早期亚低温结合后期高压氧治疗重度颅脑创伤的疗效分析  

Efficacy Analysis of Early Mild Hypothermia Combined with Post-Hyperbaric Oxygen Treatment in Severe Traumatic Brain Injury

作　　者：胡群亮[1] 张民[1] 涂悦[1] 程世翔[1] 张赛[1] 

机构地区：[1]武警部队脑创伤与神经疾病研究所,武警后勤学院附属医院脑系科,天津300162

出　　处：《天津医药》2012年第8期760-762,共3页Tianjin Medical Journal

基　　金：国家自然科学基金资助项目(项目编号:30872668)

摘　　要：目的:评估早期亚低温结合后期高压氧治疗重度颅脑创伤的疗效。方法:157例急性重度颅脑创伤患者,按住院先后顺序随机分为早期亚低温治疗组(亚低温组,54例)、早期亚低温结合后期高压氧组(亚低温加高压氧组,48例)和常规治疗组(55例)。治疗后3个月根据格拉斯哥预后评分(GOS)标准判定疗效。对于除植物生存和死亡以外的患者,采用Borthel评估患者的日常生活活动能力(ADL)。结果:亚低温加高压氧组的病死率低于常规治疗组,差异有统计学意义(P<0.05)。3组的恢复良好率差异均有统计学意义(P<0.05),亚低温加高压氧组良好率最高。亚低温组和亚低温加高压氧组的ADL评分高于常规治疗组,亚低温加高压氧组的ADL评分高于亚低温组,差异均有统计学意义(P<0.001)。结论:早期应用亚低温治疗急性重型颅脑创伤可降低患者病死率,同时后期给予高压氧治疗可以提高患者恢复良好率,二者结合的疗法是一种较好的颅脑外伤综合治疗措施。Objective： To evaluate the clinical effects of early hypothermia combined with post-hyperbaric oxygen treat- ment in severe traumatic brain injury. Methods： All 157 patients with acute severe traumatic brain injury were divided into early hypothermia therapy group （mild hypothermia group, n=54）, early hypothermia combined with post-hyperbaric oxygen group （mild hypothermia and hyperbaric oxygen group, n=48） and the conventional therapy group （n=55） according to the in- patient order. The efficacy was determined by Glasgow score （GOS） 3 months after treatment. The activities of daily living （ADL） were evaluated after treatment in patients, addition to the plant survival and death patients. Results： There were signif- icant differences in mortality rates of mild hypothermia plus hyperbaric oxygen group and conventional treatment group （P 〈 0.05）. There were significant differences in good recovery rates between three groups （P 〈 0.05）, and the highest good recov- ery rate was in mild hypothermia and hyperbaric oxygen group. There was significant difference in ADL between mild hypo- thermia group, mild hypothermia plus hyperbaric oxygen group and conventional treatment group （P 〈 0.001）, and between mild hypothermia group and mild hypothermia plus hyperbaric oxygen group （P 〈 0.001）. Conclusion： The early application of mild hypothermia can reduce the mortality in patients with severe traumatic brain injury. The early hypothermia combined with post-hyperbaric oxygen treatment can improve the good recovery rate. The combination therapy is a better treatment for the traumatic brain injury.

关 键 词：低温 人工 高压氧 脑损伤 综合疗法 

分 类 号：R651.1[医药卫生—外科学]