应用高压氧治疗经侧裂入路手术后大脑中动脉血管痉挛

Study of effect of hyperbaric oxygen therapy on vasospasm following transsylvian neurosurgery

目的研究高压氧(HBO)治疗侧裂入路手术后大脑中动脉血管痉挛及并发症的疗效及机制。方法治疗组27例,对照组20例,治疗组术后第3天开始HBO治疗,共2个疗程。分析HBO前后经颅多普勒超声(TCD)探测大脑中动脉收缩期流速,平均流速及搏动指数。结果患者均治愈出院,无明显并发症。术后患者大脑中动脉血流速度较术前明显增高,HBO治疗组术后7、14和30d大脑中动脉血流速度明显降低,且与对照组差异有显著性。结论术后早期HBO治疗能改善大脑中动脉血管痉挛,改善脑血供、降低血管阻力,从而减轻脑缺血缺氧,降低颅压,减少脑血管痉挛引起的并发症。

[Objective] To study the efficacy and mechanism of hyperbaric oxygen （HBO）therapy on vasospasm following transsylvian approach operations. [Methods] Patients were divided into therapeutic group treated with HBO （27 patients） and control group （20 patients）. Patients of therapeutic group started HBO therapy at 3 days after the surgery. Velocity（Vm and Vs） and Pulse index （PI） of middle cerebral artery CMCA） were measured with transcranial Doppler（TCD） on the day before surgery and 1, 2, 3, 7, 14, 30 days following the surgery. [Results] All patients recovered and were discharged with no severe complications from hospital. MCA blood velocity decreased significantly at 7 days after the surgery for therapeutic group, and were significantly lower than control group. [Conclusions] Early HBO therapy has antivasospasm effect. HBO therapy can also improve cerebral blood supply and reduce vascular resistance, then reduce intracranial oressure and complications caused hy vasospasm.