Analysis of curative effect of early simulation of hyperbaric oxygen treatment of severe head injury by ventilator

doi:10.3877/cma.j.issn.2095-9141.2016.04.005

Abstract

Abstract:

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Key words: Simulation of hyperbaric oxygen therapy, High concentration of oxygen, Positive end expiratory pressure, craniocerebral injury

Lanjuan Xu, Baolin Li, Caifu Yang. Analysis of curative effect of early simulation of hyperbaric oxygen treatment of severe head injury by ventilator[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2016, 02(04): 210-214.

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References 16

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组别	例数	性别		年龄	入科前GCS	气管切开术
组别	例数	男	女	年龄	入科前GCS	气管切开术
高压氧组	54	39	15	54.39±15.15	5.11±0.94	20
对照组	54	36	18	56.78±11.08	5.17±1.07	12
χ²/t	?	0.552		-0.803	-0.251	0.129
P	?	0.583		0.424	0.803	0.719

组别	例数	性别		年龄	入科前GCS	气管切开术
组别	例数	男	女	年龄	入科前GCS	气管切开术
高压氧组	54	39	15	54.39±15.15	5.11±0.94	20
对照组	54	36	18	56.78±11.08	5.17±1.07	12
χ²/t	?	0.552		-0.803	-0.251	0.129
P	?	0.583		0.424	0.803	0.719

指标	组别	第一天的第一次	第三天的最后一次	P值
指标	组别	治疗前	治疗后	P值
SjvO₂	治疗组	55.21±5.83	65.39±5.80	0.00
?	对照组	47.05±3.61	61.86±4.29^a	0.00
paO₂	治疗组	106.57±27.83	382.46±129.9	0.00
?	对照组	62.58±6.44	210.49±46.70^a	0.00
SaO₂	治疗组	97.62±1.80	99.23±0.68	0.00
?	对照组	93.15±0.82	94.59±1.39^a	0.00
PjO₂	治疗组	37.16±4.72	42.09±4.99	0.00
?	对照组	34.04±3.27	38.55±2.62^a	0.00
Lac	治疗组	1.86±1.09	0.91±0.45	0.00
?	对照组	2.32±1.25	1.61±0.57^a	0.01
Glu	治疗组	11.27±2.83	8.43±1.39	0.00
?	对照组	15.20±3.86	9.67±2.22^a	0.00

指标	组别	第一天的第一次	第三天的最后一次	P值
指标	组别	治疗前	治疗后	P值
SjvO₂	治疗组	55.21±5.83	65.39±5.80	0.00
?	对照组	47.05±3.61	61.86±4.29^a	0.00
paO₂	治疗组	106.57±27.83	382.46±129.9	0.00
?	对照组	62.58±6.44	210.49±46.70^a	0.00
SaO₂	治疗组	97.62±1.80	99.23±0.68	0.00
?	对照组	93.15±0.82	94.59±1.39^a	0.00
PjO₂	治疗组	37.16±4.72	42.09±4.99	0.00
?	对照组	34.04±3.27	38.55±2.62^a	0.00
Lac	治疗组	1.86±1.09	0.91±0.45	0.00
?	对照组	2.32±1.25	1.61±0.57^a	0.01
Glu	治疗组	11.27±2.83	8.43±1.39	0.00
?	对照组	15.20±3.86	9.67±2.22^a	0.00

组别	例数	GOS					ICU(d)
组别	例数	1	2	3	4	5	ICU(d)
模拟高压氧组	54	2(3.7%)	14(25.9%)	23(42.6%)	15(27.8%)	0	4.52±0.52
对照组	54	11(20.37%)	21(38.9%)	18(33.3%)	4(7.4%)	0	4.51±0.47
χ²/t	?	5.939	1.677	0.779	5.104	1.677	0.064
P值	?	0.015	0.196	0.377	0.024	0.196	0.949

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