摘要
目的观察早期应用高压氧（HBO）及亚低温联合治疗重型颅脑创伤（TBI）患者的临床疗效。方法采用随机数字表法将45例重型TBI患者分为联合治疗组、亚低温组及对照组。3组患者均给予脱水降颅内压（ICP）、止血、营养脑神经、抗炎、抑酸等对症支持治疗，亚低温组在上述基础上辅以亚低温干预，联合治疗组则同时辅以亚低温及HBO治疗。治疗期间连续监测各组患者ICP及脑组织氧分压（PbtO，）；于治疗前、治疗10d后分别采用格拉斯哥昏迷量表（GCS）对各组患者进行评分。结果治疗前3组患者GCS评分组间差异均无统计学意义（P〉0．05），治疗后发现联合治疗组GCS评分[（10．13±2．75）分]、亚低温组GCS评分[（9．37±2．11）分]及对照组GCS评分[（6．29±2．36）分]均较治疗前明显改善（P〈0．05）；其中联合治疗组GCS评分显著优于其他各组（P〈0．05）。从治疗第5天开始，联合治疗组[CP均显著低于其他各组（P〈0．05）；从治疗第7天开始，联合治疗组脑组织PbtO，均明显高于其他各组（P〈0．05）。结论早期HBO联合亚低温治疗可显著提高重型颅脑创伤患者临床疗效，对加速其神经功能恢复具有重要作用。
Objective To investigate the clinical effects of early hyperbaric oxygen （HBO） treatment com- bined with mild hypothermia treatment on patients with severe traumatic brain injury （TBI）. Methods A total of 45 participants with severe TBI were randomly divided into combination group （15 cases）, mild hypothermia group （ 15 cases） and control group （ 15 cases）. In control group the patients were managed with treatments for reducing the intracranial pressure （ICP） and controlling the hemorrhage and gastric acid, and with administration of neurotro- phic treatment and nutritional support. In addition to above mentioned interventions, the patients in mild hypothermia group received mild hypothermia treatment; while those in the combination group received mild hypothermia plus HBO treatment. The scores of Glasgow coma scale （GCS） were measured before and after treatment. The ICP and pressure of oxygen in brain tissue （ PbtO2） were recorded during the process of treatment. Results After treat- ment, the scores of GCS in 3 groups all increased significantly, but the improvement of the GCS scores in combination group was the highest（P 〈 0.05 ）. The ICP in combination group were significantly lower than that in mild hypothermia group and control group since the 5th day （P 〈 0.05）. The PbtO2 in combination group were significantly higher than that in mild hypothermia group and control group since the 7th day（P 〈0.01）. Conclusions Early HBO treatment combined with mild hypothermia treatment could improve the therapeutic efficiency in patients with severe TBI.
出处
《中华物理医学与康复杂志》
CAS
CSCD
北大核心
2013年第10期791-794,共4页
Chinese Journal of Physical Medicine and Rehabilitation
关键词
重型颅脑创伤
高压氧
亚低温
Severe traumatic brain injury
Hyperbaric oxygen treatment
Mild hypothermia treatment
