早期高压氧治疗高血压脑出血的临床研究

Clinical research on treatment of hypertensive cerebral hemorrhage with hyperbaric oxygen

目的探讨早期高压氧疗治疗对高血压性脑出血患者神经功能康复和预后的影响及其临床应用价值。方法参照1995年全国脑血管疾病会议修订的标准,前瞻性收集87例高血压性脑出血患者,按随机数字表法随机分为高压氧治疗组(42例)和对照组(45例);对照组给予开颅手术、控制血压、脱水降低颅内压和营养神经等常规治疗,高压氧治疗组在给予对照组常规治疗后第5天开始高压氧治疗,每天1次,共25d。采用盲法评定两组患者治疗前后GCS评分、GOS评分、脑水肿程度、神经功能以及认知功能评分,并进行统计学分析。结果治疗后1月,两组患者GCS、神经功能缺损评分、水肿面积均较治疗前明显改善(P<0.05),但高压氧治疗组又明显优于对照组(P<0.05);高压氧治疗组认知功能评分明显高于对照组(P<0.05)。治疗后随访半年,按GOS评分评定预后,高压氧治疗组预后良好32例(76.19%),对照组预后良好21例(46.67%),两组预后良好率差异显著(P<0.05)。结论高压氧能显著促进高血压性脑出血患者认知功能及神经功能恢复,提高患者生存率和生活质量。

Objective To observe the effect of hyperbaric oxygen （HBO） therapy early after the hemorrhage on neurological function rehabilitation and prognosis in patients with hypertensive cerebral hemorrhage. Methods Eighty-seven patients with hypertensive cerebral hemorrhage were randomly divided into two groups, i.e. routine treatment （control） group （n=45） and HBO therapy group （n=42）, in which HBO therapy was performed once per day 5 days after the cerebral hemorrhage and lasted 25 days. The curative effects were compared between both the HBO therapy and control groups 25 days and 6 months after HBO therapy. Results The scores of GCS were significantly higher 1 month after the treatment than those before the treatment in both the groups （P〈0.05 or P〈0.01）. The scores of GCS was significantly higher in the HBO therapy group than those in the control group 1 month after the treatment （P〈0.05）. The neurological deficit score was significantly lower, the area of cerebral edema was significantly smaller, and the cognitive function was significantly better in HBO therapy group than those in the control group 1 month after treatment （P〈0.05）. The rate of good prognosis （76.19%,32/42） was significantly higher in HBO therapy group than that （46.67%,21/45） in the control group 6 months after the treatment （P〈0.05）. Conclusion The rehabilitation of the neurological function and cognitive function may be promoted and prognosis may be improved by HBO therapy in the patients with hypertensive cerebral hemorrhage.