超早期高压氧治疗对重型颅脑损伤术后恶性脑水肿患者的影响  

Effects of very early hyperbaric oxygen treatment on patients with malignant brain edema after surgical operation for severe traumatic brain injury

作　　者：林进皇 周龙[1] 胡康[1] 郁毅刚[1] 

机构地区：[1]解放军第一七五医院暨厦门大学附属东南医院南京军区创伤神经外科中心,漳州363000

出　　处：《中华物理医学与康复杂志》2013年第10期787-790,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：全军十一五医学科研基金面上项目（06MB152）

摘　　要：目的探讨超早期高压氧治疗对重型颅脑损伤术后恶性脑水肿患者的影响。方法选取重型颅脑损伤末次术后并发恶性脑水肿的患者146例，根据患方治疗意愿及高压氧治疗介入时间的不同，将其分为超早期组（术后3d内介入高压氧治疗）、普通组（术后4—10d内介入高压氧治疗）、对照组（未行高压氧治疗），3组患者分别为55例、65例、26例。记录3组患者4周内的死亡率，于颅脑损伤术后1、2、3、4周对患者进行格拉斯哥昏迷评分（GCS），术后动态复查颅脑CT，比较各组患者脑水肿高峰的持续时间。结果观察期间，超早期组、普通组和对照组的死亡率分别为10．9％、7．7％和11．5％，差异无统计学意义（P〉0．05）。超早期组术后1、2、3、4周的GCS评分分别为（8．837±3．350）分、（10．755±3．388）分、（11．633±3．408）分、（12．367±3．408）分，术后2周与术后3周比较、术后3周与术后4周比较，差异均无统计学意义（P〉0．05），余各时间点之间比较，差异均有统计学意义（P〈0．05）；普通组术后1、2、3、4周的GCS评分分别为（8．509±3．042）分、（9．458±3．115）分、（10．186±3．203）分、（10．627±3．439）分，术后2、3、4周分别与术后1周GCS评分比较，差异均有统计学意义（P〈0．05）；对照组术后1、2、3、4周的GCS评分分别为（8．042±2．881）分、（8．417±2．962）分、（8．542±3．021）分、（8．958±3．043）分，组内各时间点比较，差异均无统计学意义（P〉0．05）。与超早期组同时间点比较，普通组、对照组GCS评分均较低（P〈0．05），且对照组术后3、4周时的GCS评分低于普通组（P〈0．05）。普通组[（10．150±1．830）d]和对照组[（11．783．±1．858）d]脑水肿高峰的持续时间均长于超早期组[（9．265±1．729）d]（P〈0．05），且对照组脑水肿高峰的持续时�Objective To investigate effects of very early hyperbaric oxygen treatment （HBOT） on pa- tients with malignant brain edema after surgical operation for treatment of severe traumatic brain injury （TBI）. Methods A total of 146 patients who suffered from malignant brain edema after last surgical operation for severe TBI were enrolled for this study. According to the intervention time of HBOT, they were randomized into a very ear- ly group （ HBOT within 3 days after operation i n = 55 ） , an ordinary group （ HBOT at 4 to 10 days after operation, n = 65 ） and a control group （ non-HBOT, n = 26）. Mortality rate of the 3 groups were recorded within 4 weeks af- ter operation, and GCS （Glasgow Coma Scale） score were assessed in 1, 2, 3 and 4 weeks after operation. Dy- namic head CT scan were performed for detecting brain status and for determine the duration of brain edema. Results The mortality of the very early group, the ordinary group and the control group were 10.9% , 7.7% and 11.5% , respectively, and no statistically significant difference was revealed among the groups （ P 〉 0.05 ）. In very early group, the GCS scores of 1 , 2, 3 and 4 weeks after operation were （8. 837 ± 3. 350） , （ 10. 755 ± 3. 388 ） , （ 11. 633 ± 3. 408 ） and （ 12. 367 ± 3. 408 ） , respectively, with significant difference between the time points 1 week and 2, 3 and 4 weeks as well as 2 and 4 weeks after surgery （P 〈 0.05） , but not between 2 and 3 as well as 3 and 4 weeks after surgery （P 〉 0.05 ）. In ordinary group, the GCS scores at 1 , 2, 3 and 4 weeks after surgery were （ 8,509 ± 3. 042 ） , （9. 458 ± 3. 115 ） , （ 10. 186 ± 3. 203 ） and （ 10. 627 ± 3. 439 ） , respectively, with significant difference between 1 week and 2, 3 and 4 weeks after operation （ P 〈 0.05 ）. In control group, the GCS scores at 1, 2, 3 and4 weeks after surgery were （8.042 ±2.881） , （8.417 ±2.962） , （8.542 ±3.02） and （8. 958 ± 3. 043 ） , with no statistical differ

关 键 词：重型颅脑损伤 高压氧 格拉斯哥昏迷评分 脑水肿 

分 类 号：R651.15[医药卫生—外科学]