高压氧综合治疗颅脑外伤后最小意识状态患者的临床分析

Effects of comprehensive hyperbaric oxygen therapy on the patients with minimal consciousness following traumatic brain injury

目的：探讨高压氧治疗能否改善颅脑外伤（traumatic brain injury，TBI）最小意识状态患者的意识及日常生活能力。方法符合最小意识状态标准的 TBI 患者共82例，经患者知情同意，并签署知情同意书后，将所有患者按治疗方法分为3组，高压氧治疗3个疗程组30例（高压氧1组），高压氧治疗6个疗程组28例（高压氧2组），常规治疗组24例。所有患者都给予药物及康复治疗。高压氧组患者在常规治疗基础上给予不同疗程高压氧治疗。在治疗12及24周应用改良的昏迷恢复量表（coma recovery scale-revised，CRS-R）及改良 Barthel 指数（modified Barthel index，MBI）评价患者的意识及日常生活能力。结果各组治疗12、24周的 CRS-R 及 MBI 评分与治疗前比较差异有统计学意义（P ＜0．01）；高压氧1、2组12、24周的 CRS-R 及 MBI 评分均高于常规治疗组，差异有统计学意义（P ＜0．05或P ＜0．01），高压氧2组仅24周的 CRS-R 及 MBI 评分高于高压氧1组，差异有统计意义（P ＜0．05）。结论高压氧治疗可改善 TBI 最小意识状态患者的意识状态及日常生活能力，6个疗程高压氧治疗效果好于3个疗程，因此不宜过早终止高压氧治疗。

Objective To investigate the capacity of comprehensive HBO therapy in the recovery of consciousness and daily life activity of the patients following traumatic brain injury （TBI）.Methods There were 82 patients who conformed to the standards of minimal consciousness,of whom 30 completed 3 courses of HBO therapy,28 completed 6 courses of HBO therapy,24 just received routine treatment.The patients in all groups received both drug therapy and rehabilitation treatment.On the basis of routine treatment,the patients in different HBO groups received various courses of HBO therapy.At week 12 and 24,the consciousness and daily life activity of the patients were evaluated by using coma recovery scale-revised （CRS-R）and modified Barthel index （MBI）.Results As compared with those before treatment,statistical significance could be seen in the scores of CRS-R and MBI in the 2 HBO groups,following 12 and 24 weeks of HBO therapy respectively（P 〈0.01）.At week 12 and 24 after HBO therapy,the scores of CRS-R and MBI in the 2 HBO groups were all higher than those of the routine treatment group,and statistical significance could be noted,when comparisons were made between them（P 〈0.05 or P 〈0.01）.At week 24,the scores of CRS-R and MBI in the 6-course HBO group were higher than those in the 3-Course HBO group,and statistical significance could be seen,when comparisons were made between them （P 〈0.05 ）. Conclusions HBO therapy could improve the consciousness and daily life activity of the patients with traumatic brain injury.Twenty-four-week follow-ups＆amp;nbsp;indicated that the therapeutic effects of 6-Course HBO therapy were obviously better than those of the 3-Course HBO therapy.For this reason,HBO therapy should not be terminated too early.