脑出血术后高压氧治疗时机及并发应激性溃疡出血的临床研究  

Timing of Postoperative Hyperbaric Oxygen Therapy in Patients with Hypertensive Intracerebral Haemorrhage and Its Impact on Complicated Stress Ulcer Bleeding

作　　者：李晓卫[1] 孙昭胜[1] 陈建超[1] 李永谦[1] 张金荣[1] 相毅[1] 赵金恋[1] 李光杰[1] 张明哲[1] 

机构地区：[1]河北医科大学附属哈励逊国际和平医院神经外科,河北省衡水市053000

出　　处：《中国全科医学》2011年第27期3101-3103,共3页Chinese General Practice

摘　　要：目的探讨高压氧治疗高血压基底核区脑出血术后患者应激性溃疡出血的发生率及治疗时机对预后的影响。方法将586例患者随机分为3组,A组:对照组;B组:术后7～14 d开始高压氧治疗;C组:术后15～30 d开始高压氧治疗。随访6个月,比较3组患者应激性溃疡出血的发生率及日常生活活动能力量表(ADL)评分。结果术后7～14 d,B组与A组、C组比较,应激性溃疡出血的发生率间差异均有统计学意义(P<0.01)。术后15～30d,C组与A组应激性溃疡出血的发生率间差异有统计学意义(P<0.01)。A、B、C 3组存活患者随访6个月时ADL评分分别为(45.7±28.8)分、(78.7±22.8)分和(62.8±28.9)分,差异有统计学意义(F=52.885,P<0.05),A组与B组、B组与C组、C组与A组比较,差异均有统计学意义(q=-33.008,P<0.01;q=15.893,P<0.01;q=17.115,P<0.01)。3组患者随访6个月时ADL评分等级间差异有统计学意义(H=69.064,P<0.05)。结论高血压基底核区脑出血术后患者的高压氧治疗应尽早进行,以术后7～14 d开始治疗疗效最好,虽增加应激性溃疡出血的发生率,但并不影响高压氧治疗的疗效,可明显降低致残率。Objective To discuss the correlations between postoperative hyperbaric oxygen therapy for hypertensive basal ganglia intracerebral haemorrhage and complicated stress ulcer bleeding and to explore the impact of treatment timing on prognosis.Methods A total of 586 postoperative patients with hypertensive basal ganglia intracerebral haemorrhage were randomly assigned to group A（control group）,group B（hyperbaric oxygen therapy was carried out 7~14 days after operation）,and group C（hyperbaric oxygen therapy was carried out 15~30 days after operation）.Incidence rates of stress ulcer bleeding and ADL scores were compared among the three groups after 6 months of follow-up.Results Incidence rates of stress ulcer bleeding remained comparable among the three groups 0~6 days after operation（P0.05）,became significantly different in group B compared with group A and C 7~14 days after operation（P0.01）,and became significantly different between group A and C 15~30 days after operation（P0.01）.ADL scores after 6 months of follow-up were（45.7±28.8）score,（78.7±22.8） score,and（62.8±28.9） score among group A,group B and group C respectively（F=52.885,P0.05）.Significant differences between group B and group A,group B and group C,group C and group A on prognosis were also noted（q=-33.008,P0.01;q=15.893,P0.01;q=17.115,P0.01）.Grade distribution based on.ADL scores showed significant differences among the three groups（H=69.064,P0.05）.Conclusion Hyperbaric oxygen therapy exhibits notable curative effects for postoperative hypertensive basal ganglia intracerebral haemorrhage and 7~14 days after operation is the best timing for such therapy.Despite the increased stress ulcer bleeding rate,it is still worth recommendation for the decreased rate of disability.

关 键 词：颅内出血 高血压性 高压氧治疗 手术后并发症 应激性溃疡出血 

分 类 号：R743.34[医药卫生—神经病学与精神病学]