磁共振扩散张量成像技术评估高压氧治疗创伤性脑损伤后患者认知障碍的临床价值

Clinical value of magnetic resonance diffusion tensor imaging in evaluating the hyperbaric oxygen therapy in the treatment of cognitive dysfunction in patients with traumatic brain injury

目的探讨磁共振扩散张量成像技术评估高压氧综合治疗创伤性脑损伤后患者认知障碍的临床价值。方法收集2020年10月至2021年10月湖州市第一人民医院收治的创伤性脑损伤后发生认知障碍患者106例作为研究对象。按照随机数字表法分为对照组和高压氧组, 每组53例。对照组患者予以常规药物治疗及康复训练, 高压氧组患者在对照组治疗的基础上予以高压氧治疗。分别于治疗前后采用简易精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCa)评估患者的认知功能。采用连线测试(TMT)评估患者治疗前后的执行功能。治疗前后对患者进行数字广度测试、数字符号替换测试(DSST)和警戒性注意能力指数(E)测试。采用磁共振扩散张量成像技术分别于治疗前后进行T1WI、DTI扫描, 获取脑白质损伤区域左侧扣带回、丘脑、额下回、海马旁、楔前叶区域各向异性分数(FA)值;采用Pearson分析FA值与高压氧综合治疗创伤性脑损伤后认知障碍指标的相关性。结果治疗后2组患者的MMSE、MoCA评分、数字广度测验评分、DSST评分、E及脑白质损伤各区域FA值均较治疗前明显提高, 且高压氧组明显高于对照组(P<0.05或P<0.01);治疗后2组患者的TMT-A、TMT-B评分较治疗前明显降低, 且高压氧组明显低于对照组(P<0.01)。FA值与高压氧治疗创伤性脑损伤后认知障碍各项指标存在相关性(P<0.05)。结论高压氧综合治疗可有效改善创伤性脑外伤患者认知功能, 提高患者注意力;磁共振扩散张量成像技术对评估高压氧治疗创伤性脑损伤后患者认知障碍具有重要参考价值。

Objective To study the clinical value of magnetic resonance diffusion tensor imaging(DTI)in the evaluation of hyperbaric oxygen therapy for cognitive dysfunction in patients with traumatic brain injury.Methods A total of 106 patients with cognitive dysfunction after traumatic brain injury admitted to the First People’s Hospital of Huzhou from October 2020 to October 2021 were selected as the research subjects and divided into control group and hyperbaric oxygen group according to the random number table method,with 53 cases in each group.The control group was given conventional drug therapy and rehabilitation training,while the hyperbaric oxygen group was given hyperbaric oxygen therapy on the basis of the treatment of the control group.The mini-mental state examination(MMSE)and the Montreal cognitive assessment scale(MoCa)were used to assess cognitive function before and after treatment.The Trail Making Test(TMT)was used to assess the executive function of patients before and after treatment.Before and after treatment,the patients are tested using the Digit Span Test,the Digit Symbol Substitution Test(DSST),and the Exogenous Attentional Orienting Index(E)test.T1WI and DTI scans were performed before and after treatment,respectively,by magnetic resonance diffusion tensor imaging to obtain the anisotropy fraction(FA)values of the left cingulate gyrus,thalamus,inferior frontal gyrus,parahippocampal region,and precuneus regions of the white matter injury areas.Pearson’s correlation coefficient was used to analyze the correlation between FA values and indicators of cognitive dysfunction treated by hyperbaric oxygen therapy for patients with traumatic brain injury.Results After treatment,the scores of MMSE,MoCA,forward and backward digit span tests,DSST,E,and the FA values of regions in all the white matter injury areas of the two groups were increased,and those scores and values in the hyperbaric oxygen group were significantly higher than those in the control group(P<0.05 or P<0.01).Besides,the scores of TMT-A and TMT-B in the two groups were siginificantly decreased compared with those before treatment,and those in the hyperbaric oxygen group were significantly lower than those in the control group(P<0.01).There were correlations between FA values and various indicators of cognitive dysfunction treated by hyperbaric oxygen therapy for patients with traumatic brain injury(P<0.05).Conclusion Hyperbaric oxygen therapy can effectively improve cognitive function and attention of patients with traumatic brain injury,and magnetic resonance diffusion tensor imaging has important reference value in evaluating hyperbaric oxygen therapy for cognitive dysfunction in patients with traumatic brain injury,which is worthy of clinical application.