同步高压氧在脑胶质瘤术后辅助治疗中的应用价值研究

Application value of adjuvant inhalation of hyperbaric oxygen in viability and life quality of postoperative patients with malignant gliomas

目的探讨同步高压氧治疗对脑胶质瘤术后联合放化疗患者疗效及生存能力与质量的影响。方法选择广州军区广州总医院神经外科及解放军第四五七医院神经外科自2009年1月至2013年12月收治的脑恶性胶质瘤术后患者86例，根据患者及其家属意愿分为2组，高压氧组47例术后行高压氧联合放化疗治疗，对照组39例术后单纯行放化疗。化疗方案：术后2~4周（平均3周）开始化疗，第1周期口服替莫唑胺150mg／m2体表面积，1次／d，连续服用5d；第2～5周期口服替莫唑胺200mg／m2体表面积，1次，d，连续服用5d，均完成5周期化疗。高压氧治疗方案：与口服替莫唑胺的周期同步，高压氧治疗时长60min，压力为2．8个大气压．高压氧治疗后30min内口服替莫唑胺。2组病例化疗后均常规行放疗，6000cGy／30F。采用WHO制定的实体肿瘤化疗敏感性评判标准评估并比较2组患者治疗有效率，采用日常生活能力评分（ADL）量表及SF-36量表评估患者治疗前及治疗后3个月、6个月的生存能力及生存质量。结果高压氧组总有效率、治疗后3个月及6个月的ADL〉60分比例分别为95．74％、53．2％、72．3％，明显高于对照组上述3项指标（分别为58．97％、30．8％、48．7％），差异有统计学意义（P＜0．05）。高压氧组术后3个月、术后6个月SF-36量表各指标评分亦明显高于对照组相应指标，差异有统计学意义（P＜0．05）。结论术后同步高压氧治疗可提高放化疗对脑胶质瘤的疗效，改善患者预后。

Objective To explore the influence of chemoradiotherapy combined with inhalation of hyperbaric oxygen in short-term therapeutic effectiveness, viability and quality of life of postoperative patients with malignant gliomas. Methods A total of 86 patients with malignant gliomas, admitted to our hospital from January 2009 to December 2013, were chosen in our study; according to the wishes of patients and their families, all patients were divided into two groups： chemoradiotherapy combined with inhalation of hyperbaric oxygen group （n=47） and chemoradiotherapy group （n=39）. Chemotherapy regimens were given： temozolomide of 150 mg/m2 body surface area at the first period once daily for a consecutive five days and temozolomide of 200 mg/m2 body surface area since the second period once daily for consecutive five days. Hyperbaric oxygen therapy was given with duration of 60 min at pressure of 2.8 arm. Conventional radiotherapy （6000 cGy/30F） was given in both groups. WHO established solid tumor chemosensitivity criteria was used to evaluate the effective rate of total symptoms, and activity of daily living （ADL） scale and F-36 scale were employed to evaluate the viability and life quality before and three and six months after the intervention. Results The effective rate of total symptoms, ratio of ADL〉60 points in chemoradiotherapy combined with inhalation of hyperbaric oxygen group 3 and 6months after treatment were 95.74%, 53.2% and 72.3%, which were significantly higher than those in the chemoradiotherapy group （58.97 %, 30.8% and 48.7%,p〈0.05）. The scores of all the items of SF-36 scale in ehemoradiotherapy combined with inhalation of hyperbaric oxygen group 3 and 6 months after treatment were significantly higher than those in the chemoradiotherapy group （P〈0.05）. Conclusion Inhalation of hyperbaric oxygen can significantly improve short-term therapeutic effectiveness, survival duration, viability and quality of life of postoperative patients with malignant gliomas, and obviously improve the prognosis of patients.