不同压力高压氧治疗对重型弥漫性轴索损伤预后的影响

Effect of different pressure hyperbaric oxygen therapy on patients with diffuse axonal injury

目的 探讨不同压力高压氧治疗对重型弥漫性轴索损伤的治疗价值及对预后的影响.方法 收集我院2013年9月至2015年3月收治的30例弥漫性轴索损伤患者,按照数字表法随机分成对照组、0.20 MPa组和0.25 MPa组,每组各10例.对照组仅予以常规治疗,0.20 MPa组在常规治疗基础上待生命体征稳定后给予3个疗程0.2 MPa治疗,0.25 MPa组给予3个疗程0.25 MPa治疗.采用GOS评分、NIHSS评分评价各组患者神经功能.应用磁共振波谱观察3组胼胝体压部和基底节N-乙酰天冬氨酸（N-acetylaspartate,NAA）/肌酸和磷酸肌酸（creatine compound,Cr）、胆碱复合物（cholinecontaining compounds,Cho）/Cr、肌醇（mINs）/Cr等指标的差异.结果 0.25 MPa组（18.450,8.09±4.35）与0.20 MPa组（16.630,12.05±2.15）及对照组（12.040,13.35 ±2.34）比较GOS评分及NIHSS评分差异均有统计学意义（P＜0.05或P＜0.01）.0.25 MPa组伤后3个月胼胝体压部NAA/Cr、Cho/Cr、mlNs/Cr、基底节区NAA/Cr、Cho/Cr,与0.20 MPa组和对照组相比,差异均有统计学意义（P ＜0.05或P＜0.01）.结论 对于重型弥漫性轴索损伤患者,高压氧治疗可改善胼胝体压部及基底节区脑组织代谢,改善神经功能缺损与患者预后.

Objective To investigate the value of different pressure hyperbaric oxygen （HBO） therapy on clinical outcomes and effect on prognosis of the patients with severe diffuse axonal injury （DAI）.Methods Thirty cases of diffuse axonal injury admitted into our hospital from September 2013 to March 2015 were randomly divided into 3 groups： the control group, the lower hyperbaric oxygen group （or the lower HBO group） and the higher hyperbaric oxygen group （or the higher HBO group） , each consisting of 10 cases.The control group was just given routine treatment, the lower HBO group received 3 courses of 0.2 MPa HBO therapy in addition to routine treatment after vital signs became stable, and the higher HBO group received 3 courses of 0.25 MPa HBO therapy in addition to routine treatment.Neural functions of the 3 groups were evaluated by using GOS and NIHSS.Magnetic resonance spectroscopy was used to observe changes in the indicators of N-acetylaspartate （NAA）/ creatine （Cr）, choline-containing compounds （Cho）/Cr and mINs/Cr.Results Statistical differences could be seen in the scores of GOS and NIHSS, when comparisons were made between the groups （P 〈0.05 or P 〈0.01）.As compared with those of the lower HBO group and the control group, the levels of NAA/Cr, Cho/Cr, mlNs/Cr in the splenium of corpus callosumin, and NAA/Cr and Cho/Cr in basal ganglia for the 0.25 MPa HBO group were either elevated or decreased, with statistical significance （P 〈 0.05 or P 〈 0.01）.Conclusions For the patients with severe diffuse axonal injury, higher pressure HBO therapy could obviously enhance metabolism of brain tissues in the splenium of corpus callosumin and basal ganglia and improve neurological deficits prognosis of the disorder.