高压氧联合神经节苷脂对颅脑外伤的神经保护效果

Analysis of the Neuroprotective Effect of Hyperbaric Oxygen and Ganglioside for Traumatic Brain Injury

目的 观察高压氧联合神经节苷脂治疗对颅脑外伤（TBI）的神经保护作用。方法 选取2013年9月至2015年6月重庆三峡中心医院收治的78例TBI患者作为研究对象,采用随机数字表法将患者分为高压氧组（39例）和联合组（39例）。高压氧组给予高压氧治疗,时间为80-90 min,每日1次,联合组在此基础上加用神经节苷脂治疗（急性期,每日100 mg＋250 m L 0.9%氯化钠注射液,每日1次,静脉滴注;维持阶段,每日40 mg＋250 m L 0.9%氯化钠注射液,每日1次,静脉滴注）。观察两组患者治疗前和治疗后1周、2周、4周的简易精神状态评价量表（MMSE）评分、血清神经元特异性烯醇化酶（NSE）水平、血清髓磷脂碱性蛋白（MBP）水平、大脑中动脉（MCA）血流速度,并统计治疗4周后的疗效及不良反应发生情况。结果 两组患者的MMSE评分、血清NSE、MBP的水平以及MCA在组间、时点间以及组间·时点间比较差异均有统计学意义（P〉0.05）。联合组患者治疗的总有效率为94.87%（37/39）,明显高于高压氧组患者的76.92%（30/39）,差异有统计学意义（P〈0.05）,疗效比较差异有统计学意义（P=0.047）。高压氧组和联合组不良反应发生率比较差异无统计学意义[23.08%（9/39）比30.77%（12/39）,P〉0.05]。结论 高压氧联合神经节苷脂可有效保护TBI患者脑部神经,有利于改善患者神经功能状况,临床应用价值高。

Objective To analyze the neuroprotective effect of hyperbaric and oxygen ganglioside for traumatic brain injury （TBI）. Methods Seventy-eight TBI patients in Chongqing Three Gorges Central Hospital from Sep. 2013 to Jul. 2015 were selected as the objects, according to the random number table method the patients were divided into a hyperbaric oxygen group （ 39 cases ） and a combined group （ 39 cases）. The hyperbaric oxygen group received hyperbaric oxygen therapy for 80-90 rain each day, the combined group were treated with ganglioside on the basis of hyperbaric oxygen group（ acute stage, 100 mg gan- glioside ＋ 250 mL of normal saline intravenous drip, once a day, maintaining stage,40 mg ganglioside ＋ 250 mL normal saline intravenous drip, once a day）. The mini-mental state evaluation scale （ MMSE）, serum neuron-specific enolase（ NSE ） levels, serum myelin basic protein （MBP） levels, middle cerebral artery （MCA） flow velocity were observed before and after one week, two weeks and four weeks of treatment, the effect and adverse reactions of the two groups were compared. Results The MMSE scores, serum NSE levels, MBP levels and MCA between groups, time points and groups · time points had statistically significant differences （ P 〉 0. 05 ）. The total effective rate of the combined group was 94.87% （ 37/39,30/39 ）, and it was significantly higher than the hyperbaric oxygen group（76. 92% ） （P 〈0. 05）. The incidence of adverse reactions of the hyperbaric oxygen group and the combined group were 23.08% （9/39） and 30. 77% （ 12/ 39 ）, the difference was not statistically significant （ P 〉 0. 05 ）. Conclusion Hyperbaric oxygen combined with ganglioside can effectively protect the brain nerve and improve neurological status of the patients with TBI, thus has a high clinical value.