高压氧治疗重度闭合性颅脑创伤的疗效及依达拉奉的干预作用

Clinical Evaluation of Hyperbaric Oxygenation in Severe Closed Traumatic Brain Injury and Effects of Edaravone

目的探讨高压氧(HBO)治疗重度闭合性颅脑损伤(TBI)患者的临床疗效和依达拉奉的干预作用。方法42例TBI患者,随机分为两组,HBO治疗组21例,行HBO和其他常规治疗;依达拉奉干预组(EB干预组)21例,在HBO和其他常规治疗基础上加用依达拉奉;另选12例健康志愿者为正常对照组。于治疗前、治疗14d后行格拉斯哥昏迷评分(GCS)并检测血清丙二醛(MDA)、蛋白质氧化硝基化指标3-硝基酪氨酸(3-nitrotynosine,3-NT)水平及抗氧化酶铜、锌离子超氧化物歧化酶(CuZn-superoxide dismutase,CuZn-SOD)和谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-px)的活力变化,病程3个月时行格拉斯哥预后评分(GOS)。结果治疗前HBO治疗组和EB干预组的GCS、血清MDA、3-NT水平及CuZn-SOD、GSH-px活力间差异无统计学意义(P>0.05),但与正常对照组比较差异均有统计学意义(P<0.01);而治疗后HBO治疗组和EB干预组上述各指标间差异均有统计学意义(P<0.05),病程3个月时两组患者GOS间差别亦有统计学意义(P<0.05)。结论依达拉奉联合HBO治疗重度闭合性TBI的疗效优于单纯HBO治疗。

Objective To observe the therapeutic effects of hyperbaric oxygenation （HBO） combined with edaravone,a potent scavenger of hydroxyl radicals,on severe closed traumatic brain injury（TBI）.Methods Forty-two patients were randomized into groups HBO and HBO＋EB （receiving treatment of HBO and edarayone）,21 in each.Another 12 healthy volunteers were chosen as normal controls.Before treatment and after 14 d of treatment,Glasgow Coma Scores （GCS） were performed and Malondialdehyde（MDA）,3-nitrnosine（3-NT）,CuZn-superoxide dismutase（CuZn-SOD）and glutathione peroxidase（GSH-px）were detected in 2 treatment groups.After 3 months,Glasgow Outcome Scales （GOS） were performed.Results There were not significant differences in levels of GCS,MDA,3-NT and activities of CuZn-SOD,GSH-px between groups HBO and HBO＋EB before treatment （P〉0.05）,but there were between 2 treatment groups and control （P〈0.01）.After treatment,significant difference was noted in levels of GCS,MDA,3-NT and activities of CuZn-SOD,GSH-px,and in GOS at months 3 between groups HBO and HBO＋EB（P〈0.05）.Conclusion HBO＋EB is superior to HBO in treatment of severe closed TBI.