高压氧对创伤性脑损伤后认知功能障碍的保护作用

Protective effects of hyperbaric oxygenation on cognitive dysfunction in traumatic brain injury patients

目的探讨高压氧治疗创伤性脑损伤(TBI)后认知功能障碍的临床效果及其调控脑损伤血清标志蛋白的可能作用。方法选取该院自2011年10月至2014年10月收治的TBI后认知功能障碍患者78例,随机分为对照组和高压氧组;治疗前后采用中文版神经行为认知状况测试量表(NCSE)和简易精神状态检查量表(MMSE)评价患者认知功能,采用功能独立性评测(FIM)评分评价患者日常生活能力,采用酶联免疫吸附(ELISA)方法检测患者血清蛋白S100B和神经元特异性烯醇化酶(NSE)浓度。结果两组患者在经治疗后认知功能都得到显著改善,表现为语言能力、推理能力、表达能力、回忆能力、运动功能、认知功能及NCSE、MMSE、FIM总分均比治疗前明显提高(P<0.05或P<0.01);而高压氧组患者的治疗改善作用显著优于对照组(P<0.05)。在经治疗后,各组患者血清蛋白S100B和NSE浓度出现明显下降(P<0.05或P<0.01);而高压氧组患者的血清S100B和NSE浓度显著低于对照组(P<0.05)。结论高压氧治疗能够显著改善TBI患者的认知功能障碍,而且这一作用可能通过调控脑损伤标志蛋白NSE及S100B表达来实现。

Objective To explore the clinical efficacy of hyperbaric oxygen treatment on cognitive dysfunction and serum markers of brain injury in traumatic brain injury patients. Methods 78 patients with cognitive impairment caused by traumatic brain injury were randomly divided into control and hyperbaric oxygen groups. Before and after treatment,Chinese neurobehavioral cognitive status tests（ NCSE）and Mini Mental State Examination（ MMSE） were performed to evaluate the cognitive function,and Functional Independence Measure（ FIM）was performed to evaluate the activities of daily living of patients. The serum protein S100 B and NSE concentrations were measured by ELISA. Results The cognitive function was significantly improved after treatment in both groups,including language skills,reasoning ability,ability of expression,ability to recall,motor function,cognitive function and NCSE,MMSE,FIM scores（ P〈0. 05 or P〈0. 01）. Moreover,hyperbaric oxygen treatment showed better therapeutic effects on the improvement of cognitive function compared with those of control group（ P〈0. 05）. After treatment,the serum protein S100 B and NSE levels of patients were decreased significantly（ P〈0. 05 or P〈0. 01）,and serum S100 B and NSE concentrations of hyperbaric oxygen group were significantly lower than those of control group（ P〈0. 05）. Conclusions Hyperbaric oxygen therapy could significantly improve the cognitive dysfunction in traumatic brain injury patients,and this effect might be achieved by regulating brain injury markers NSE and S100 B protein expressions.