颅脑外伤后高压氧介入时间对患者格拉斯哥昏迷量表评分和功能独立性评定评分影响的临床研究

Clinical study on the effect of hyperbaric oxygen intervention time on GCS and FIM scores in patients following traumatic brain injury

目的 观察颅脑外伤（traumatic brain injury,TBI）后高压氧介入时间对患者格拉斯哥昏迷量表评分（glasgow coma score,GCS）和功能独立性评定（functional independent measure,FIM）评分改善的作用,为探讨综合康复治疗最佳介入时机提供临床依据.方法 颅脑外伤患者130例,根据受伤时间分为对照组25例,高压氧1组（TBI＜ 15 d）与高压氧2组（15 d≤TBI≤30 d）各40例,高压氧3组（TBI＞30 d）25例,都给予药物治疗和采取康复措施,高压氧各组在此基础上行高压氧治疗共40次,以治疗前和治疗第30天、60天的GCS和FIM评分进行疗效评价.结果 各组患者在治疗第30、60天的GCS、FIM评分比较差异均有统计学意义（P＜0.01）;GCS评分高压氧1、2组（13.36±3.06,13.66±1.42）分与对照组（11.83±3.57）分比较在第60天差异有统计学意义（P＜0.05）,FIM评分高压氧1、2组与对照组比较在第30、60天差异有统计学意义（P＜0.05）,GCS、FIM评分变化量在各组都为高压氧1组＞2组＞3组＞对照组.结论 TBI患者高压氧不同时间介入对GCS和FIM评分有不同程度的改善作用,总体显示TBI＜ 15 d组优于15 d≤TBI≤30 d组优于TBI＞ 30 d组.

Objective To investigate the effect of hyperbaric oxygen intervention time on Glasgow Coma Score （GCS） and functional independent measure （FIM） scores in patients following traumatic brain injury,so as to provide clinical evidence for optimal intervention time in the comprehensive rehabilitation of those patients.Methods There were 130 patients with moderate or severe traumatic brain injury （TBI）,who were divided according to different injury time into 4 groups：the control group （n =25）,the HBO group 1 （TBI 〈 15 d） （n =40）,the HBO group 2 （TBI time of 15 to 30 d） （n =40） and the HBO group 3 （TBI 〉 30 d） （n =25）.The patients in all the groups received drug therapy and rehabilitation treatment measures.On the basis of the above routine treatment,the patients in all the HBO groups were treated with HBO for a total of 40 sessions.Therapeutic efficacy was assessed by using GCS and FIM scores performed respectively at day one,day 30 and day 60.Results Statistical significance could be noticed in all the TBI groups in GCS and FIM scores performed at day 30 and day 60（P 〈0.01）.For HBO group 1 and group 2,statistical differences could be seen in GCS scores detected at day 60 （13.36 ± 3.06,13.66 ± 1.42,11.83 ± 3.57）,as compared with those of the control group（P 〈 0.05）.For HBO group 1 and group 2,statistical differences could also be seen in FIM scores detected respectively at day 30 and day 60,as compared with those of the control group （P 〈 0.05）.Variance in the scores of GCS and FIM was：group 1 was greater than group 2,group 2 was greater than group 3 and group 3 was greater than the control group.Conclusions Different HBO intervention time seemed to have some effect on the improvement of GCS and FIM scores in patients with traumatic brain injury.On the whole,treatment results indicated that the therapeutic effects for the HBO group 1 were superior to those for the HBO group 2,and the therapeutic effects for the HBO group 2 were superior to those for the HBO group 3.