高压氧在重型创伤性脑损伤昏迷患者促醒治疗中的作用
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摘要
目的探讨高压氧(HBO)在重型创伤性脑损伤(sTBI)昏迷患者促醒治疗中的作用。方法选取东莞市人民医院神经外科2016年2月至2018年2月收治的80例sTBI昏迷患者为研究对象,根据随机数表法分为观察组和对照组各40例,对照组患者采用脑外伤常规治疗,观察组患者在对照组治疗的基础上加用高压氧治疗3个月,采用格拉斯哥昏迷量表(GCS)评分评价两组患者1～3个月的促醒效果,采用格拉斯哥预后量表(GOS)比较两组患者治疗3个月后疗效的差异。结果治疗3个月后,观察组与对照组患者的GOS评分分别为(4.52±1.73)分和(3.65±1.15)分,较治疗前的(2.51±0.62)分和(2.62±0.51)分明显增高,且观察组治疗3个月后的GOS评分明显高于对照组,差异均有统计学意义(P<0.05);观察组患者在治疗1个月、2个月、3个月时的清醒率分别为47.5%、65.0%、87.5%,均高于对照组的25.0%、42.5%、65.0%,差异均具有统计学意义(P<0.05);观察组患者的治疗总有效率为90.0%,明显高于对照组的67.5%,差异具有统计学意义(P<0.05)。结论高压氧对重型创伤性脑损伤昏迷患者具有促醒作用,可提高重型创伤性脑损伤的治疗效果。
Objective To explore the role of hyperbaric oxygen(HBO) in promoting arousal therapy in coma patients with severe traumatic brain injury(sTBI). Methods A total of 80 coma patients with sTBI in Department of Neurosurgery, Dongguan People's Hospital from February 2016 to February 2018 were selected and divided into observation group and control group according to the random number table. The control group(40 cases) was treated with conventional treatment of brain trauma, and the observation group(40 cases) was treated with hyperbaric oxygen for 3 months on the basis of the control group. Glasgow Coma Scale(GCS) was used to evaluate the 1-3 month wake-up effect of the two groups, and Glasgow Prognostic Scale(GOS) was used to compare the difference of curative effect between the two groups after 3 months of treatment. Results After 3 months of treatment, the GOS scores of the patients in the observation group and the control group were 4.52 ± 1.73 and 3.65 ± 1.15, respectively, which were significantly higher than 2.51±0.62 and 2.62±0.51 before treatment. The GOS scores in the observation group were significantly higher than those in the control group after 3 months of intervention(P<0.05), and the difference was statistically significant(P<0.05). The waking rate of the observation group in 1 month, 2 months, and 3 months were 47.5%, 65.0%, and 87.5%respectively, which were significantly higher than 25.0%, 42.5%, 65.0% in the control group(P<0.05). The effective rate of the observation group was 90.0%, significantly higher than 67.5% in the control group(P<0.05). Conclusion Hyperbaric oxygen can promote wakefulness in patients with severe traumatic brain injury and improve the therapeutic effect of severe traumatic brain injury.
Objective To explore the role of hyperbaric oxygen(HBO) in promoting arousal therapy in coma patients with severe traumatic brain injury(sTBI). Methods A total of 80 coma patients with sTBI in Department of Neurosurgery, Dongguan People's Hospital from February 2016 to February 2018 were selected and divided into observation group and control group according to the random number table. The control group(40 cases) was treated with conventional treatment of brain trauma, and the observation group(40 cases) was treated with hyperbaric oxygen for 3 months on the basis of the control group. Glasgow Coma Scale(GCS) was used to evaluate the 1-3 month wake-up effect of the two groups, and Glasgow Prognostic Scale(GOS) was used to compare the difference of curative effect between the two groups after 3 months of treatment. Results After 3 months of treatment, the GOS scores of the patients in the observation group and the control group were 4.52 ± 1.73 and 3.65 ± 1.15, respectively, which were significantly higher than 2.51±0.62 and 2.62±0.51 before treatment. The GOS scores in the observation group were significantly higher than those in the control group after 3 months of intervention(P<0.05), and the difference was statistically significant(P<0.05). The waking rate of the observation group in 1 month, 2 months, and 3 months were 47.5%, 65.0%, and 87.5%respectively, which were significantly higher than 25.0%, 42.5%, 65.0% in the control group(P<0.05). The effective rate of the observation group was 90.0%, significantly higher than 67.5% in the control group(P<0.05). Conclusion Hyperbaric oxygen can promote wakefulness in patients with severe traumatic brain injury and improve the therapeutic effect of severe traumatic brain injury.
