高压氧对重型颅脑损伤患者外周血白细胞和继发性脑损害的影响

Influences of hyperbaric oxygenation on white blood cell and polymorphonuclear neutropil of severe craniocerebral injured patient and secondary brain injury

目的探讨高压氧(HBO)对重型颅脑损伤患者白细胞(WBC)及多形核嗜中性白细胞(PMN)和继发性脑损害的影响。方法将伤后24h内入院的重型颅脑损伤患者160例,根据基本情况平衡的原则,分为HBO治疗组和常规治疗组(对照组)各80例。分别于伤后1d、7d、14d、21d测定外周血WBC和PMN;并复查头颅CT,计算脑出血量及脑水肿体积;同时进行GCS评分;统计两组患者出现脑梗死的例数;伤后6个月,对两组患者进行GOS预后评分。测定40例健康体检者外周血WBC参数作为正常对照。结果 (1)伤后1d,两组患者WBC和PMN较正常对照组升高,但两组之间比较差异均无统计学意义(P>0.05);伤后7d、14d,HBO治疗组WBC和PMN较对照组低(P<0.05或0.01);HBO治疗组和对照组分别于伤后14d、21d时WBC和PMN恢复正常;(2)伤后7d、14d和21dHBO治疗组的脑出血量和水肿体积明显小于对照组(P<0.05或0.01);(3)伤后7d、14d和21dHBO治疗组GCS评分高于对照组(P<0.05或0.01);HBO治疗组出现外伤性脑梗死的例数较对照组少(P<0.05);伤后6个月,HBO治疗组GOS评分高于对照组(P<0.05)。结论 HBO治疗能够减轻重型颅脑损伤的继发性损害和改善患者预后,它的作用机制之一可能是HBO能尽快、较好地恢复外周血WBC和PMN的变化。

Objective To investigate the effects of hyperbaric oxygenation （HBO） on white blood cell（WBC） and polymorphonuclear neutropil（PMN） of severe craniocerebral trauma patients and secondary brain injury. Methods 160 severe craniocerebral trauma cases injured within 24 hours were assigned to HBO group and control group （80 cases in each group ） based on the principle of maintaining a basic balance. The determination of WBC and PMN, and CT re-examination were completed in the 1st day, 7th day, 14th day and 21st day after injury. In the meantime, the volumes of brain hemorrhage and cerebral edema were calculated and GCS score was evaluated, and the number of brain infarction happened in the two groups was recorded. The prognosis score of GOS in 6th month after injury was evaluated. Results （ 1 ） In the 1 st day after injury, the changes of WBC and PMN have not statistical differences between the two groups （P 〉0. 05） ; The WBC number and PMN in HBO group were lower than that in control group in 7th day, 14th day after injury （P 〈0. 05 or 0. 01 ） , respectively; The WBC number and PMN recovered to normal in 14th day after injury in HBO group, but in 21st day after injury in control group . （2）The volumes of brain hemorrhage and cerebral edema in HBO group were smaller than those in control group in 7th day,14th day and 21st day after injury（P 〈0. 05 or 0. 01 ）. （3）The GCS score in HBO group was higher than that in control group in 7th day, 14th d and 21th d after injury（P 〈 0. 05 or 0. 01 ） ; The traumatic brain infarction cases happened in HBO group was less than that in control group（P 〈0. 05） ; The GOS score in HBO group in the 6th month after injury was higher than that in control group （P 〈 0. 05）. Conclusions The HBO therapy can relieve the secondary injury of severe craniocerebral trauma and improve prognosis. One possible action mechanism is that HBO may make WBC and PMN in peripheral blood recover to normal as soon as possible.