重型颅脑损伤患者去骨瓣减压术后高压氧治疗效果及影响因素分析

Influencing factors of the therapeutic effects of hyperbaric oxygen therapy after decompressive craniectomy in treating patients with severe craniocerebral injury

目的观察重型颅脑损伤(SCI)患者去骨瓣减压术(DC)后高压氧(HBO)的治疗效果,并分析其可能的影响因素。方法回顾性分析、收集2018年1月至2020年12月商丘市第一人民医院神经外科完成治疗及随访的30例SCI患者经DC后HBO治疗有效者的病历资料,设为有效组;另收集同期医院完成治疗及随访的30例SCI患者经DC后HBO治疗无效者的病历资料,设为无效组。设计一般资料填写表,采集并记录患者基线资料,将可能的影响因素纳入,经单因素与多因素检验,分析SCI患者经DC后HBO治疗效果的影响因素。结果无效组患者血清肿瘤坏死因子α(TNF-α)[(39.71±2.92)μg/L]、白细胞介素-6(IL-6)[(79.72±3.51)μg/L]水平高于有效组[(36.44±2.46)μg/L、(75.06±3.28)μg/L],HBO治疗时机为伤后>10 d(53.33%)、合并神经系统并发症(40.00%)占比均高于有效组的23.33%、10.00%(P<0.05)。经单因素分析后,建立多元回归模型行多因素分析显示,血清TNF-α、IL-6过表达、HBO治疗时机为伤后>10 d、合并神经系统并发症可能是SCI患者经DC后HBO治疗无效的影响因素(OR>1,P<0.05)。结论血清TNF-α、IL-6过表达、HBO治疗时机为伤后>10 d、合并神经系统并发症均可能是SCI患者经DC后HBO治疗无效的影响因素。

Objective To observe the therapeutic effects of hyperbaric oxygen(HBO)after decompressive craniectomy(DC)in patients with severe craniocerebral injury(SCI),and to analyze the possible influencing factors.Methods The treatment and follow-up records of 30 SCI patients with effective HBO treatment after DC treated in the Department of Neurosurgery of the First People’s Hospital of Shangqiu from January 2018 to December 2020 were collected and retrospectively analyzed,and these patients were included into the effective group;the treatment and follow-up records of another 30 SCI patients with ineffective HBO treatment after DC during the same period were also collected and analyzed,and these patients were included into the ineffective group.The demographic data form was designed to collect the baseline data of the patients as well as the possible influencing factors.The univariate and multivariate tests were used to analyze the influencing factors of the therapeutic effects of HBO treatment after DC in SCI patients.Results The levels of serum tumor necrosis factorα(TNF-α)[(39.71±2.92)μg/L]and interleukin-6(IL-6)[(79.72±3.51)μg/L]of patients in the ineffective group were higher than those in the effective group[(36.44±2.46)μg/L and(75.06±3.28)μg/L,respectively];the HBO treatment timing of over ten days after injury took 53.33%in the ineffective group,while that took 23.33%in the effective group;the proportion of comorbid neurological complications in the ineffective group(40.00%)was higher than that in the effective group(10.00%);and all the differences were statistically significant(P<0.05).After univariate analysis,the multivariable regression model was established,and the multivariate analysis showed that the overexpression of serum TNF-αand IL-6,the HBO treatment timing of over ten days after injury,and the comorbid neurological complications all may be the influencing factors of ineffective HBO treatment after DC in SCI patients(OR>1,P<0.05).Conclusion The overexpression of serum TNF-αand IL-6,the HBO treatment timing of over ten days after injury,and the comorbid neurological complications all may be the influencing factors of ineffective HBO treatment after DC in SCI patients.