不同压力方案高压氧治疗对颅脑外伤患者预后及安全性的影响

The impact of different pressure protocols in hyperbaric oxygen therapy on the prognosis and safety of patients with traumatic brain injury

目的:探讨0.20 MPa、0.25 MPa高压氧(HBO)治疗对颅脑外伤患者预后及氧化应激水平的影响。方法:收集2017年1月至2019年12月首都医科大学附属复兴医院康复中心住院治疗的52例颅脑外伤患者的临床资料。按照随机数字表法分为对照组和治疗组,每组26例。对照组采用0.20 MPa HBO治疗方案,观察组采用0.25 MPa HBO治疗方案。比较2组疗程结束后患者血清氧化应激指标水平。分别于治疗前、治疗后3个月,采用格拉斯哥昏迷量表(GCS)评估患者的意识状态。采用格拉斯哥预后量表(GOS)对患者预后进行评估。结果:与对照组比较,观察组治疗后血清氧化应激指标差异无统计学意义( P>0.05)。与治疗前比较,2组中、重度患者治疗后GCS评分明显提高( P<0.05或 P<0.01),而轻度患者提高不明显( P>0.05);与对照组治疗后比较,观察组重度患者治疗后GCS评分明显提高( P<0.05),而中、轻度患者提高不明显( P>0.05)。观察组预后良好率(80.77%)明显高于对照组(53.85%),GOS评分明显高于对照组( P<0.05)。 结论:0.25 MPa HBO方案治疗重症颅脑外伤患者具有更优的临床效果和预后,且未加剧氧化应激反应,具有较高的安全性;轻、中度颅脑外伤患者可选用0.20 MPa HBO治疗方案。

ObjectiveTo explore the the effects of hyperbaric oxygen(HBO)therapy at 0.20 MPa and 0.25 MPa on the prognosis and oxidative stress levels of patients with traumatic brain injury.MethodsThe clinical data of 52 patients with traumatic brain injury admitted to the Rehabilitation Center of the Fuxing Hospital,Capital Medical University,from January 2017 to December 2019,were collected.According to the random number table method,the patients were divided into control group and observation group,with 26 cases in each group.The control group received HBO therapy at 0.20 MPa,while the observation group received HBO therapy at 0.25 MPa.The serum oxidative stress index levels were compared between the two groups after treatment.Before treatment and three months after treatment,the Glasgow coma scale(GCS)was used to assess the patient’s state of consciousness,and the Glasgow outcome scale(GOS)was used to evaluate the prognosis.ResultsAfter treatment,there was no statistically significant difference in serum oxidative stress index levels between the observation group and the control group(P>0.05).After treatment,the GCS scores of patients with moderate to severe conditions in both groups were all significangtly increased(P<0.05 or P<0.01),while the improvement was not significant in patients with mild conditions(P>0.05).Compared with the control group after treatment,the GCS scores of patients with severe condition in the observation group significantly improved(P<0.05),while there was no significant improvement in patients with mild to moderate conditions(P>0.05).The ratio of patients with good prognosis in the observation group(80.77%)was significantly higher than that in the control group(53.85%),and the GOS scores were also significantly higher in the observation group than those of the control group(P<0.05).ConclusionThe treatment protocol of 0.25 MPa HBO demonstrates better clinical effects and prognosis in treating patients with severe traumatic brain injury,without aggravating the oxidative stress response,thus ensuring higher safety.Patients with mild to moderate traumatic brain injury can choose the treatment protocol of 0.20 MPa HBO.