高压氧联合亚低温治疗对重型颅脑损伤患儿临床疗效及垂体相关激素分泌的影响

Clinical efficacy of hyperbaric oxygen combined with mild hypothermic therapy on children with severe traumatic brain injury and its effects on secretion of pituitary-related hormones

目的:探究高压氧联合亚低温治疗重型颅脑损伤(STBI)患儿的临床疗效及对患儿垂体相关激素分泌的影响。方法:回顾性分析2016年8月至2021年8月运城市中心医院收治的80例STBI患儿的临床资料,根据患儿的治疗方式将其分为治疗组和对照组,各40例。对照组行亚低温治疗,治疗组行高压氧联合亚低温治疗。比较2组患儿入院时及入院治疗3、5、7、10 d后的脑水肿体积、垂体相关激素[生长激素(GH)、催乳素(PRL)、促肾上腺皮质激素(ACTH)、促甲状腺激素(TSH)]水平和格拉斯哥昏迷评分量表(GCS)评分。随访6个月,比较2组患儿的预后情况。结果:2组患儿的脑水肿体积,GH、PRL、ACTH、TSH水平及GCS评分的时点、组间及时点与组间的交互作用差异均有统计学意义(均P<0.05)。入院治疗5、7、10 d时,治疗组患儿脑水肿体积及GH、PRL、ACTH、TSH水平均低于对照组(均P<0.05),GCS评分高于对照组(P<0.05)。随访期内,患儿死亡10例,其中治疗组3例、对照组7例。治疗组患儿的平均生存时间高于对照组,经log-rank检验显示差异有统计学意义(χ^(2)=4.091,P=0.043)。结论:高压氧联合亚低温治疗STBI患儿可有效降低脑水肿体积,改善早期垂体相关激素分泌紊乱情况,改善患儿的预后。

Objective:To study the clinical efficacy of hyperbaric oxygen(HBO)combined with mild hypothermic therapy on children with severe traumatic brain injury(STBI)and its effect on secretion of pituitary-related hormones.Methods:The clinical data of 80 children with STBI admitted to Yuncheng Central Hospital from August 2016 to August 2021 were retrospectively analyzed.According to the different treatment methods,the children were divided into treatment group and control group,with 40 cases in each group.The control group was treated with mild hypothermic therapy,and the treatment group was treated with hyperbaric oxygen combined with mild hypothermic therapy.The cerebral edema volume,levels of pituitary-related hormones[growth hormone(GH),prolactin(PRL),adrenocorticotropic hormone(ACTH),thyroid-stimulating hormone(TSH)]and Glasgow coma scale(GCS)scores were compared between the two groups at admission and 3,5,7,and 10 days after treatment.After 6 months of follow-up,the prognosis of the two groups was compared.Results:There were significant differences in brain edema volume,GH,PRL,ACTH,TSH levels,GCS score at different time points,time points between groups,and interaction between groups(P<0.05).After 5,7,and 10 days of treatment,the cerebral injury edema volume and the levels of GH,PRL,ACTH,and TSH of the children in the treatment group were lower than those in the control group(P<0.05),and the GCS score was higher than that in the control group(P<0.05).During the follow-up period,10 children died,including 3 in the treatment group and 7 in the control group.The average survival time of the children in the treatment group was longer than that in the control group,and the Log-Rank test showed that the differences were statistically significant(χ^(2)=4.091,P=0.043).Conclusion:Hyperbaric oxygen combined with mild hypothermic therapy in the treatment of children with STBI can effectively reduce the cerebral injury edema volume,improve early pituitary-related hormone secretion disorders,thus improving the prognosis of children.