不同时间窗高压氧治疗急性脑梗死的疗效

Efficacy of different hyperbaric oxygen therapy time windows in the treatment of patients with acute cerebral infarction

目的观察不同时间窗高压氧对急性脑梗死(ACI)患者神经损伤恢复、脑能量代谢及氧化应激损伤的影响。方法选取解放军联勤保障部队第九〇四医院常州医疗区2017-01—2020-12收治的120例首次发病的ACI患者为研究对象,通过随机数表法将患者分为3组各40例。参照脑梗死治疗指南,对照组接受常规治疗,A组发病48 h内在对照组基础上行高压氧治疗,B组在发病48 h~7 d内在对照组基础上接受高压氧治疗,共治疗2个疗程。治疗期间,采用美国国立卫生研究院卒中量表(NIHSS)评估ACI患者神经功能变化情况,对各组患者治疗前后神经功能指标[脑特异性蛋白(S100-β)、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)]、能量代谢指标[血糖(Glu)、血氧饱和度(SaO2)、乳酸(Lac)]、氧化应激指标[谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)、超氧化物歧化酶(SOD)、过氧化氢酶(CAT)]、血清细胞因子[巨噬细胞集落刺激因子(M-CFS)、氧化修饰低密度脂蛋白(ox-LDL)、可溶性细胞间黏附分子-1(s ICAM-1)]变化情况进行分析比较。结果治疗2个疗程后A组NIHSS评分[(4.38±2.66)分]明显低于B组和对照组(P<0.05);治疗2个疗程后A组血清S100-β水平[(0.32±0.10)μg/L]明显低于B组和对照组(P<0.05);治疗2个疗程后A组血清NSE[(7.64±1.53)ng/mL]明显低于B组和对照组(P<0.05);治疗2个疗程后A组血清GFAP水平[(0.32±0.10)pg/mL]明显低于B组和对照组(P<0.05);治疗2个疗程后A组血清Glu水平[(3.74±2.83)mmol/L]明显低于B组和对照组(P<0.05);治疗2个疗程后A组血清Sa O2水平[(99.06±14.63)%]明显高于B组和对照组(P<0.05);治疗2个疗程后A组血清Lac水平[(3.68±2.41)mmol/L]明显低于B组和对照组(P<0.05);治疗2个疗程后A组血清GSH-Px[(149.26±13.08)mg/mL]明显高于B组和对照组(P<0.05);治疗2个疗程后A组血清MDA水平[(5.89±2.17)mmol/L]明显低于B组和对照组(P<0.05);治疗2个疗程后A组血清SOD水平[(66.53±5.27)U/L]明显高于B组和对照组(P<0.05);治疗2个疗程后A组血清CAT水平[(8.04±0.67)U/mL]明显高于B组和对照组(P<0.05);治疗2个疗程后A组血清M-CSF水平[(625.27±188.42)μg/L]明显低于B组和对照组(P<0.05);治疗2个疗程后A组血清ox-LDL水平[(242.87±70.48)μg/L]明显低于B组和对照组(P<0.05);治疗2个疗程后A组血清sICAM-1水平[(536.58±141.54)μg/L]明显低于B组和对照组(P<0.05)。结论高压氧治疗ACI效果优于常规治疗,可有效促进ACI患者神经功能恢复,改善脑能量代谢,减轻氧化应激损伤,调节血清细胞因子表达水平,高压氧治疗时间越早疗效越显著。

Objective To observe the effects of different time windows of hyperbaric oxygen therapy on nerve injury repair,brain energy metabolism and oxidative stress injury in patients with acute cerebral infarction(ACI).Methods Totally 120 patients with first onset ACI treated in our hospital from January 2017 to Decem ber 2020 were selected as the research object.The patients were divided into three groups with 40 cases in each group by random number table method.According to the treatment guidelines for cerebral infarction,all patients re ceived routine treatment.Group A received hyperbaric oxygen treatment within 48 hours of onset,and group B re ceived hyperbaric oxygen treatment within 48 hours-7 days of onset,with a total of 2 courses of treatment.During the treatment,NIHSS score was used to evaluate the neurological function of patients with ACI.Neurological func tion indexes of each group before and after treatment(S100-β,neuron-specific enolase(NSE),glial fibrillary acidic protein(GFAP)),indexes of energy metabolism(blood glucose(Glu),oxygen saturation(SaO2),lactic acid(Lac)),indexes of oxidative stress(glutathione peroxidase(GSH PX),malondialdehyde(MDA),superoxide dis mutase(SOD),catalase(CAT)),and serum cytokines(macrophage-stimulating factorm-CFS(M-CSF),oxidized low-density lipoproteins(ox-LDL),soluble intercellular adhesion molecule-1(sICAM-1)),the change situation is analyzed and compared.Results After 2 courses of treatment,the NIHSS score of group A(4.38±2.66)points was significantly lower than that of group B and control group(P<0.05).The level of serum S100-βin group A((0.32±0.10)μg/L)after 2 courses of treatment lower than group B and control group(P<0.05);serum NSE((7.64±1.53)μg/L)in group A after 2 courses of treatment was significantly lower than that in group B and control group(P<0.05).After 2 courses of treatment,the level of serum GFAP in group A((0.32±0.10)ng/L)was signif icantly lower than that in group B and control group(P<0.05).After 2 courses of treatment,the level of serum Glu in group A((3.74±2.83)mmol/L)was significantly lower than that in group B and control group(P<0.05).The serum SaO2 level in group A after 2 courses of treatment((99.06±14.63)%)was significantly higher than that in group B and control group(P<0.05),the serum Lac level in group A after 2 courses of treatment((3.68±2.41)mmol/L)was significantly lower than that in group B and control group(P<0.05).After 2 courses of treat ment,serum GSH-Px((149.26±13.08)g/L)in group A was significantly higher than that in group B and control group(P<0.05),serum MDA level in group A after 2 courses of treatment((5.89±2.17)mmol/L)was significant ly lower than that in group B and control group(P<0.05),serum SOD level in group A after 2 courses of treat ment((66.53±5.27)U/L)was significantly higher than group B and control group(P<0.05).After 2 courses of treatment,serum CAT level in group A((8.04±0.67)U/mL)was significantly higher than group B and control group(P<0.05),the level of serum M-CSF in group A((625.27±188.42)μg/L)was significantly lower than that in group B and control group(P<0.05),the level of serum ox-LDL in group A((242.87±70.48)μg/L)was sig nificantly lower than group B and control group(P<0.05),serum sICAM-1 level in group A((536.58±141.54)μg/L)was significantly lower than group B and control group(P<0.05).Conclusion Hyperbaric oxygen treatment of ACI is better than conventional treatment,can effectively promote the recovery of neurological function in ACI pa tients,improve brain energy metabolism,reduce oxidative stress injury,regulate the expression level of serum cyto kines,hyperbaric oxygen treatment time earlier,the more significant the effect.