早期高压氧综合治疗对颅内动脉瘤栓塞术后迟发性脑血管痉挛及神经功能的影响  

Effects of Early Hyperbaric Oxygen Therapy on Delayed Cerebral Vasospasm and Neural Function after Intracranial Aneurysm Embolism Surgery

作　　者：田家林[1] 邵彬[1] 龚琴[1] 刘婷[1] 刘宁[1] 

机构地区：[1]广州军区武汉总医院康复理疗科,湖北武汉430070

出　　处：《华南国防医学杂志》2014年第3期221-224,共4页Military Medical Journal of South China

摘　　要：目的探讨早期高压氧治疗(hyperbaric oxygen therapy,HBO)对颅内动脉瘤栓塞术后迟发性脑血管痉挛(delayed cerebral vasospasm,DCVS)及神经功能的影响。方法将按标准选出的颅内动脉瘤栓塞术后的96例患者随机分为对照组和HBO组(各48例),对照组予以常规药物和康复治疗;HBO组除上述治疗外加用早期HBO治疗,观察两组患者治疗前后大脑中动脉(middle cerebral artary,MCA)血流速度、DCVS及脑梗死发生率、神经功能缺损(neurologic function impairment,NFI)评分和Barthel评分。结果两组术后第8天时血流速度较第1天增加显著(P<0.01),第15天时血流速度较第8天均有降低(P<0.01),治疗组第8天、第15天的血流速度均明显低于对照组(P<0.01);与治疗前相比,治疗后两组NFI评分降低、Barthel评分升高(P<0.01),且HBO组各指标的改善情况均优于对照组(P<0.01);HBO组DCVS、脑梗死发生率明显低于对照组(P<0.01)。结论术后早期运用HBO综合治疗对颅内动脉瘤栓塞术后DCVS的防治有积极的作用,可显著改善神经功能缺损,促进患者日常生活活动(activity of daily living,ADL))能力恢复。Objective To explore the influence of early hyperbaric oxygen （HBO） therapy on delayed cerebral vasospasm （DCVS） and neural function in patients with intracranial aneurysm after embolism surgery. Methods A total of 96 cases with intracranial aneurysms after early embolism surgery were randomly divided into both HBO therapy and control groups with 48 cases in each group. The two groups were given the same treatment at first, and the HBO group was given early HBO therapy additionally. The scores of neurologic function inapairment （NFI）, Barthel, cerebral blood flow velocity of the middle cerebral artery （MCA） and the rate of DCVS and cerebral infarction were observed and compared. Results The cerebral blood flow velocity of MCA on the 8th day after the treatment was significantly higher than that on the first day in both groups, but the cerebral blood flow velocity of MCA on the 15th day after the treatment was significantly lower than that on the 8th day in both the groups. The NFI score after treatment were significantly lower than that before in both groups （P〈0. 01）. The cerebral blood flow velocity of MCA on the 8th day and 15th day, NFI score and the rate of DCVS and cerebral infarction after the treatment were significantly lower in HBO treatment group than those in the control group after treatment. Barthel score after the treatment was significantly higher than that before treatment in both groups （P〈0. 01）, and was significantly higher in HBO treatment group than that in control group after treatment （P〈 0. 01 ）. Conclusion Early HBO therapy after the embolism surgery can significantly facilitate the treatment of DCVS and improve the neurologic deficits of patients with intracranial aneurysms.

关 键 词：颅内动脉瘤 迟发性脑血管痉挛 高压氧 日常生活能力 蛛网膜下隙出血 

分 类 号：R739.41[医药卫生—肿瘤]