高压氧治疗时机对颅脑创伤患者疗效及脑血流速度、垂体功能的影响

Effects of HBO intervention at different times on curative effect,cerebral blood flow and pituitary function in patients with traumatic brain injury

目的探究颅脑创伤(TBI)患者不同高压氧(HBO)治疗时机对其疗效及脑血流速度、垂体功能的影响。方法选取2019年10月至2020年10月在太原钢铁(集团)有限公司总医院就诊的88例TBI患者,按照治疗时机分为早期组(n=45)和晚期组(n=43)。2组患者均在常规治疗的基础上进行HBO治疗,早期组在创伤后1个月内、晚期组在创伤后1~2个月内开始HBO治疗。比较2组患者的临床疗效,格拉斯哥昏迷量表(GCS)、日常生活能力量表(ADL)、残疾等级量表(DRS)评分,脑血流速度和格拉斯哥预后量表(GOS)分级;使用化学发光免疫分析测定患者治疗前后血清相关垂体激素水平的变化。结果早期组患者治疗后的临床总有效率(77.8%)高于晚期组(44.2%),差异有统计学意义(P<0.05)。与治疗前相比,治疗后2组患者的GCS、ADL及DRS评分均有明显改善。治疗后,早期组患者的GCS和ADL评分显著高于晚期组,DRS评分显著低于晚期组,差异有统计学意义(P<0.01);早期组患者的GOS分级优于晚期组,差异有统计学意义(P<0.05);2组患者的脑血流速度差异无统计学意义(P>0.05)。治疗前2组患者的促肾上腺皮质激素(ACTH)、生长素(GH)、促甲状腺素(TSH)、催乳素(PRL)、促卵泡生成素(FSH)以及黄体生成素(LH)水平差异无统计学意义(P>0.05)。与治疗前相比,早期组患者治疗后GH水平显著降低晚期组患者治疗后LH水平显著升高,差异均有统计学意义(P<0.05)。治疗后,早期组患者FSH水平显著低于晚期组,差异有统计学意义(P<0.05)。结论TBI患者尽早进行HBO治疗可有效改善脑组织缺氧,有利于神经功能恢复。

Objective To investigate the effects of hyperbaric oxygen(HBO)therapy at different times on the curative effect,cerebral blood flow,and pituitary function of patients with traumatic brain injury(TBI).Methods A total of 88 TBI patients who were treated in the General Hospital of Taiyuan Iron&Steel(Group)Co.,Ltd.from October 2019 to October 2020 were selected and divided into early group(n=45)and late group(n=43)according to the timing of HBO treatment.Both groups were given HBO on the basis of conventional treatment,the early group was given HBO within 1 month after trauma;while the late group was given HBO within 1-2 months after trauma.The clinical efficacy,cerebral blood flow,and the scores of Glasgow Coma Scale(GCS),Activities of Daily Living(ADL),Disability Rating Scale(DRS),and Glasgow Outcome Scale(GOS)were compared between the two groups.The changes of serum-related pituitary hormone levels before and after treatment were determined by using chemiluminescence immunoassay.Results The total clinical effective rate(77.8%)in the early group after treatment was higher than that in the late group(44.2%),and the difference was statistically significant(P<0.05).Compared with those before treatment,the scores of GCS,ADL,and DRS in the two groups were significantly improved after treatment;the scores of GCS and ADL in the early group were significantly higher than those in the late group,and the DRS score was significantly lower than that in the late group,and the differences were statistically significant(P<0.01).After treatment,the GOS grading of patients in the early group was better than that in the late group,and the difference was statistically significant(P<0.05).There was no significant difference in cerebral blood flow between the two groups after treatment(P>0.05).There was no significant difference in the levels of adrenocorticotropic hormone(ACTH),growth hormone(GH),thyroid stimulating hormone(TSH),prolactin(PRL),follicle-stimulating hormone(FSH),and luteinizing hormone(LH)between the two groups before treatment(P>0.05).Compared with those before treatment,the level of GH in the early group was significantly decreased after treatment;the level of LH in the late group was significantly increased after treatment,and the differences were statistically significant(P<0.05).After treatment,the level of FSH in the early group was significantly lower than that in the late group,and the difference was statistically significant(P<0.05).Conclusion Early HBO treatment in patients with TBI can effectively improve brain tissue hypoxia,which is beneficial to the recovery of neurological function.