高压氧治疗重型颅脑损伤合并多发伤的相关因素分析  

Related factors analysis of hyperbaric oxygen in treatment of severe craniocerebral injury complicated by multiple injuries

作　　者：张禹[1] 赵儒钢[1] 郭大志[1] 孟祥恩[1] 胡慧军[1] 潘树义[1] 

机构地区：[1]海军总医院高压氧科,北京100048

出　　处：《中国医药导报》2013年第12期56-59,共4页China Medical Herald

基　　金：海军科研计划课题(编号08-3310)

摘　　要：目的探讨高压氧治疗重型颅脑损伤合并多发伤的时机和疗程,并对影响其预后相关因素进行分析。方法分析海军总医院高压氧科住院进行高压氧治疗的96例重型颅脑损伤合并多发伤患者的临床资料。96例患者分别依据伤后开始高压氧治疗时间的不同分成≤30 d组和>30 d组,依据高压氧治疗次数的不同分成≤30次组和>30次组,比较不同组间治疗前后的残疾分级量表(DRS)评分;考虑的可能影响预后的因素为:性别、年龄、既往史、脑部手术、气管切开、脑疝、合并伤的种类、脑损伤的类型等,在伤后半年根据格拉斯哥昏迷量表(GOS)分级标准进行预后分组,将上述因素进行单因素分析和Logistic多因素回归分析。结果≤30 d组治疗后DRS评分明显低于>30 d组,差异有高度统计学意义(P<0.01);≤30次组和>30次组治疗后DRS评分比较无差异(P>0.05);影响预后的主要因素包括:年龄、合并肺挫裂伤、合并脊柱骨折、发生脑疝、发生原发脑干损伤(P<0.05)。结论年龄超过45岁,发生脑疝、原发脑干损伤,合并肺挫裂伤、脊柱骨折的重型颅脑损伤合并多发伤患者预后差;伤后30天内开始高压氧治疗是合适的治疗时机,可以促进病情的恢复,降低残疾程度。Objective To investigate the timing and treatment course of hyperbaric oxygen in the treatment of severe craniocerebral injury complicated by multiple injuries and to analyze related factors influencing its prognosis. Methods Clinical data of 96 patients with severe craniocerebral injury complicated by multiple injuries who received hyperbaric oxygen therapy in our department were analyzed. The 96 patients were assigned to 〈30 days group and 〉30 days group according to the commence time of hyperbaric oxygen therapy, and were divided into 30 times group and 〉 30 times group according to the number of times of hyperbaric oxygen therapy, the DRS scores of the groups before and after treatment were compared. Possible influencing factors were gender, age, past history, brain surgery, tracheotomy, hernia, type of associated injuries and type of brain damage; half a year after the injury, the patients were assigned to different prognosis groups according to the GOS grading standard; The above factors were analyzed using single factor analysis and Logistic regression analysis. Results 〈 30 days group was significantly lower than 〉30 days group in the DRS score after treatment, with significant difference （P 〈 0.01）. 〈30 times group and 〉 30 times group were not sig- nificantly different in the DRS score after treatment （P 〉 0.05）. The major factors influencing prognosis included age, associated pulmonary contusion, associated spinal fractures, occurrence of brain herniation and occurrence of primary brain stem injury （P 〈 0.05）. Conclusion Patients over the age of 45 and having brain herniation and primary brain stem injury complicated by pulmonary contusion and spinal fractures have poor prognosis. Starting hyperbaric oxygen therapy within 30 days after injury is the appropriate timing of treatment, which can promote the recovery of the disease and reduce the degree of disability.

关 键 词：高压氧 重型颅脑损伤 多发伤 预后 相关因素 

分 类 号：R651.1[医药卫生—外科学]