早期高压氧对重型颅脑损伤开颅术后患者疗效分析  

Efficacy analysis of early hyperbaric oxygen therapy in patients with severe traumatic brain injury after craniotomy

作　　者：刘康峰[1] 黄文娟[1] 黄富[1] 蔡仁端[1] 于志虎[1] 王磊[1] 肖华[1] 

机构地区：[1]南方医科大学附属花都医院神经外科,广州510800

出　　处：《中国医师进修杂志》2011年第29期5-8,共4页Chinese Journal of Postgraduates of Medicine

基　　金：基金项目：2011年度广州市医药卫生科技重点项目（201102A212027）

摘　　要：目的观察早期高压氧治疗重型颅脑损伤开颅术后患者的疗效，并分析格拉斯哥昏迷评分（GCS）6～8分及GCS3～5分患者的疗效区别。方法采用病例对照研究，入选2009年2月6日至2010年11月25日的重型颅脑损伤患者61例，采用随机数字表法分为高压氧组30例和对照组31例，记录患者入院时、高压氧治疗前、完成高压氧治疗时的GCS；记录高压氧治疗前、完成高压氧治疗时及入院后3个月的格拉斯哥预后评分（GOS）。结果高压氧组及GCS3～5分的高压氧组患者完成高压氧治疗时GCS分别为（12．63±2．70）、（11．64±2．50）分，与相应对照组的（10．61±3．01）、（8，44±1．67）分比较差异均有统计学意义（P〈0．05）；高压氧组及GCS3—5分的高压氧组患者完成高压氧治疗时COS改善程度（△GOSf）及入院后3个月GOS改善程度（AGOS3M）平均秩次分别为35．37、12．14和35．87、13．09，与相应对照组的26．77、8.05和26.29、7.33比较差异均有统计学意义（P〈0.05）；但GCS6～8分的高压氧组患者的AGOSf和AGOS3M平均秩次，与相应对照组比较差异均无统计学意义（P〉0.05）。结论对重型颅脑损伤开颅术后患者总体丽言，早期高压氧治疗有促进意识恢复及改善预后盼作用；且对特重型（GCS3～5分）患者疗效更为显著。Objective To evaluate the effect of hyperbaric oxygen therapy （HBOT） in patients with severe traumatic brain injury （STBT） after craniotomy, and evaluate the difference of HBOT effects on the patients whose Glasgow coma score （GCS） were 6-8 scores and 3-5 scores. Methods Using case-control study, 61 neurosurgical in-patients with STBI from February 6, 2009 to November 25, 2010 were divided into two groups by random digits table, 30 in HBOT group and 31 in control group. Their GCS at the periods on admission, before HBOT and when they finished HBOT were recorded, as well as the Glasgow outcome score （COS） before HBOT, finished HBOT, and 3 months after admission （GOS3M）. Results The GCS finished HBOT were （12.63 ±2.70） scores in HBOT group and （11.64 ±2.50） scores in GCS 3-5 subgroup, there were statistically differences than those in control group [ （10.61 ± 3.01 ）, （8.44 ± 1.67） scores] （P 〈0.05）. The mean rank of GCS finished HBOT improvement （△ GOSf） and GOS scores 3 months after admission （ △ GOS3M） in HBOT group was 35.37 and 35.87, which were significantly higher than those in control group （26.77 and 26.29） （P 〈0.05）. Meanwhile, the mean rank of AGOSf andA GOS3M in GCS 3-5 subgroup was 12.14 and 13.09, which were significantly higher than those in control group （8.05 and 7.33 ）（P 〈 0.05 ）. In GCS 6-8 subgroup, there was no significant difference in △ GOSf and △ GOS3M between HBOT group and control group （P 〉 0.05）. Conclusion Early HBOT is effective to improve the recovery of consciousness and prognosis of the postoperative patient with STBI, especially of the patients with the special STBI （ GCS 3-5 scores ）.

关 键 词：高压氧 颅脑损伤 颅骨切开术 

分 类 号：R651.15[医药卫生—外科学]