亚低温联合高压氧对重型颅脑损伤术后患者应激反应的改善作用及对血清半胱氨酸蛋白酶3、髓鞘碱性蛋白水平的影响

Ameliorative Effect of Subhypothermia Combined with Hyperbaric Oxygen on Stress Response and the Effect on Se⁃rum Cysteine Proteinase 3 and Myelin Basic Protein Level in Patients after Heavy Craniocerebral Injury Surgery

目的:观察亚低温联合高压氧对重型颅脑损伤患者术后应激反应的改善作用及对于血清中半胱氨酸蛋白酶3(Caspase-3)、髓鞘碱性蛋白(MBP)的影响,为重型颅脑损伤患者术后恢复提供临床治疗方案。方法:选取2018年6月—2019年6月民权县人民医院收治的94例重型颅脑损伤术后患者作为研究对象,随机数表法分为A、B组,每组各47例,A组给予亚低温治疗,B组给予亚低温联合高压氧治疗。比较治疗前后A、B两组患者的颅内压值(ICP)及日常生活能力;比较A、B两组患者的治疗效果;比较A、B两组患者治疗前后血清皮质醇(CORT)、肾上腺素(E)、Caspase-3和MBP水平。结果:治疗后,两组患者ICP水平降低,Barthel指数升高,差异有统计学意义(t=2.380、2.815,P<0.01);B组总有效率高于A组,差异有统计学意义(χ2=4.398,P<0.05)。治疗后两组患者CORT、E、Caspase-3、MBP水平均降低,B组低于A组,差异有统计学意义(t=2.349、4.239、7.855、6.353,P<0.05)。结论:重型颅脑损伤患者术后应用亚低温联合高压氧治疗可减轻应激反应,降低血清Caspase-3、MBP水平,改善恢复效果。

Objective:To observe the effect of subhypothermia combined with hyperbaric oxygen on the improvement of post⁃operative stress response and the effect on cysteine proteinase 3(Caspase-3)and myelin basic protein(MBP)in serum of patients with severe craniocerebral injury.Methods:94 postoperative patients with heavy craniocerebral injury admitted to the hospital from June 2018 to June 2019 were selected for the study,and were divided into group A and group B by the random number table method,with 47 cases in each group.Group A was given subhypothermia and group B was given subhypothermia combined with hy⁃perbaric oxygen therapy.The intracranial pressure values(ICP)and daily living ability of patients in both groups were compared be⁃fore and after treatment,and the treatment effects of patients in both groups were compared,as well as the serum cortisol(CORT),epinephrine(E),Caspase-3 and MBP levels before and after treatment in both groups.Results:After treatment,ICP levels de⁃creased and Barthel index increased in both groups,with statistically significant differences(t=2.380,2.815,P<0.01).The total ef⁃fective rate in group B was higher than that in group A,and the difference was statistically significant(χ2=4.398,P<0.05).CORT,E,Caspase-3,and MBP levels were reduced in both groups after treatment and were lower in group B than in group A,and the dif⁃ferences were statistically significant(t=2.349,4.239,7.855,6.353,P<0.05).Conclusion:Postoperative application of subhypo⁃thermia combined with hyperbaric oxygen therapy in patients with severe craniocerebral injury can reduce stress response,lower se⁃rum Caspase-3 and MBP levels,and improve recovery outcomes.