Efficacy of hyperbaric oxygen combined with ganglioside on diffuse axonal injury and effects on serum-related indexes and prognosis

目的探讨高压氧联合神经节苷脂治疗弥漫性轴索损伤的疗效及其对血清相关指标和预后的影响.方法选取2014年1月至2018年2月海安市人民医院神经外科收治的82例弥漫性轴索损伤患者,根据治疗方式的不同,分为研究组和对照组(各41例),对照组给予激素、止血、脱水降颅压、营养神经、维持水电解质平衡、补液及常规护理等对症支持治疗.研究组在对照组基础上联合高压氧及神经节苷脂治疗.比较2组患者治疗后清醒率及意识平均恢复时间、血清相关指标、认知功能和预后情况.结果治疗后研究组患者的清醒率(80.5%)及意识平均恢复时间[(9.3±1.4)d]均优于对照组患者清醒率(56.1%)及意识平均恢复时间[(16.1±3.3)d](χ^2=5.632,t=6.349,P<0.05);治疗后研究组神经元特异性烯醇化酶(neuron-specific enolase,NSE)[(11.1±2.3)μg/L]、S100B(S100 calcium binding protein B,S100B)[(1.1±0.1)ng/L]、髓鞘碱性蛋白(myelin basic protein,MBP)[(6.6±1.2)μg/L]显著优于对照组NSE[(16.7±3.1)μg/L]、S100B[(1.6±0.2)ng/L]、MBP[(8.5±1.0)μg/L](t1=4.684,t2=5.219,t3=4.352,P<0.05);治疗后研究组患者的MMSE评分[(28.3±5.3)分]和ADL评分[(25.1±1.1)分]显著优于对照组MMSE评分[(25.2±4.1分)]和ADL评分[(33.6±1.5)分](t1=4.429,t2=5.642,P<0.05);半年后,研究组患者的预后良好率(73.2%)显著高于对照组患者(41.5%)(χ^2=8.424,P<0.05).结论高压氧联合神经节苷脂对弥漫性轴索损伤的疗效更为显著,最大限度地避免了继发性脑损伤加重并可帮助神经功能恢复,最终改善患者预后,值得临床推广应用.

Objective To investigate the efficacy of hyperbaric oxygen(HBO)combined with ganglioside on diffuse axonal injury and effects on serum-related indicators and prognosis.Methods Eighty-two patients with diffuse axonal injury admitted into our department were equally divided into 2 groups(n=41),according to different treatment methods.The control group was given such symptomatic supportive treatment as hormone,hemostasis,reduction of intracranial pressure via dehydration,nerve nutrition,maintenance of electrolyte balance,fluid infusion and routine nursing care.The study group was treated with HBO therapy combined with ganglioside in addition to the treatment received by the control group.The rate of consciousness and mean conscious recovery time,serum-related indicators,cognitive function and prognosis after treatment were compared between the patients of the 2 groups.Results After treatment,the rate of consciousness(80.5%)and mean conscious recovery time of the study group(9.3±1.4days)were all superior to(56.1%)and(16.1±3.3 days)of the control group(χ^2=5.632,t=6.349,P<0.05).After treatment,the levels of neuron-specific enolase(NSE)(11.1±2.3μg/L),S100 calcium binding protein B(S100B)(1.1±0.1 ng/L)and myelin basic protein(MBP)(6.6±1.2μg/L)were all significantly better than(16.7±3.1)μg/L,(1.6±0.2)ng/L and(8.5±1.0)μg/L of the control group(t1=4.684,t2=5.219,t3=4.352,P<0.05).Following treatment,the MMSE scores(28.3±5.3)and ADL scores(25.1±1.1)of the study group were significantly better than the MMSE scores(25.2±4.1)and ADL scores(33.6±1.5)of the control group(t1=4.429,t2=5.642,P<0.05).Six months after treatment,the prognosis rate of the study group(73.2%)was significantly higher than that of the control group(41.5%)(χ^2=8.424,P<0.05).Conclusion HBO combined with ganglioside could produce better therapeutic effects in the treatment of diffuse axonal injury.In the meantime,it could avoid deterioration of secondary brain injury to the largest extent and promote recovery of nerve function,and ultimately improve the prognosis of patients.For this reason,it is worth further clinical application.