高压氧对急性脑出血灶周水肿的影响

Effects of Hyperbaric Oxygen on Perihematomal Edema in Acute Spontaneous Intracerebral Hemorrhage

目的研究高压氧(HBO)治疗对急性脑出血灶周水肿的影响,以期动态评估HBO的临床疗效。方法发病在24 h内入院的72例脑出血患者随机分为HBO组(36例)和对照组(36例)。两组均给予常规治疗,前者于病程第7天同时给予HBO治疗,每日1次,连续20 d。在病程第7天和第28天时,分别用T2WI图像和表观扩散系数(ADC)观测脑水肿的范围及程度。两组治疗前及治疗第28天时行卒中临床神经功能缺损(NIHSS)评分评定功能障碍的程度、改良巴氏指数(MBI)评定日常生活活动能力的变化。结果⑴病程第28天,HBO组的绝对水肿体积、相对水肿体积和ADC值均明显小于对照组,差异均有统计学意义(均P<0.05);⑵病程第28天,脑水肿仍有一定程度的存在;⑶第28天时NIHSS和MBI评定,HBO组两种量表评分的变化量均明显大于对照组,差异均有统计学意义(均P<0.05)。结论HBO治疗急性脑出血可明显减轻脑水肿的程度和缩小脑水肿的范围,且有利于患者神经功能的恢复。

Objective To study the effects of hyperbaric oxygen（HBO） therapy on perihematomal edema in acute spontaneous intracerebral hemorrhage（ICH） so as to assess the therapeutic effect dy-namically.Methods Seventy two cases of acute ICH were randomly divided into the HBO group（n=36） and the control group（n=36）.Routine therapy was applied in both groups,HBO therapy was used in the HBO group on the 7th day after the event when the patients’ conditions were stable（1 time/d,for 20 d）.At the end of the 7th and 28th day respectively,T2WI and apparent diffusion coefficient（ADC） were ap-plied to observe the edematous range and degree.The degree of functional disturbance was scored by NIHSS and the alteration of activities of daily living evaluated by MBI.Results ⑴On the 28th day,the absolute edema volume,the relative edema volume and ADC value in the HBO group were smaller than those in the control group（P〈0.05）;⑵Brain edema was still existing at the 28th day;⑶The shifting magnitudes of evaluation scores with two scales were much larger in the HBO group than those in the control group（P〈0.05）.Conclusion HBO therapy can clearly lessen the edematous degree and range of acute ICH,contributing to functional recovery.