高压氧治疗中青年重型颅脑损伤患者的临床疗效观察

The effect of hyperbaric oxygen therapy on young patients with severe traumatic brain injury

目的观察高压氧(hyperbaric oxygen,HBO)治疗中青年重型颅脑损伤(severe traumatic brain in-jury,STBI)的临床疗效,以及探讨HBO治疗的不同时机对STBI患者疗效的影响。方法回顾性分析2008年9月～2010年9月,124例STBI患者,HBO组(68例)与常规治疗组(56例),以伤后6个月格拉斯哥预后评分(Glasgow Outcome Scale,GOS)为疗效评定标准,比较两组疗效。同时对HBO组不同治疗时机治疗的效果进行比较。结果 HBO组恢复良好率和中度残疾率高于对照组P均<0.05,重度残疾率和植物生存或死亡率低于对照组均P<0.05。不同时间组间疗效有显著统计学意义(P<0.01),受伤后10 d内开始HBO治疗预后良好率升高,20 d后开始HBO治疗重残发生率增加。结论 HBO治疗可改善患者预后降低残疾率,是一种有效、安全、简便的治疗方法,越早开始HBO治疗效果越好。

【Objective】 The aim of this study was to explore the efficacy of systemic hyperbaric oxygen（HBO） therapy on young patients with severe traumatic brain injury（STBI）,and the influence of different starting time of HBO therapy on STBI patients.【Methods】 From September 2008～September 2010,124 STBI patients were analyzed retrospectively.The treatment group of 68 patients who received HBO therapy after the patients＇ condition stabilization within 1 month of injury,and the other 56 corresponding condition patients were assigned into the matched control group who were not treated with HBO therapy.Both groups were admitted drug treatment and rehabilitation training.HBO therapy was the medical therapeutic use of oxygen at a higher atmospheric pressure,which was applied once a day,5 days a week,each session lasted 120 min at 2.0 absolute temperature air（ATA）.Glasgow Outcome Scale（GOS） was analyzed statistically at 6 months follow-up.At the same time the patients in the treatment group were allocated into three groups according to the beginning time of their treatment.【Results】 The rate of good recovery（GR） and moderate disability（MD） of HBO group was higher than that of control group（P〈0.05）.The rate of severe disability（SD） was lower than control group（P〈0.05）,and the rate of persistent vegetation state（PVS） or death（D） was lower than control group（P〈0.05）.There are significant differences between different beginning time groups.The rate of good recovery was increased within 10 days of injury with HBO,the rate of SD was increased after 20 days.One patient in the HBO therapy endured barotraumas.Oxygen toxicity,seizures,or pneumothorax were not seen.【Conclusions】 The study showed that adjunctive treatment with HBO therapy could effectively reduce the mortality and morbidity,and it is an effective and safety method to treat STBI.The earlier patients were treated with HBO,the better prognosis they would get.