早期高压氧治疗对未行血肿清除手术的基底节区脑出血患者预后的影响

Effect of early hyperbaric oxygen therapy on prognosis of basal ganglia hemorrhage patients without hematoma evacuation

目的探讨早期高压氧治疗(HBOT)对未行血肿清除手术的基底节区脑出血患者神经功能的康复作用。方法回顾性分析南京紫金医院与东部战区空军医院2015年1月至2020年1月收治的高血压基底节区脑出血患者41例,部分患者因出血量小而未行血肿清除手术,其中18例患者(治疗组)进行了早期HBOT;其余23例(对照组)于出血2周后接受同样条件的HBOT。采用定期头颅CT扫描观察血肿量及血肿周围水肿的变化,并于出血后第10天比较2组患者脑血肿周围水肿扩大发生率。所有患者于入院当天及3个月后采用美国国立卫生研究院卒中量表(NIHSS)和格拉斯哥预后量表(GOS)评定患者的神经功能。结果所有患者在定期头颅CT扫描检查过程中未发现有再出血现象。入院第10天与第1天的头颅CT检查结果比较,治疗组血肿周围水肿扩大者比率占16.7%,而对照组血肿周边水肿扩大者比率为91.3%(P<0.01)。治疗3个月后,2组患者NIHSS评分均降低,GOS评分均升高,但治疗组NIHSS评分低于对照组,GOS评分高于对照组,差异均有统计学意义(P<0.05)。结论对于未行血肿清除手术的基底节区脑出血患者早期行HBOT是安全可行的,早期HBOT可有效减轻血肿周围水肿的发生,改善患者预后。

Objective To evaluate the effect of early hyperbaric oxygen therapy(HBOT)on neurological function recovery of basal ganglia hemorrhage patients who didn’t receive hematoma evacuation.Methods A total of 41 basal ganglia hemorrhage patients treated in Nanjing Zijin Hospital and PLA Air Force Hospital of The Eastern Theater Command from January 2015 to January 2020 were included in this study.They did not undergo hematoma evacuation surgery due to small hematoma volume,18 of whom received early HBOT(treatment group),and the remaining 23 patients received the same HBOT two weeks after hemorrhage(control group).The hematoma volume and the changes of perihematomal edema(PHE)were observed using regular head CT scan,and the incidences of PHE expansion in the two groups were compared on the 10th day after the hemorrhage.All the 41 patients’neurological functions were assessed by the National Institutes of Health stroke scale(NIHSS)and Glasgow outcome scale(GOS)upon their admission and three months after admission.Results No re-hemorrhage was found in any patient on the head CT scan.On the 10th day after admission,the incidence of PHE expansion was 16.7%in the treatment group and 91.3%in the control group,respectively,the difference was statistically significant(P<0.01).After three months of treatment,the NIHSS scores of both groups were decreased,and the GOS scores of both groups were increased.The NIHSS score of the treatment group was lower than that of the control group,while the GOS score in the treatment group was higher than that of the control group,both with statistically significant differences(P<0.05).Conclusion Early HBOT is a safe treatment for basal ganglia hemorrhage patients without hematoma evacuation,and it can reduce the occurrence of PHE and improve the prognosis of patients.