高压氧对重型颅脑损伤患者红细胞GSH和MDA影响的研究

Study of hyperbaric oxygenation on erythrocyte GSH and MDA in patients with severe craniocerebral injury

目的探讨重型颅脑损伤患者高压氧治疗前后,外周血红细胞还原型谷胱苷肽(GSH)和丙二醛(MDA)的水平变化与高压氧(HBO)治疗效果及预后的关系。方法60例颅脑损伤患者作为高压氧治疗组(HBO组),行HBO+常规治疗;60例颅脑损伤患者作为疾病对照组,仅单纯常规治疗;60名健康体检者为正常对照组。分别于治疗前、中、后用哥拉斯哥结果评分(Glasgow outcome scale,GOS)对患者评定;用谷胱苷肽还原酶法测定GSH,采用硫代巴比妥酸比色法检测MDA。结果HBO组和疾病对照组治疗前GSH和MDA差异无统计学意义,P>0.05,但与正常对照组比较差异均有统计学意义,P<0.01;HBO组治疗1个疗程后,GSH水平升高,MDA水平下降,与相同哥拉斯哥昏迷评分(Glasgow coma scale,GCS)的疾病对照组比较,差异均有统计学意义,P<0.05;HBO组治疗3个疗程后,在GOS3～5分的患者中,与疾病对照组比较GSH和MDA水平差异均有统计学意义,P<0.05;HBO组和疾病对照组治疗后GOS评定结果比较,HBO组死亡率(10%,6/60)低于疾病对照组(20%,12/60),预后良好率(53.3%,32/60)高于疾病对照组(40%,24/60),P<0.01。结论高压氧能影响颅脑损伤患者红细胞GSH和MDA水平,提示检测患者外周血红细胞GSH和MDA水平,可作为观察HBO治疗效果和患者预后的辅助指标。

【Objective】To study the effects and prognosis of hyperbaric oxygenation （HBO） on erythrocyte glutathione （GSH） and malonaldehyde （MDA） in patients with severe craniocerebral injury.【Methods】120 patients were divided by two groups.One was treated with HBO combined with conventional treatment （as HBO group）.The other was treated only with conventional treatment （as control group）,there were 60 healthy as the health group.The levels of erythrocyte GSH and MDA were measured with glutathione reductase and spectrophotometry respectively.【Results】 In the HBO and control group,the levels of GSH were lower and that of MDA was higher than those in the health group.There was a statistical difference between the HBO group,control group and health group Pall〈0.01;After one course of HBO treatment,there were differences in GSH and MDA levels between HBO group and control group in the same Glasgow coma scale （GCS） score Pall〈0.05.After three course of HBO treatment,there were differences between HBO group and control group in Glasgow outcome scale （GOS） 3～5 score P 〈0.05.Compared with the GOS score,the death rate in HBO group was lower than that in control group,the prognosis was good in HBO group than in control group,P 〈0.01.【Conclusion】HBO may affect the levels erythrocyte GSH and MDA in patients with severe craniocerebral injury.It suggests be an important adjuvant marker of the prognosis and HBO treatment.