目的
探讨早期高压氧治疗对重型颅脑损伤患者术后神经功能的影响。
方法
选取解放军第105 医院和连云港市第一人民医院神经外科自2011 年3 月至2014 年4 月收治的78例术后恢复期的重型颅脑损伤患者,根据随机数字表法分为早期组38例和对照组40例,早期组在术后3 d内开始行高压氧治疗;对照组在手术7 d后开始高压氧治疗。术后动态复查颅脑CT,比较两组患者脑水肿持续时间;分别对两组患者术后1、2、3、4 周意识状态进行格拉斯哥昏迷评分(GCS),术后1、2、3个月进行美国国立卫生院神经功能缺损评分(NIHSS)。
结果
早期组脑水肿持续时间为(10.39±4.05) d,较对照组的(12.65±4.42) d 明显减少,差异有统计学意义(t=23.45,P<0.05)。对照组术后l、2、3、4 周GCS 评分为(7.68±1.49)分、(9.38±1.51)分、(10.28±1.55)分、(11.13±1.68)分;早期组术后l、2、3、4周GCS评分为(8.63±1.28)分、(10.08±1.26)分、(11.03±1.31)分、(12.13±1.32)分,与对照组比较,早期组术后GCS评分明显升高,差异有统计学意义(F=11.23,P<0.05)。对照组术后1、2、3月NIHSS评分为(13.55±2.54)分、(9.05±2.46)分、(6.43±2.19)分;早期组术后1、2、3月NIHSS评分分别为(12.05±2.09)分、(7.90±2.14)分、(5.24±1.98)分,与对照组比较,早期组神经功能缺失明显减少,差异有统计学意义(F=25.32,P<0.05)。
结论
重型颅脑损伤患者术后行早期高压氧治疗可显著缩短脑水肿持续时间,改善术后意识状态,减轻神经功能缺损。
Objective
To investigate the effects of early hyperbaric oxygen treatment on patients with severe craniocerebral injury on the postoperative neurological function.
Methods
A total of seventy eight patients with severe traumatic brain injury in recovery period after surgical operation were selected for this study.According to the intervention time of hyperbaric oxygenation,they were randomly divided into early group(HBOT within 3 days after operation,n=38)and control group(HBOT without 7 days after operation,n=40).Dynamic head CT scan was performed for detecting and determine the duration of brain edema. Patients’ consciousness were assessed in 1, 2, 3, 4 weeks after the operation by GCS (Glasgow Coma Scale) and the neurological function were performed l, 2, 3 months after the operation by NIHSS (National Institutes of Health Stroke Scale).
Results
Compared with the control group (12.65±4.42) d, the duration of brain edema in early group (10.39 ±4.05) d was significantly reduced(P<0.05). The GCS scores were (7.68±1.49), (9.38±1.51), (10.28±1.55), (11.13±1.68) after operation 1, 2, 3, 4 weeks in control group, respectively; and the early group were (8.63±1.28), (10.08±1.26), (11.03±1.31), (12.13±1.32), respectively. Compared with the control group, the GCS score in early group was significantly increased (P<0.05). The NIHSS scores were(13.55±2.54), (9.05±2.46), (6.43±2.19) after operation 1, 2, 3 months in control group, respectively;and the early group were (12.05±2.09), (7.90±2.14), (5.24±1.98). Compared with the control group,the neurological defections were significantly reduced in early group (P<0.05).
Conclusion
Early hyperbaric oxygen treatment on severe traumatic brain injury patients after surgery can shorten the duration of brain edema significantly, improve the state of consciousness and reduce the neurological function impairment.