高压氧治疗小儿颅脑损伤45例临床疗效观察

A clinical observation of therapeutic effect of hyperbaric oxygen therapy for 45 children with traumatic brain injury

目的探讨高压氧治疗小儿颅脑损伤的临床疗效，并分析不同部位颅脑损伤的好转率与治愈率情况及格拉斯哥昏迷评分的比较。方法选择陕西省延安市人民医院2004年4月~2009年1月因小儿重型颅脑损伤住院患儿90例，随机将其分为高压氧组和对照组各45例，所有患儿入院后均给予补液、抗感染、改善脑血供等常规治疗。其中对照组仅进行常规治疗，高压氧组在常规治疗的基础上加高压氧治疗。结果高压氧组的治疗总有效率明显高于对照组，经比较有显著性差异（χ2=19.342，P〈0.05）。经高压氧治疗后，硬膜下（外）血肿的好转率达70.0%（14/20）；脑挫裂伤的治愈率达71.4%（10/14）。应用高压氧治疗前两组格拉斯哥昏迷评分经比较无显著性差异（t=0.315，P〉0.05），应用高压氧治疗后两组格拉斯哥昏迷评分比较有显著性差异（t=4.217，P〈0.05）。两组治疗后与治疗前分别比较均有显著性差异（t分别为4.837、7.332，均P〈0.05），且治疗后高压氧组格拉斯哥昏迷评分的改善较对照组更为明显。结论高压氧治疗小儿颅脑损伤较单纯应用常规治疗的效果好，能提高治疗的总有效率，对颅脑损伤的患儿在进行常规治疗时应尽早采用高压氧治疗。

ObjectiveTo observe therapeutic effect of hyperbaric oxygen therapy for children with traumatic brain injury, and to analyze and compare improvement rate and curative rate of children with different parts of brain injury and Glasgow coma scores （GCS scores）. Methods 90 children with severe traumatic brain injury admitted to our hospital in a period from April, 2004 to January, 2009 were randomly divided into hyperbaric oxygen therapy group and control group（in each group, n=45）. All inpatient children were treated with conventional therapies such as fluid replacement therapy, antiinfection therapy and brain blood supply improving therapy and so on. The children in the control group only received conventional therapy, while those children in the hyperbaric oxygen therapy group were given additional hyperbaric oxygen therapy as well as conventional therapy. Results The total effective rate in hyperbaric oxygen therapy group was significantly higher than that in the control group, the difference was significant（χ2=19.342, P〈0.05）. After hyperbaric oxygen therapy, epidural hematoma regression rate reached to 70% （14/20）. The curative rate of contusion and laceration of brain was 71.4%（10/14）. Before hyperbaric oxygen therapy, in GCS score there was no statistically significant difference between the two groups （t=0.315, P〉0.05）, but after hyperbaric oxygen therapy, there was significant difference between the two groups （t=4.217, P〈0.05）. After treatment, the GCS of the children in the two groups were improved significantly as compared with those before treatment （t=4.837, 7.332 respectively, both P〈0.05） , and the improvement in GCS in the hyperbaric oxygen therapy group was more significant than the control group. Conclusion The therapeutic effect of hyperbaric oxygen therapy combined with conventional therapy for children with traumatic brain injury is more significant as compared with conventional therapy alone. The combined treatment can improve overall effective rate. So, for those children with traumatic brain injury, hyperbaric oxygen therapy should be given early at the same time of giving them conventional therapy.