高压氧治疗对中重型颅脑损伤患者脑血流动力学和动态脑电图的影响及疗效分析

Effect of hyperbaric oxygen on cerebral hemodynamics and ambulatory electroencephalogram of patients with moderate and severe brain trauma and analysis of therapeutic efficiency

目的 观察高压氧（HBO）治疗对外伤性中重型颅脑损伤患者脑血流动力学和动态脑电图（AEEG）的影响及其治疗效果。方法 142例外伤性中重型颅脑损伤患者分为常规治疗组（71例）和HBO＋常规治疗组（71例）,常规治疗组采用必要的神经外科处理及常规药物治疗；HBO组＋常规治疗组在常规治疗的基础上，病情稳定后加用HBO治疗3个疗程。另选30名健康体检者作为正常对照组。治疗前及治疗后第10天、第30天行经颅多普勒（TCD）检查，治疗前、治疗后第30天行动态脑电图（ambulatory electroencephalogram，AEEG）检查及格拉斯哥昏迷评分（GCS），伤后6个月随访,行格拉斯哥预后评分（GOS）。结果 治疗前常规治疗组与HBO＋常规治疗组收缩期峰血流速度（Vs）、舒张期末血流速度（Vd）、平均血流速度（Vm）、搏动指数（PI）、脑血管阻力指数（RI）均明显高于正常对照组（P＜0.05），AEEG异常率分别为94.4％、95.8％。治疗后第10天，常规治疗组Vs、Vm、PI、RI较治疗前下降（P＜0.05）,较正常对照组仍升高（P＜0.05）；HBO＋常规治疗组Vs、Vm、PI、RI与常规治疗组比较下降更为明显（P＜0.05），Vs、Vm、PI仍高于正常对照组（P＜0.05）。治疗后第30天，常规治疗组Vs、Vm降至低于正常组（P＜0.05），PI、RI仍高于正常对照组（P＜0.05）；HBO＋常规治疗组Vs、Vm、Vd、PI、RI与正常对照组比较差异无统计学意义（P＞0.05）。治疗后第30天2组AEEG异常率较治疗前明显下降（P＜0.05），GCS较治疗前明显升高（P＜0.05），且HBO＋常规治疗组与常规治疗组比较两者改善更为明显（P＜0.05）；伤后6个月GOS评分显示，HBO＋常规治疗组预后良好患者较常规治疗组明显增多，死亡率明显下降（P＜0.05）。结论 HBO治疗能缓解中重型颅脑损伤患者的脑血管痉挛，调节脑血流，并改善神经元细胞的电生理活动和功能，从而提高临床疗效。

Objective To investigate the effects of hyperbaric oxygen （HBO） on cerebral hemodynamics and ambulatory electroencephalogram（AEEG） of patients with moderate and severe brain trauma and to analyze its therapeutic efficiency. Methods One hundred and forty-two patients with moderate and severe brain trauma were randomly divided into the conventional therapy group （71 cases） and the HBO plus conventional therapy group （71 cases）. The conventional therapy group received surgical treatment and conventional drug treatment, while the HBO group received the same treatment as the conventional therapy group and plus 3 courses of HBO treatment, following stabilization of the illness. Thirty normal healthy people who received physical check-ups were used as control. All the patients received Transcranial Doppler （TCD）detection, before treatment and on the 10th and 30th day after treatment. Ambulatory electroencephalogram （AEEG） was detected and the scores of Glasgow coma scale （GCS） were evaluated before treatment and on the 30th day after treatment. The scores of Glasgow outcome scale （GOS） were again measured in a clinical followup, following 6 months of brain trauma. Results Before treatment, Vs, Vm, Vd, PI and RI of the middle cerebral artery （MCA） in all the patients of both the conventional therapy group and HBO plus conventional therapy group were significantly higher than those of the normal control group （ P 〈 0. 05 ） and the abnormal rates of AEEG accounted for 94. 4% and 95.8% respectively. On the 10th day after treatment, Vs, Vm, PI and RI in the conventional therapy group decreased significantly （P 〈 0. 05）, but were still higher than those of the normal control group （ P 〈 0. 05 ）. Vs, Vm, PI and RIin the HBO plus conventional therapy group decreased more significantly, when compared with those of the conventional therapy group （ P 〈 0. 05 ）,however, Vs, Vm and PI were still higher than those of the normal control group （ P 〈 0. 05 ）. On the 30th day after treatment, Vs and Vm in the conventional therapy group were lower than those of the normal control group （P〈0. 05）, but, PI and RI were still higher than those of the normal control group （P 〈0.05）. No significant differences in Vs, Vm, Vd, PI and RIcould be noted between the HBO plus conventional therapy group and the normal control group （P 〉0. 05 ）. On the 30th day after treatment, abnormal rates of AEEG of both groups decreased significantly than those before treatment （ P 〈 0. 05 ）, while scores of GCS increased significantly than those before treatment （ P 〈 0. 05 ） and more significant differences could be noticed in the HBO plus conventional therapy group, when compared with those of the conventional therapy group （P 〈 0. 05）. Six months after brain trauma, GOS scores indicated that the number of patients with good prognosis in the HBO plus conventional therapy group increased, and mortality rate decreased obviously, when compared with those of the conventional therapy group （P 〈 0. 05 ）. Conclusions HBO therapy could alleviate cerebral vascular spasms, regulate cerebral blood flow and promote the electrophysiological activity and function of neurons, thus enhancing therapeutic efficiency of the patients with moderate and severe traumatic brain injury.