不同疗程高压氧治疗对急性脑梗死患者神经功能恢复及相关炎症因子的影响

Effect of different courses of hyperbaric oxygen therapy on neurological recovery and related inflammatory factors in patients with acute cerebral infarction

目的 探讨不同疗程高压氧(HBO)治疗对急性脑梗死(ACI)患者神经功能恢复及相关炎症因子的影响。方法 选取2020年5月—2021年12月焦作市人民医院收治的76例ACI患者作为研究对象,采用随机数字表法分为研究组与对照组,每组38例。对照组患者接受常规治疗,研究组患者在对照组基础上给予HBO治疗,2组患者均以10 d为1个疗程,共治疗6个疗程,在治疗前及治疗2个疗程、4个疗程、6个疗程时检测患者神经功能指标[脑特异性蛋白(S100B)、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)]及血清炎症因子[基质金属蛋白酶-9(MMP-9)及C反应蛋白(CRP)]水平。结果 2组患者治疗前血清S100B、NSE、GFAP水平比较,差异均无统计学意义(P>0.05);研究组患者治疗2个疗程、4个疗程及6个疗程时血清S100B、NSE、GFAP水平均低于对照组,差异均有统计学意义(P<0.05);对照组患者治疗前及治疗后不同时间点血清S100B、NSE、GFAP水平比较,差异均无统计学意义(P>0.05);研究组患者治疗前及治疗后不同时间点血清S100B、NSE、GFAP水平比较,差异有统计学意义(P<0.05);研究组患者治疗后不同时间点血清S100B、NSE、GFAP水平均低于治疗前,治疗4个疗程及6个疗程时低于治疗2个疗程时,差异均有统计学意义(P<0.05)。2组患者治疗前血清MMP-9及CRP水平比较,差异均无统计学意义(P>0.05);2组患者组内治疗前及治疗后不同时间点血清MMP-9及CRP水平比较,差异均有统计学意义(P<0.05);研究组患者治疗2个疗程、4个疗程及6个疗程时血清MMP-9和CRP水平均低于对照组,差异均有统计学意义(P<0.05)。2组患者组内及组间不同疗程内不良反应发生率比较,差异均无统计学意义(P>0.05)。结论 随着HBO治疗疗程的延长,ACI患者神经功能恢复更加明显,炎症指标水平明显下降,因此临床采用HBO治疗ACI患者期间可通过检测各项神经功能及炎症指标水平,并结合患者实际情况确定治疗最佳疗程。

Objective This study aimed to investigate the effects of different courses of hyperbaric oxygen(HBO)therapy on neurological recovery and related inflammatory factors in patients with acute cerebral infarction(ACI).Methods Seventysix patients with ACI admitted to Jiaozuo People's Hospital from May 2020 to December 2021 were selected as the study participants.They were randomly assigned to the study group and the control group,with 38 cases in each group.Patients in the control group received routine treatment,while patients in the study group were treated with HBO on the basis of the control group.The patients in both groups were treated with 10 days as a course of treatment,for a total of 6 courses.The neurological function parameters[brain-specific protein(S100B),neuron-specific enolase(NSE),glial fibrillary acidic protein(GFAP)]and serum inflammatory factors[matrix metalloproteinase-9(MMP-9)and C-reactive protein(CRP)]levels were measured before treatment and at 2,4 and 6 courses of treatment.Results There was no significant difference in serum S100B,NSE,and GFAP levels before treatment between the two groups(P>0.05).The serum S100B,NSE,and GFAP levels at 2 courses,4 courses and 6 courses in the study group were significantly lower than those in the control group(P<0.05).The serum S100B,NSE,and GFAP levels before treatment and at different time points after treatment in the control group were not statistically significant(P>0.05).The serum S100B,NSE,and GFAP levels at different time points after treatment in the study group were lower than those before treatment,and at 4 courses and 6 courses of treatment were lower than those at 2 courses of treatment,with statistical significance(P<0.05).There were no significant differences in serum MMP-9 and CRP levels between the two groups(P>0.05).Significant differences were observed in serum MMP-9 and CRP levels between the two groups at different time points before and after treatment(P<0.05).The serum MMP-9 and CRP levels in the study group were significant lower than those in the control group at 2,4,and 6 courses of treatment(P<0.05).There were no significant differences in the incidence of adverse reactions within different courses of treatment between the 2 groups(P>0.05).Conclusion The recovery of neurological function in patients with ACI is more obvious,and the level of inflammatory markers is markedly decreased over the course of HBO treatment.Therefore,the best course of treatment can be determined,combined with the actual condition of patients,by detecting the levels of neurological function and inflammatory markers in patients with ACI treated with hyperbaric oxygen during clinical treatment.