观察早期适当呼吸末正压下高浓度氧治疗对重型颅脑损伤患者的治疗作用，探讨其对该类患者脑氧代谢及预后的影响。

将郑州大学第一附属医院2013年4月至2015年7月期间收治的108例重型颅脑损伤患者按随机数字表法分为两组，对照组（54例）：给予标准治疗，治疗组（54例）：在标准治疗的基础上给予呼吸机支持适当呼吸末正压5~8 cmH₂O联合高浓度氧（100%纯氧），监测两组患者第1、3天的动脉血氧分压（PaO₂）、颈静脉球血氧饱和度（SjvO₂）、血乳酸（Lac）；对于治疗组，监测治疗前和治疗中30 min的颈静脉球压力（Pjv）、中心静脉压力（CVP）、治疗前1 h和治疗后6 h的支气管肺泡灌洗液（BAL）IL-6水平；同时监测两组第1、3天GCS评分ICU住院天数以及第28天GOS评分等。

治疗前两组患者SjvO₂、PjvO₂、SaO₂、PaO₂、Lac无明显差异，治疗后治疗组SjvO₂、PjvO₂、SaO₂、PaO₂显著高于对照组（P<0.05）；Lac明显下降（P<0.05）；而第3天和第1天比较，两组患者SjvO₂、PjvO₂、SaO₂、PaO₂显著提高，（P<0.05），Lac明显下降（P<0.05）；治疗组第1次治疗前与治疗中Pjv、CVP相比较无显著差异（P>0.05）；治疗组患者治疗前1 h和治疗后6 h的（BAL）IL-6水平无差异统计学意义（P>0.05）；模拟高压氧组和对照组治疗后GOS相比，模拟高压氧治疗后GOS评分为1的例数显著性低于对照组，评分为4的例数显著性高于对照组（P<0.05），2和3分差异不显著（P>0.05）。两组治疗后ICU天数无显著性差异。

重度颅脑损伤患者早期利用呼吸机模拟高压氧治疗可以提高患者动脉、颈静脉球部血氧分压，明显改善脑氧代谢，且不增加ICU住院天数，显著改善该类患者的预后，并且不增加患者颅内压、胸腔内压力及氧中毒的发生。

To investigate the prognosis and cerebral oxygen metabolism of severe brain injury patients treated by high-concentration oxygen plus proper positive end expiratory pressure in early stage.

One hundred and erght severe brain injury patients addmited from April 2013 to July 2015 at zhengzhou central hospital affiliated to zhengzhou univercity were grouping as oxygen-peep treatment group(TG, 54) and standard treatment control group(CG, 54) randomly. Oxygen-peep treatment group used high-concentration oxygen(100% pure oxygen)combined with PEEP(5-8 cmH₂O) based on standard treatment. Both groups were monitted several index as the days 1st and 3rd partial pressure of oxygen(PaO₂), jugular venous oxygen saturation (SjvO₂), lactic acid, GCS score, in-ICU days and days 28th GOS score; otherwise TG group also monitted jugular bulb pressure(Pjv), central venous pressure(CVP) 30 minites before and during treatment, bronchoalveolar lavage fluid (BAL)IL-6 level 1 h before and 6 h after treatment.

There are no difference in SjvO₂, PjvO₂, SaO₂, PaO₂, Lac between 2 groups but SjvO₂, PjvO₂, SaO₂, PaO₂ significantly higher while Lac lower than CG after treatment, and days 1st and 3rd (P<0.05). There are no difference in both TG’s Pjv, CVP before 1st and after treament, and bronchoalveolar lavage fluid(BAL)IL-6 level 1 h before and 6 h after treatment (P>0.05); The number of TG in GOS score are more than CG with score 4, less with score 1, no difference with score 2 and 3 (P>0.05). In-ICU days are also no difference between 2 groups.

There are obvious improvement of the prognosis and cerebral metabolism of severe brain injury patients treated by high-concentration oxygen plus proper positive end expiratory pressure in early stage, especially advanced SjvO₂, PjvO₂, SaO₂, PaO₂ and without adding in-ICU days, ICP, Intra thoracic pressure and oxygen poisoning.