高压氧治疗未破裂颅内动脉瘤夹闭术后脑梗死疗效及影响因素分析

The Efficacy of Hyperbaric Oxygen Therapy for Cerebral Infarction after Unruptured Intracranial Aneurysm Clipping

目的探讨高压氧治疗未破裂颅内动脉瘤夹闭术后脑梗死疗效及影响因素。方法回顾性纳入未破裂颅内动脉瘤夹闭术后脑梗死患者,根据是否进行高压氧治疗(压力0.2 Mpa,稳压60 min,每日1次)分为高压氧组和对照组。应用NIHSS评分评估患者出院时神经功能缺损程度,观察高压氧治疗是否有效。将出院NIHSS评分较脑梗死发病24 h内评分下降≥4分作为治疗显效的标准,应用多因素Logistic回归分析,探讨术后脑梗死疗效的影响因素。结果共纳入56例患者,平均年龄53.63±11.02岁,其中男性24例(42.9%)。高压氧组41例,对照组15例。高压氧组出院NIHSS评分低于对照组[6(4~8)分vs 12(7~15)分,P=0.001]。纳入患者中治疗显效22例(39.3%),多因素Logistic回归分析显示,脑梗死发病24 h内NIHSS评分高(OR 1.411,95%CI 1.134~1.756,P=0.002)是未破裂动脉瘤术后脑梗死治疗显效的独立影响因素;与未行高压氧治疗对比,高压氧治疗1~5次(OR 16.454,95%CI 1.326~204.191,P=0.029),高压氧治疗6~9次(OR 20.966,95%CI 1.996~220.253,P=0.011),高压氧治疗≥10次(OR 47.026,95%CI 3.651~605.774,P=0.003)与术后脑梗死治疗显效呈独立正相关。结论高压氧治疗颅内动脉瘤夹闭术后脑梗死有效,脑梗死发病24 h内NIHSS评分及高压氧治疗是未破裂颅内动脉瘤术后脑梗死治疗显效独立影响因素。

Objective To investigate the efficacy of hyperbaric oxygen therapy(HBOT)for cerebral infarction after microsurgical clipping of unruptured intracranial aneurysm and influencing factors for the treatment effect.Methods A retrospective analysis of clinical data of patients with cerebral infarction after unruptured intracranial aneurysm clipping admitted to Beijing Tiantan Hospital from August 2012 to January 2020 was performed.All the included patients were divided into HBOT group and control group.The patients of HBOT group were given hyperbaric oxygen of 0.2 Mpa for 60 minutes once a day.The efficacy of HBOT was evaluated using NIHSS at discharge.The effective treatment was defined as a NIHSS score at discharge decreasing≥4 points compared to the baseline score.Multivariate logistic regression analysis was used to explore the influencing factors for the effective treatment of cerebral infarction.Results A total of 56 patients were included,with a mean age of 53.63±11.02 years and 24 males(42.9%).There were 41 cases in HBOT group and 15 cases in control group.The NIHSS score at discharge of HBOT group was lower than that of control group[6(4-8)score vs 12(7-15)score,P=0.001].The treatment were effective in 22 patients(39.3%)of the two groups.Multivariate logistic regression analysis showed that the high baseline NIHSS score(OR 1.411,95%CI 1.134-1.756,P=0.002)was an independent influencing factor for the effective treatment of cerebral infarction after unruptured intracranial aneurysm clipping.Compared to no HBOT,HBOT 1-5 times(OR 16.454,95%CI 1.326-204.191,P=0.029),HBOT 6-9 times(OR 20.966,95%CI 1.996-220.253,P=0.011),HBOT≥10 times(OR 47.026,95%CI 3.651-605.774,P=0.003)were both positively associated with the treatment efficacy of cerebral infarction after unruptured intracranial aneurysm clipping.Conclusions Hyperbaric oxygen was effective in treating cerebral infarction after unruptured intracranial aneurysm clipping.The NIHSS score within 24 hours after cerebral infarction onset and HBOT were independent influencing factors for treatment efficacy of cerebral infarction after unruptured intracranial aneurysm clipping.