高压氧对颅脑损伤患者血清中相关指标变化规律的影响(英文)

Changes of serum indexes in head injury patients treated with hyperbaric oxygenation

背景:高压氧治疗(hyperbaricoxygenationtreatment,HBOT)颅脑损伤的效果显著,但治疗方案和疗程由医生经验而定,长短不一。目前,尚无灵敏的检测指标用于判断HBOT的疗效和预后,以及指导HBOT方案的调整。目的:研究重型闭合性颅脑损伤HBOT前中后血清脂质过氧化物代谢产物丙二醛(malonicdialdehyde,MDA)、血清超氧化物歧化酶-1(supeoxidedismutase1,SOD-1)和血浆内皮素(plasmaendothelin,ET)浓度的变化,分析其变化与HBOT疗程和疗效的关系。设计:将1997-01/1999-03期间重型闭合性颅脑损伤住南方医院治疗的患者和门诊健康体检者分为正常组、HBOT组和对照组进行研究。地点和对象:对象为颅脑损伤住南方医院治疗的患者和门诊健康体检者。方法:50名颅脑损伤患者,32例为HBOT组,行HBOT和外科常规治疗和康复治疗;18例为对照组,行外科常规治疗和康复治疗;30名健康志愿者作为正常组。于治疗前中后用硫代巴比妥酸比色法检测MDA、用放射免疫法检测ET和SOD-1。主要观察指标:血清丙二醛(MDA)、血清超氧化物歧化酶-1(SOD-1)和血浆内皮素(ET)。结果:治疗前:HBOT组和对照组MDA、ET和SOD-1值差异无显著性意义(t=1.903,1.906和1.926,P>0.05);两组三项指标MDA为(5.27±1.59)μmol/L,ET为(66.80±9.01)ng/L、SOD-1为(261.30±102.

BACKGROUND:Hyperbaric oxygenation treatment(HBOT) appears to be a very effecti ve method for treating head injury.However,the Rxs and length of treatment cours es are different from case to case according to doctors' experience.By now,there is no sensitive detecting index for evaluating the therapeutic effects and prog nosis of HBOT as well as instructing the adjustment of treatment plans. OBJECTIVE:To study the consistence changes of serum malonic dialdehyde(MDA) wh ich is the peroxide metabolic product of lipid, serum super oxide dismutase 1(SO D-1) and plasma endothelin(ET) in severely closed head injury cases before and after HBOT, and analyze the relationship between the changes and treating course and effects. DESIGN:The total cases including severely closed head injury patients and peop le coming for physical examination in South Hospital from January 1997 to March 1999 were divided into normal group,HBOT group and control group. SETTING and PARTICIPANTS:All the research subjects were head injury inpatients or people going to South Hospital for physical check-up. METHODS:There were 50 head injury patients.The 32 cases in HBOT group would ta ke HBOT and surgical routine treatments as well as rehabilitation.The other 18 c ases of control group only took surgical routine treatments and rehabilitation.T hirty healthy volunteers were selected to form a normal group. MDA would be assa yed by colorimetric method of thiobarbituric acid.ET and SOD-1 would be assayed by radioimmunoassay. MAIN OUTCOME MEASURES:Serum MDA,SOD-1,and plasma ET. RESULTS:Before treatment: There was no significant difference on the values of MDA,ET and SOD-1 between HBOT group and control group(t=1.903,1.906,1.926,P >0 .05).The values of MDA,ET and SOD-1 of two groups were(5.27±1.59) μmol/L,(66. 80±9.01) ng/L and(261.30±102.92) μg/L respectively. However, there was signif icant difference in the three indexes as compared with those of normal group(t=3 .016,3.085,3.112,P< 0.01). There was positive correlation between MDA and ET(γ= 0.875 3,P< 0.01) and negative correlation between MDA and SOD-1 as well as ET a nd SOD-1(γ=-0.401 8,-0.389 6,P< 0.01).After treatment:There was significant difference on the values of MDA, ET and SOD-1 between HBOT group and control gr oup(t=2.635,2.531,2.566,P< 0.05).There was significant difference in effective r ates between two groups(χ2=6.630 1,P< 0.01).It also indicated that there would be poor thera-peutic effects and prognosis in the cases, which had increased v alues of MDA a nd ET,along with obviously decreased value of SOD-1.They should take phased HBO T. CONCLUSION:The values of MDA,ET and SOD-1 are related to the severe level of injury,they can be used to evaluate the therapeutic effects and prognosis of HBO T,and also serve as basis for adjusting the HBOT plan.