过度高压氧治疗对缺氧性脑病所致持续性植物状态预后的影响

Excessive hyperbaric oxygen therapy for persistent vegetative state after hypoxic encephalopathy

目的研究过度高压氧治疗(HBO)对缺氧性脑病所致的持续性植物状态(PVS)患者预后的影响,探讨高压氧的治疗机制及过度治疗的不良影响。方法收集我院收治的缺氧性脑病致PVS患者60例,根据其高压氧治疗的病史分为常规HBO组,超长HBO组,未接受HBO治疗对照3组。以发病后6个月为观察点。观察指标包括PVS意识及预后评分(南京2001年版);改良Ashworth量表(MAS)评定;日抽搐次数;头CT/MRI中第三脑室宽度;颅内压;脑电图等。结果获得随访51例。3组患者在年龄、患病时间、意识及脑电图无显著性差异。第三脑室宽度及颅内压数据分析,超长HBO组的第三脑室宽度明显大于常规HBO组与对照组,同时颅内压较低,且这种差异在预后恢复有显著性差异(P<0.05)。肌张力评定提示对照组及常规HBO组统计学分析无显著性差异。但与超长HBO组肌张力明显高于其他组,有显著性差异(P<0.05)。超长组中抽搐次数较其他2组增加,但无统计学差异。结论高压氧治疗对脑损伤后意识恢复具有一定的疗效,但过度高压氧治疗可能导致脑昏迷患者严重的脑萎缩、巨大脑室及低颅压状态。形成不可逆、迟发性脑损伤,影响意识恢复。因此需合理、规范应用高压氧治疗。

Objective To explore the therapeutic effect of hyperbaric oxygen therapy（HBO） and adverse effect of over-treatment in persistent vegetative state （PVS） caused by anoxic encephalopathy. Methods Consecutive 60 cases of PVS patients in anoxic encephalopathy in our hospital. Divided into 3 groups （ n = 20 ）, conventional HBO group, excessive HBO group and control group. We measured the width of the third ventricle in CT/MRI, intracranial pressure, muscle tension, seizure frequency, electroencephalogram, and assess recovery after 6 months later with Nanjing efficacy standard rated scale. Results 51 cases were followed up. No significant difference in age,duration of disease, and awareness in three groups. The excessive HBO group compared the control group and the conventional HBO group had significant difference （P 〈 0.05 ） in third ventricle width and intracranial pressure. Follow-up consciousness scale in 6 months later, excessive HBO group comparing to others groups,there was a significant difference （P 〈 0.05 ）. Conclusions Excessive hyperbaric oxygen therapy for patients with persistent vegetative state caused severe brain atrophy, huge ventricle and low intracranial pressure state. Leading to irreversible delayed brain damage and difficulty in recovery of PVS. Therefore, it is very important to emphasize the rational and evidence-based application of hyperbaric oxygen therapy for PVS following anoxic encephalopathy.