高原地区亚低温及高压氧联合药物治疗重型颅脑损伤疗效分析

Analysis of the therapeutic effects of sub-hypothermia and hyperbaric oxygen combined with drugs in the treatment of patients with severe traumatic brain injury in the high plateau region

目的 探讨高原地区亚低温及高压氧（hyperbaric oxygen,HBO）联合药物治疗重型颅脑损伤的疗效及其机制.方法 经患者知情同意及医院伦理委员会批准,将118例重症颅腑损伤患者分为综合组（58例）、亚低温组（30例）和HBO组（30例）.综合组58例在常规药物治疗基础上应用亚低温及HBO治疗,亚低温组30例在常规药物基础上应用亚低温治疗,HBO组30例在常规药物基础上辅以HBO治疗,观察并比较3组治疗前后格拉斯哥昏迷评分（GCS评分）、格拉斯哥预后评分（GOS评分）和治疗效果.结果 3组疗效比较,综合组总有效率为93.16％,明显高于亚低温组66.7％和HBO组76.7％,差异有统计学意义（P＜0.05）.3组治疗前,GCS评分比较差异无统计学意义（P＞0.05）.进行相关治疗后,3组的GCS评分均有所提高,且治疗前后的差异均有统计学意义（P＜0.05）;治疗后综合组的GCS、GOS得分显著高于亚低温组和HBO组,组间差异有统计学意义（P＜0.05）.结论 早期应用亚低温治疗,在病情相对平稳后及时进行HBO治疗,可以明显提高高原地区重症颅脑损伤患者治疗效果,降低死亡率,降低脑损伤后神经功能障碍及后遗症的发生率,提高其生活质量.

Objective To explore the therapeutic effects of sub-hypothermia and hyperbaric oxygen （HBO） combined with drugs in the treatment of patients with severe traumatic brain injury in the high plateau region and possible mechanism involved.Methods With the knowledge and consent of the patients and following the approval of the ethics committee,118 patients with severe traumatic brain injury were randomly divided into the comprehensive treatment group （58 cases）,the sub-hypothermia group （30 cases） and the HBO group （30 cases）.Fifty-eight patients in the comprehensive treatment group had sub-hypothermia and HBO treatment,in addition to routine drug therapy; the patients in the sub-hypothermia group were treated with sub-hypothermia in addition to routine drug therapy; and the patients in the HBO groups received HBO therapy in addition to routine drug therapy.Glasgow coma scale （GCS） scores,Glasgow outcome scale （GOS） scores and therapeutic effects were closely observed and compared both before and after treatment between the 3 groups.Results Analyses indicated that total efficacy for the comprehensive treatment group was 93.16%,which was higher that of the sub-hypothermia group （66.7%） and the HBO group （76.7%）,with statistical significance（P 〈 0.05）,when comparisons were made between the 3 groups.Before therapy,there were significant differences in the GCS scores for the 3 groups （P 〉 0.05）.Following treatment with respective protocols,GCS scores for the 3 groups all increased to some extent,and differences could be uoted in statistical significance,when comparisons were made between pre-therapy and post-therapy （P 〈 0.05）.Following treatment,GCS and GOS scores for the comprehensive treatment group were obviously higher than those of the sub-hypothermia group and the HBO group,and there were statistical differences when comparisons were made between the 3 groups （P 〈 0.05）.Conclusions Early application of sub-hypothermia and timely treatment with HBO could significantly improve the therapeutic effects on patients with severe traumatic brain injury,decrease mortality,reduce incidence of neural function disorder after severe traumatic brain injury and the incidence of sequelae,and at the same time could improve the life quality ofthe patients.