引文
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[10]刘瑞太,潘福茂,王建国,等.大骨瓣开颅减压术在对冲性颅脑损伤治疗中的应用观察[J].中国医药导刊, 2014, 16(9):1210-1211.
[11]沈泉,方以群,吴建国,等.高压氧联合经颅磁刺激治疗颅脑损伤致昏迷患者的疗效观察[J].中华航海医学与高气压医学杂志, 2016,23(1):9-12.
[12]吴建波,杨刚.高压氧联合尼莫地平及依达拉奉治疗重型颅脑损伤患者的安全性及有效性研究[J].重庆医学, 2017, 46(3):329-330,334.
[13]郭成军,申天喜,胡刚,等.醒脑静注射液联合高压氧治疗老年颅脑损伤致昏迷患者的疗效及对血清炎症因子的影响[J].中国老年学杂志, 2018, 38(8):1887-1889.
[2]梁维萍.高压氧对重型颅脑损伤昏迷患者促醒效果观察[J].中国医药导报, 2013, 10(30):85-87, 90.
[3]沈洪,蒋健.中国心肺复苏关注的问题—回顾国际《心肺复苏及心血管急救指南2005》的修订[J].中国危重病急救医学, 2006, 18(4):193-194.
[4] MCMILLAN T, WILSON L, PONSFORD J, et al. The Glasgow Out-come Scale-40 years of application and refinement[J]. Nat Rev Neu-rol, 2016, 12(8):477-485.
[5] International Liaison Committee on Resudcitaton, ILOR(2005). In-ternational consensus on CPR&ECC science with treatment recom-mendations[J]. Circulation, 2005, 112(22):29.
[6]姬云翔,王冰,李桂花,等.高压氧治疗对重型颅脑损伤患者血清NT-proBNP的影响及与预后相关性的研究[J].中国急救医学,2015, 35(10):900-903.
[7]黄亿平,陈文延,吴植念.神经节苷脂联合高压氧治疗对颅脑损伤患者预后的影响[J].中国药业, 2017, 26(10):75-77.
[8]杨博,滕进忠,黄春玲.高压氧配合针刺治疗重型颅脑损伤昏迷患者的疗效观察[J].现代诊断与治疗, 2011, 22(1):23-24.
[9]尹秀玲,帅浪,冯珍.高压氧治疗对重度昏迷患者早期促醒的疗效[J].实用临床医学, 2012, 13(11):18-19.
[10]刘瑞太,潘福茂,王建国,等.大骨瓣开颅减压术在对冲性颅脑损伤治疗中的应用观察[J].中国医药导刊, 2014, 16(9):1210-1211.
[11]沈泉,方以群,吴建国,等.高压氧联合经颅磁刺激治疗颅脑损伤致昏迷患者的疗效观察[J].中华航海医学与高气压医学杂志, 2016,23(1):9-12.
[12]吴建波,杨刚.高压氧联合尼莫地平及依达拉奉治疗重型颅脑损伤患者的安全性及有效性研究[J].重庆医学, 2017, 46(3):329-330,334.
[13]郭成军,申天喜,胡刚,等.醒脑静注射液联合高压氧治疗老年颅脑损伤致昏迷患者的疗效及对血清炎症因子的影响[J].中国老年学杂志, 2018, 38(8):1887-1889.