重度脑挫裂伤患者术后早期高压氧治疗疗效观察

Early treatment of severe cerebral contusion patients with hyperbaric oxygen after craniotomy

目的 探讨重症脑外伤患者早期高压氧 (hyperbaric oxygen,HBO)治疗的临床效果。方法 重度脑挫裂伤患者 5 6例 ,入院时患者的格拉氏哥评分 (Glasgow coma scale,GCS)为 3～ 8,均于入院1h内行去骨瓣减压术或同时行血肿清除术 ;2 0例在伤后 5～ 2 0 h内行早期 HBO治疗 ,36例在脑水肿消退后 (7～ 18d)行常规 HBO治疗。两组均治疗 2个疗程。观察 3周后重新 GCS评分 ,6个月后进行格拉氏哥结果评级 (Glasgow Outcome Scale,GOS)。结果 两组患者治疗后 3周 GCS评分和 6个月后 GOS评分和生存质量出现明显差异。早期 HBO治疗组明显优于常现 HBO治疗组。结论 在颅脑损伤患者中 ,重度脑挫裂伤并脑内血肿是神经外科最难处理的病症 ,因为它常伴有恶性的颅内压增高、脑缺氧 ,患者的预后也较差 ;早期的高压氧治疗可以及时提高血氧含量 ,阻止恶性缺血缺氧的发生。重症脑挫裂伤患者术后在可能的条件下应尽早行 HBO治疗 ,以提高患者的生存质量。

Objective To study the effectiveness of hyperbaric oxygen(HBO) treatment on severe brain contusion patients after traumatic head injury. Methods For 56 cases of severe brain contusion patients with GCS of 3～8, all bone flaps were removed or hematoma evacuation done at the same time within one hour at admission. HBO treatment was given within 5～20 hours to 20 cases, while the other 36 cases were given HBO treatment after subsidence of brain edema (7~18 days).Results Obviously differences were seen between the two groups in GCS after 3 weeks and GOS after 6 months.Conclusions Traumatic brain contusion and hematoma is the most difficult disease to manage in neurosurgical department, because it is often companied by malicious hypoxia and increased ICP, with poor prognosis; earlier HBO treatment can enhance the oxygen saturation in blood to block the malicious cycle of brain hypoxia, and to increase the clinical cure rate.