高压氧治疗ICU重症颅脑损伤恢复期患者的临床研究

Clinical study on hyperbaric oxygen therapy for convalescent patients with severe craniocerebral injury in ICU

目的分析高压氧治疗ICU重症颅脑损伤(SCI)恢复期患者的临床效果。方法回顾性分析2016年7月—2019年6月成都医学院第一附属医院ICU收治的67例SCI恢复期患者的临床资料。其中男性40例,女性27例;年龄23~65岁,平均47.0岁;道路交通伤44例,坠落伤20例,击打伤3例;损伤类型:脑挫裂伤56例,颅内血肿10例,其他1例。按照治疗方法分为高压氧组(n=35)与对照组(n=32),对照组给予常规治疗,高压氧组给予常规+高压氧治疗。观察两组治疗前后血清神经元特异性烯醇化酶(NSE)、视黄醇结合蛋白(RBP 4)、胶质纤维酸性蛋白(GFAP)、淀粉样蛋白A(SAA)、髓鞘碱性蛋白(MBP)等脑损伤指标及FGL 2,动脉-颈内静脉球部血氧差(Da-jvO 2)、脉搏血氧饱和度(SpO 2)、颈内静脉血氧饱和度(SjvO 2)、脑氧摄取率(ERO 2)等脑氧代谢指标以及并发症发生情况。结果治疗1疗程后,高压氧组血清NSE、RBP 4、GFAP、SAA、MBP、FGL 2水平均低于对照组[(1.92±0.21)ng/mL vs.(2.04±0.23)ng/mL,(11.32±1.26)mg/L vs.(12.37±1.33)mg/L,(8.06±0.83)pg/mL vs.(8.62±0.89)pg/mL,(3.42±0.36)mg/L vs.(3.68±0.40)mg/L,(23.86±2.51)ng/mL vs.(26.08±2.72)ng/mL,(68.94±7.87)ng/mL vs.(73.64±8.07)ng/mL,P<0.05)]。高压氧组ERO 2、SjvO 2水平均低于对照组[(20.22±2.41)%vs.(21.36±2.44)%,(61.29±6.26)%vs.(64.64±6.55)%],Da-jvO 2、SpO 2高于对照组(45.39±4.72)mL/L vs.(42.68±4.38)mL/L,(99.76±10.28)%vs.(94.17±9.62)%,P<0.05)]。高压氧组总有效率高于对照组(85.71%vs.62.50%,P<0.05)。高压氧组并发症发生率低于对照组(2.86%vs.21.88%,P<0.05)。结论高压氧治疗ICU SCI恢复期患者可有效改善脑氧代谢指标,缓解机体免疫炎性反应,降低FGL2水平,疗效好,并发症发生率低,值得临床推荐。

Objective To analyze the clinical effects of hyperbaric oxygen therapy on convalescent patients with severe craniocerebral injury(SCI).Methods A total of 67 convalescent patients with SCI admitted to the ICU in the First Affiliated Hospital of Chengdu Medical College from Jul.2016 to Jun.2019 were included in this study and divided into hyperbaric oxygen group(n=35)and control group(n=32)using random number table method.Among them,there were 40 males and 27 females,aged 23-65 years with an average age of 47.0 years.There were 44 road traffic injuries,20 fall injuries and 3 blow injuries.There were 56 cases of cerebral contusion and laceration,10 cases of intracranial hematoma and 1 case of other injury.Conventional treatment was given to patients in control group,conventional treatment+hyperbaric oxygen was given to patients in hyperbaric oxygen group.Serum indexes including neuron-specific enolase(NSE),retinol binding protein 4(RBP 4),glial fibrillary acidic protein(GFAP),serum amyloid A(SAA),myelin basic protein(MBP),and FGL 2,and cerebral oxygen metabolism index including arterial to jugular bulb venous oxygen content difference(Da-jvO 2),pulse oxygen saturation(SpO 2),jugular venous oxygen saturation(SjvO 2),cerebral extraction rate of oxygen(ERO 2)and complications were observed before and after treatment.Results After treatment,the serum levels of NSE,RBP 4,GFAP,SAA,MBP,FGL 2 in the hyperbaric oxygen group were lower than those in the control group[(1.92±0.21)ng/mL vs.(2.04±0.23)ng/mL,(11.32±1.26)mg/L vs.(12.37±1.33)mg/L,(8.06±0.83)pg/mL vs.(8.62±0.89)pg/mL,(3.42±0.36)mg/L vs.(3.68±0.40)mg/L,(23.86±2.51)ng/mL vs.(26.08±2.72)ng/mL,(68.94±7.87)ng/mL vs.(73.64±8.07)ng/mL](P<0.05).ERO 2 and SjvO 2 in the hyperbaric oxygen group were lower than those in control group[(20.22±2.41)%vs.(21.36±2.44)%,(61.29±6.26)%vs.(64.64±6.55)%],Da-jvO 2 and SpO 2 in the hyperbaric oxygen group were higher than those in the control group[(45.39±4.72)ml/L vs.(42.68±4.38)ml/L,(99.76±10.28)%vs.(94.17±9.62)%,P<0.05).The total effective rate of the hyperbaric oxygen group was higher than that of the control group(85.71%vs.62.50%,P<0.05).The incidence of complications in the hyperbaric oxygen group was lower than that in the control group(2.86%vs.21.88%,P<0.05).Conclusion Hyperbaric oxygen therapy can effectively improve cerebral oxygen metabolism indexes,relieve the immune inflammatory response,and reduce the level of FGL 2 in the convalescent patients of SCI in ICU,with good efficacy and low incidence of complications,which is worthy of clinical recommendation.