高压氧治疗缺血缺氧性脑损伤后慢性意识障碍的疗效观察

Efficacy of hyperbaric oxygen in treatment of prolonged disorders of consciousness after hypoxic-ischemic brain injury

目的探讨高压氧(hyperbaric oxygen, HBO)治疗对缺血缺氧性脑损伤(hypoxic-ischemic brain injure, HIBI)后慢性意识障碍(prolonged disorders of consciousness, pDOC)患者意识及预后的影响。方法回顾性分析2010年1月至2019年6月在解放军南部战区总医院住院治疗的HIBI后pDOC患者78例。按照治疗方法分为对照组(19例)和高压氧组(59例);根据患者入院时病程是否超过3个月将高压氧组分为长病程组(21例)和短病程组(38例)。对照组给予常规治疗,高压氧组在常规治疗基础上应用HBO治疗。记录所有患者的性别、年龄、入院时格拉斯哥昏迷量表(Glasgow Coma Scale, GCS)评分、入院和出院时修订版昏迷恢复量表(Coma Recovery Scale-Revised, CRS-R)评分。出院1年后采用格拉斯哥结局量表(Glasgow Outcome Scale, GOS)进行随访。结果高压氧组患者出院时CRS-R(11.51±6.33)评分高于对照组(8.05±4.81),意识改善患者比例(66.10%)高于对照组(26.32%)。出院1年后,高压氧组患者GOS评分(2.53±1.12)高于对照组(1.42±0.69),病死率(20.34%)低于对照组(68.42%),差异均有统计学意义(P<0.05)。短病程组出院时CRS-R评分(12.45±6.73)高于对照组(8.05±4.81),意识改善患者比例(71.05%)高于对照组(26.32%),出院1年后GOS评分(2.58±1.13)高于对照组(1.42±0.69),病死率(18.42%)低于对照组(68.42%),差异均有统计学意义(P<0.05)。长病程组出院时意识改善患者比例(57.14%)高于对照组(26.32%),出院1年后GOS评分(2.43±1.12)高于对照组(1.42±0.69),病死率(23.81%)低于对照组(68.42%),差异均有统计学意义(P<0.05)。结论 HBO治疗可以改善HIBI后pDOC患者的意识,即使其病程超过3个月;HBO治疗可以改善远期预后,降低病死率。

Objective To investigate the effect of hyperbaric oxygen(HBO)therapy on consciousness and prognosis in patients with prolonged disorders of consciousness(pDOC)after hypoxic-ischemic brain injury(HIBI).Methods Clinical data of 78 pDOC patients after HIBI treated in the General Hospital of Southern Theater Command from January 2010 to June 2019 were collected and analyzed retrospectively.In accordance with their treatment,they were divided into control group(n=19)and HBO group(n=59).Then,the HBO group was further assigned into long-course subgroup(n=21)and short-course subgroup(n=38)according to whether the course of disease was longer than 3 months.The patients in the control group received only routine treatment,while those in the HBO group got HBO therapy on the basis of routine treatment.Gender,age,GOS score at admission,and Coma Recovery Scale-Revised(CRS-R)score at admission and discharge were recorded.Glasgow Outcome Scale was used for follow-up survey in 1 year after discharge.Results The HBO group had significantly higher CRS-R score at discharge(11.51±6.33 vs 8.05±4.81),larger proportion of those achieving better consciousness(66.10%vs 26.32%)when compared with the control group(P<0.05).In 1 year after discharge,the GOS score was significantly higher(2.53±1.12 vs 1.42±0.69)and lower mortality(20.34%vs 68.42%)in HBO group than the control group(P<0.05).Moreover,in the short-course subgroup,the CRS-R score at discharge was obviously higher(12.45±6.73 vs 8.05±4.81),the proportion of patients with consciousness improved was larger(71.05%vs 26.32%),the GOS score in 1 year after discharge was higher(2.58±1.13 vs 1.42±0.69),and lower mortality rate was lower(18.42%vs 68.42%)when compared with the control group(P<0.05).And in the long-course subgroup,similiar results of above indicators were seen in comparison with the control group(57.14%vs 26.32%;2.43±1.12 vs 1.42±0.69;23.81%vs 68.42%;P<0.05).Conclusion HBO therapy can improve the consciousness of patients with pDOC after HIBI,even if the course exceeds 3 months.Further more,HBO therapy can improve long-term prognosis and reduce mortality rate in these patients.