高压氧联合亚低温脑保护对重症颅脑外伤患者疗效及预后的影响

Effect of hyperbaric oxygen combined with mild hypothermia cerebral protection in patients with severe craniocerebral trauma and prognosis

目的探讨高压氧联合亚低温脑保护对重症颅脑外伤患者疗效及预后的影响。方法选取2018年8月至2019年8月绍兴文理学院附属新昌医院收治的重症颅脑外伤患者112例,其中采取高压氧+亚低温脑保护治疗56例,为观察组;仅高压氧治疗56例,为对照组。比较两组患者治疗前及治疗30 d后血清神经元特异性烯醇化酶(NSE)、S-100β水平及美国国立卫生研究院卒中量表(NIHSS)评分,以及随访1年后的预后。结果治疗前,两组患者血清NSE、S-100β水平及NIHSS评分比较,差异均无统计学意义(均P>0.05);治疗30 d后均较治疗前明显降低(均P<0.05),且观察组均明显低于对照组(均P<0.05)。随访1年观察组死亡2例、植物生存9例、重度残疾11例、中度残疾13例、恢复良好21例,对照组死亡4例、植物生存12例、重度残疾17例、中度残疾14例、恢复良好9例,观察组患者预后明显优于对照组(P<0.05)。结论高压氧联合亚低温脑保护可改善重症颅脑外伤患者神经元损伤,促进脑功能和神经功能恢复,可在临床上推广应用。

Objective To investigate the effect of hyperbaric oxygen combined with mild hypothermia cerebral protection on the efficacy and prognosis of patients with severe craniocerebral trauma.Methods A total of 112 patients with severe craniocerebral trauma who were admitted to Xinchang Hospital Affiliated to Shaoxing University of Arts and Sciences from August 2018 to August 2019 were selected.They were divided into observation group(hyperbaric oxygen+mild hypothermia cerebral protection treatment)and control group(hyperbaric oxygen therapy),56 cases in each group.The level of serum neuron-specific enolase(NSE),S-100β,and the National Institutes of Health stroke scale(NIHSS)scores before and after 30 days of treatment were compared between the two groups,as well as the prognosis after1-year follow-up.Results Before treatment,there were no significant differences in serum NSE,S-100βlevels and NIHSS scores between the two groups(all P>0.05).After 30 days of treatment,the levels of the serum markers were significantly lower than those in the control group(all P<0.05).Follow-up for 1 year in the observation group,two died,nine survived vegetative state,eleven were severely disabled,thirteen were moderately disabled,and 21 recovered well.In the control group,four died,twelve survived vegetative state,seventeen were severely disabled,and 14 were moderately disabled.Nine cases recovered well,and the prognosis of the observation group was significantly better than that of the control group(P<0.05).Conclusion Hyperbaric oxygen combined with mild hypothermia cerebral protection can improve neuronal damage in patients with severe craniocerebral trauma,promote the recovery of brain function and neurological function,which can be popularized and applied clinically.