早期高压氧治疗对急性脑梗死患者缺血半暗带和神经功能的影响

Effect of Early Hyperbaric Oxygen Treatment on Ischemic Penumbra and Neurological Function in Patients with Acute Cerebral Infarction

目的观察急性脑梗死(acute cerebral infarction,ACI)早期高压氧治疗(hyperbaric oxygen,HBO)对缺血半暗带(ischemic penumbra,IP)及神经功能的影响。方法按照磁共振灌注加权像(perfusion weighted imaging,PWI)/弥散加权成像(diffusion weighted imaging,DWI),即PWI/DWI不匹配原理,入选40例具有IP的ACI患者,随机分为观察组和对照组,每组20例。两组患者均给予神经内科常规治疗,观察组同时给予高压氧治疗2个疗程。根据DWI异常信号的高低在患侧选取病灶的中心区、病灶的边缘区、病灶的中心区与边缘区中点、病灶的外周区共4个点,测量治疗前后4点的相对表观弥散系数(relative apparent diffusion coefficient,rADC)。同时采用美国国立卫生研究院脑卒中量表(National institute of health stroke scale,NIHSS)评估治疗前后神经功能的缺损程度。结果治疗后,观察组除梗死中心区以外,其余3个点的rADC均高于对照组,差异具有统计学意义(P<0.05);同时观察组的NIHSS评分明显低于对照组,差异具有统计学意义(P<0.01)。结论早期高压氧治疗,能够有效挽救ACI的IP并改善神经功能缺损。

Objective To observe the effect of early hyperbaric oxygen （HBO） treatment on ischemic penumbra （IP） and neurological function in patients with acute cerebral infarction （ACI）. Methods According to mismatch mechanism of perfusion weighted imaging （PWI） / diffusion weighted imaging （DWI）, 40 ACI patients with IP were selected and randomly divided into observation group （n = 20） and control group （n = 20）. All patients received routine treatment at the first stage. The observation group accepted HBO treatment additionally for 2 courses. Based on abnormal signal of DWI,4 regions of interest （ROIs） were chosen including the core region of infarction, broad zone of core region, inter-region of core and broad zone, and peri-infarction area. The relative apparent diffusion coefficient （rADC） of these 4 ROI was calculated pre- and post-treatment. The neural function was assessed via National institute of health stroke scale （NIHSS）. Results After treatment, except of the core region of infarction, the rADC2s of the other 3 regions in observation group were significantly higher than those in the control group （all P〈0. 05）. NIHSS scores in observation group were significantly lower than those in the control group （P〈0. 01）. Conclusion Early HBO treatment can save IP and improve neurological function effectively in patients with ACI.