不同压力下高压氧治疗儿童脓毒性脑病的临床疗效及对脑氧代谢功能的影响

Clinical effect of hyperbaric oxygen at different pressures on sepsis-associated encephalopathy in children and its effect on cerebral oxygen metabolism

目的探讨不同压力下高压氧(HBO)治疗儿童脓毒性脑病的临床疗效及对脑氧代谢功能的影响。方法选取2015年3月至2018年3月青海省妇女儿童医院收治的180例儿童脓毒性脑病患者作为研究对象,采用随机数字表法分为0.24 MPa HBO治疗组(高压组,n=90)和0.15 MPa HBO治疗组(低压组,n=90)。比较治疗前后2组患儿急性生理学及慢性健康状况(APACHEⅡ)、儿童脑功能分类量表(PCPC)评分及儿童生活功能量表(PEDI)评分,检测2组患儿治疗前后脑损伤标志物神经元特异性烯醇化酶(NSE)、S100B蛋白多肽(S100B),以及炎性因子水平肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)的水平,同时计算治疗前后2组患儿颈内静脉血氧饱和度(SjvO2)、颈动脉-静脉血氧含量差(AVDO2)、脑氧摄取率(CEO2)和脑组织氧分压(PbtO2)。结果治疗4个疗程后,高压组患者治疗后的APACHEⅡ、PCPC评分显著低于低压组(P<0.05);PEDI量表中,高压组患者治疗后日常活动、移动能力和交流能力均显著低于低压组(P<0.05);高压组患者治疗后血清NSE、S100B、TNF-α、CRP和IL-6水平均显著低于低压组治疗后(P<0.05);高压组患者治疗后SjvO2、CEO2明显高于低压组治疗后,AVDO2明显低于低压组治疗后(P<0.05),而治疗后2组患者PbtO2水平比较差异无统计学意义(P>0.05)。结论高压HBO治疗儿童脓毒性脑病可明显降低脑损伤标志物及炎性因子水平,纠正脑氧代谢紊乱,有利于脑损伤恢复,可提高患者生活质量。

Objective To investigate the clinical effect of hyperbaric oxygen(HBO)at different treatment on sepsis-associated encephalopathy(SAE)in children and its effect on cerebral oxygen metabolism.Methods A total of 180 children with SAE,treated in Qinghai Women and Children′s Hospital from March 2015 to March 2018,were selected as the research objects and divided into the 0.24 MPa HBO group(high pressure group,n=90)and 0.15 MPa HBO group(low pressure group,n=90)by random number table method.The scores of the Acute Physiology And Chronic Health Evaluation scoring system(APACHEⅡ),Pediatric Cerebral Performance Category scale(PCPC),and Pediatric Evaluation of Disability Inventory(PEDI)before and after treatment were compared between the two groups.The markers of brain injury[neuron-specific enolase(NSE),S100B protein polypeptide(S100B)],inflammatory factor levels[tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)]of the two groups after treatment were detected;and the jugular venous oxygen saturation(SjvO2),carotid-venous blood oxygen content difference(AVDO2),cerebral oxygen uptake rate(CEO2),and cerebral tissue oxygen partial pressure(PbtO2)differences of the two groups before and after the treatment were calculated.Results After 4 courses of treatment,the scores of APACHEⅡand PCPC in the high pressure group were significantly lower than those of the low pressure group(P<0.05).In the PEDI scale,the daily activities,mobility,and communication abilities of patients in the high pressure group after treatment were all significantly lower than those in the low pressure group(P<0.05).The levels of NSE,S100B,TNF-α,CRP,and Il-6 of the high pressure group after treatment were significantly lower than those of the low pressure group after treatment(P<0.05).After treatment,the scores of SjvO2 and CEO2 in the high-pressure group were significantly higher than those in the low-pressure group,while AVDO2 was significantly lower than that in the low-pressure group(P<0.05).However,there was no statistically significant difference in PbtO2 level between the two groups before and after the treatment(P>0.05).Conclusion HBO on SAE in children can significantly reduce the levels of brain injury markers and inflammatory factors,correct brain oxygen metabolism disorder,facilitate the recovery of brain injury,and improve the quality of life of patients.