影响高压氧治疗颅脑损伤患者疗效的常见因素分析

Analysis of common factors influencing on effectiveness of hyperbaric oxygen on craniocerebrai injury

目的探讨高压氧（HBO）治疗颅脑损伤患者疗效的常见影响因素。方法对进行HBO治疗的179例颅脑损伤患者的疗效进行回顾性分析。考察的影响因素包括：性别、年龄、损伤类型、昏迷程度（GCS评分）、损伤部位、病灶数量、气管切开与否、颅脑手术次数、合并损伤、基础疾病、并发症、外伤性脑积水、开始HBO治疗的时间、HBO治疗的次数等，将上述因素对疗效的影响进行统计学分析。分别以“首次HBO治疗的昏迷程度、HBO治疗时是否已行气管切开手术和开始HBO治疗的时间”为分组条件，将患者分为3组，并比较HBO对3组患者的疗效。结果影响疗效的主要因素包括：首次HBO治疗时的昏迷程度、HBO治疗时是否行气管切开手术、开始HBO治疗的时间。GCS评分〈9分的患者有效率为58．11％，与其他组比较最低（P〈0．01）；气管切开术后的患者有效率为46．43％，与对照组比较差异有统计学意义（P〈0．01）；首次HBO治疗距离外伤时间〈1个月的患者有效率为91．35％，与其他组比较最高（P〈0．05）。结论HBO治疗颅脑外伤患者疗效显著，排除禁忌证后应尽早行HBO治疗。

Objective To investigate common factors influencing on effectiveness of hyperbaric oxygen （HBO） on patients with craniocerebral injury. Methods The influencing factors were investigated statistically through a restrospective analysis of the effectiveness of HBO on 179 patients with craniocerebral injury, including sex, age, types of injury, degree of coma （ Glasgow coma scale, GCS）, locations of injury, quantities of injury focus, incision of trachea, times of craniocerebral operations, combining injury, previous diseases, complications,traumatic hydrocephalus,beginning time of HBO and times of HBO. The patients were divided into three groups on the base of degree of coma, circumstance of incision of trachea and beginning time of HBO. Effective rates of HBO on the patients from three groups were compared respectively, Results Degree of coma of patients treated with HBO at the first time, circumstance of incision of trachea in the cause of treatment and time of beginning to treat with HBO were major influencing factors. The effective rate（58.11% ） of HBO on the patients whose the scores of GCS were all less 9 was the lowest than the other groups（ P 〈0.01 ）. The effective rate（46.43% ） of HBO on the patients who were performed operation of incision of trachea was significantly lower than that of control group （ P 〈0.01 ）. The effective rate（91.35% ） of HBO on the patients who began to receive HBO when they had subjected injury for less 1 month was the highest than the other groups（ P 〈 0. 05 ）. Conclusions The curative effect of HBO on craniocerebral injury is significant and patients should receive HBO as early as possible except contraindications.