高压氧治疗对重型颅脑损伤患者全身炎症反应的影响  

Effects of hyperbaric oxygen on the systemic inflammation response in patients with severe traumatic brain injury

作　　者：谭敏[1] 彭华[1] 段军伟[1] 唐晓平[1] 

机构地区：[1]川北医学院附属医院神经外科,南充637000

出　　处：《中华物理医学与康复杂志》2011年第2期116-119,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：四川省教育厅自然科学重点项目（07za186）;四川省医学重点建设学科基金（川卫办发[2007]407号）

摘　　要：目的探讨高压氧（HBO）对重型颅脑损伤患者全身炎症反应的影响及可能机制。方法将70例重型颅脑损伤患者分为常规组及HBO组，2组均给予常规治疗（包括手术、降颅内压、营养脑细胞、抗感染及营养支持等），HBO组患者于病情稳定后辅以HBO治疗；另选取性别、年龄与之相匹配的20例健康体检者作为正常对照组。分别于伤后1，7，14及21d时抽取常规组和HBO组患者静脉血，检查C反应蛋白（CRP）水平，采用酶联免疫吸附法测定血清白介素-6（IL-6）水平，并于上述各时间点对2组患者进行序贯器官衰竭评分（SOFA）及格拉斯哥昏迷量表（GCS）评分，逐日判定有无全身炎症反应综合征（SIRS）发生。结果重型颅脑损伤可导致患者血清IL-6、CRP水平明显升高，经HBO治疗后，HBO组患者各时间点IＬ-6、CRP水半均显著低于常规组（P〈0．01或0．05），SIRS发生率及持续时间也明显低于常规组（P〈0．05或0．01），伤后14d及21d时SOFA分值显著低于常规组（P〈0．01），伤后21d时GCS评分明显高于常规组（P〈0．01）；发生SIRS的患者其IL-6及CRP水平、SOFA分值在各时间点均明显高于未发生SIRS患者，GCS评分均明显低于未发生SIRS患者（P〈0．01）。结论HBO治疗能抑制IL-6的产生与释放，从而减轻脯损伤后全身炎症状态，保护重要器官功能，提高临床疗效。Objective To investigate the effeets of hyperbarie oxygen （HBO） oh the systemic inflammation respunse in patients with severe traumatic brain injury （TBI） , and to explore HBO therapy mechanisms. Methods Seventy patients with severe TBI were randomly divided intu a routine treatment gruup （ RT group, n = 35） and an HBO gruup （n = 35 ）. All patients received conventional treatment, but the HBO group received additional early HBO therapy. Twenty age-and sex-matehed normal subjeets were reruited and served as normal controls. Serum interleukin-6 （IL-6） was measured by ELISA, and C reactive protein （CRP） was also measured on days 1, 7, 14 and 21 after injury. Sequential urgan failure assessments （SOFAs） and Glasgow coma scale （GCS） scores were evaluated at the same time points. Systemic inflammatory response syndrome （SIRS） was assessed daily. Results The concentrations of serum IL-6 and CRP increased obviously following TBI, but patients in the HBO group exhibited signifieantly lower levels at each time point than those in the RT group. In the HBO group fewer cases of SIRS developed, and they had a significantly shorter average duration than those in the RT group. The average SOFA score in the HBO group was significantly lower than that of the RT group at days 14 and 21 after injury, and the GCS seores had improved significantly more by day 21. Compared with the patients who were free of SIRS, the patients with SIRS showed higher levels of IL-6 and CRP, higher SOFA scores as well as lower GCS scores （ all differences statistically significant）. Conclusions HBO therapy can attenuate systemic inflammation after TBI, protect the functions of important organs and improve clinical outcomes. Decreasing the level of IL-6 may contribute to the effectiveness of HBO.

关 键 词：高压氧 重型颅脑损伤 全身炎症反应综合征 白介素-6 C反应蛋白 

分 类 号：R651.15[医药卫生—外科学]