高压氧治疗脑外伤并视神经损伤的疗效分析  

Analysis of therapeutic effect of hyperbaric oxygen on cerebral trauma combined with optic nerve injury

作　　者：李雁[1] 陶剑[2] 黄绳跃[2] 韩涛[1] 

机构地区：[1]福建省立医院心血管病研究所高压氧室,福建省福州350001 [2]福建省立医院神经外科

出　　处：《中华航海医学与高气压医学杂志》2007年第5期272-275,共4页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的通过观察不同压力和吸氧方式以及不同时机的高压氧治疗对脑外伤合并间接性视神经损伤患者疗效的影响，探讨一种对视神经损伤疗效高而不良反应小的高压氧治疗方案；同时，观察高压氧干预后对病程及疗效的影响。方法回顾性总结125眼间接性视神经损伤患者资料，根据是否实施高压氧治疗分A组（常规治疗组：67眼）和B组（高压氧治疗组：58眼）。根据治疗时机不同A组又分为≤3d治疗组37眼，4～7d治疗组21眼，〉7d治疗组9眼；B组又分为≤3d治疗组25眼，4～7d治疗组23眼，〉7d治疗组10眼，观察治疗后20d内的视力变化情况。近期疗效评定以20d时的治疗效果为准。结果高压氧治疗组总有效率明显高于常规治疗组（P〈0．01）；治疗压力0．1MPa（表压）者疗效明显高于治疗压力0．15MPa者（P〈0．01）；≤3d治疗组中A、B两组总有效率差异无统计学意义．而4—7d治疗组和〉7d治疗组中B组总有效率明显高于A组（P〈0．01，P〈0．05）；在B组中，≤7d治疗组较〉7d治疗组起效快（P〈0．01）；而在A组中，治疗时机对起效快慢影响不大。结论颅脑外伤合并视力障碍者在病情相对稳定的情况下应尽量在7d内实施高压氧配合下的常规治疗，这样可以提高有效率，起效快，有可能缩短疗程；其治疗压力不宜过高，0．1MPa较0．15MPa更为适宜，给氧应短时多次法。患者常规治疗必须在7d内实施，以提高有效率；如果早期治疗（≤7d）被延误，则不能单纯的行常规治疗，应采取高压氧配合下的常规治疗。Objective To investigate effect of hyperbaric oxygen （HBO） on cerebral trauma combined with optic nerve injury in different pressure, different pattern and different juncture, and to establish an effective HBO treatment with little side effect. Methods The files of 125 eyes with indirect optic nerve injury were retrospective summarized, which were divided into group A （routine treatment： 67 eyes） and group B （HBO treatment：58 eyes） according to the different method of treatment. Group A and group B were divided into three groups respectively according to the different time of treatment after injury （group A：37 eyes, ≤ 3 days group;21 eyes,4-7 days group;9 eyes, 〉7 days group;group B：25 eyes, ≤3 days group,23 eyes,4-7 days group;10 eyes, 〉 7 days group ）. The changes of vision were recorded within 20 days after treatment. The therapeutic effect evaluation were made on the 20th day after treatment. Results The total effective rate of group B was significantly higher than that of group A （P 〈0. 01 ）. The therapeutic effect of HBO treatment with the pressure of 0. 1 MPa was more than that of the other HBO treatment with the pressure of 0. 15 MPa （ P 〈 0. 01 ）. No significant difference was found between A and B group when the delayed treatment time after injury was less than 3 days, while the effective ratio of the group B was higher than that of the group A when the delayed treatment time was more than 3 days and less than 7 days （ P 〈 0. 01 ）, the same result when the treatment time was more than 7 days （ P 〈 0. 05 ）. In the B group, the patients recover more quickly in ≤ 7 days group than in 〉 7 days group, but in the A group, no significant difference was found. Conclusions The patients with cerebral trauma combined with optic nerve injury should be treated with conventional therapy combined with HBO within 3 to 7 days after vital signs are stable, so the patients will recover more quickly and effectively. The 0. 1 MPa HBO treatment pressure is fitter th

关 键 词：高压氧治疗 脑外伤 间接性视神经损伤 疗效 

分 类 号：R7[医药卫生—临床医学] R651