高压氧治疗重型颅脑损伤的疗效分析

Analysis of Curative Effect of Hyperbaric Oxygenation on Severe Craniocerebral Injury

目的观察高压氧对重型颅脑损伤的治疗效果,并分析其作用机制。方法80例重型颅脑损伤患者随机分为高压氧治疗组(n=40)和对照组(n=40),观察两组患者的清醒人数,清醒时间,GCS评分的变化,治疗3个月后GOS评分、病死和植物状态比例,并分析两组的临床疗效,同时监测治疗前后脑动脉血流速度变化。结果治疗组的清醒人数的比例明显高于对照组(P<0.05),觉醒平均时间较对照组明显缩短(P<0.05),3疗程后GCS评分和3个月后的GOS评分明显高于对照组(P<0.05)、植物状态及死亡率较对照组低(P<0.05)、治愈率及总有效率明显高于对照组(P<0.01);治疗组2个疗程后血流速度较对照组下降明显(P<0.05)。结论早期行高压氧治疗对重型颅脑损伤具有明显疗效,可能与高压氧能有效提高血氧含量、扩大血氧弥散半径、促进血管生成和侧枝循环建立、有效缓解脑血管痉挛状态、清除自由基、减少缺血区脑细胞凋亡等作用有关。

Objectives To observe the therapeutic effect of hyperbaric oxygenation (HBO) on severe craniocerebral injury and to analyse its mechanism. Methods Eighty patients with severe craniocerebral injury were randomly divided into two groups, i.e. HBO therapeutic group (n=40) and control group (n=40). The curative effects including the number of awakened patients in one month and awakening time, the changes in GCS, GOS 3 months after the treatment, the rate of vegetative state and mortality were compared between both the groups. ACA and MCA blood flow speeds were determined by TCD. Results The number of anabiosis patients was significantly more, the average coma time significantly shorter, the GCS and GOS significantly higher, the vegetative state rate and mortality significantly lower in the therapeutic group than those in the control group (P<0.05). The total effective rate and healing rate were significantly higher in the therapeutic group than those in the control group (P<0.01). The decrease in the cerebrovascular blood flow speed in the therapeutic group was more than that in the control group after two cures were taken (P<0.05). Conclusions HBO can enhance the curative effect on severe craniocerebral injury. The curative effect of HBO on the severe craniocerebral injury may be related to the increase in blood oxygen content and oxygen dispersion radius, relaxation of the cerebrovascular spasm, elimination of free radical, inhibiting cerebral cells apoptosis and so on induced by HBO treatment.