高压氧综合治疗对急性脑挫裂伤患者血浆一氧化氮、内皮素-1含量的影响  

Effects of comprehensive hyperbaric oxygen therapy on the plasma levels of nitric oxide and endothelin-1 in patients with acute brain contusion and laceration

作　　者：于连荣[1] 李学慧[4] 李志才[1] 骆晓梅 江小伟 穆小萍[1] 陈梅香[1] 柳青[1] 

机构地区：[1]解放军第九七医院高压氧科,江苏省徐州221004 [2]解放军第九七医院检验科,江苏省徐州221004 [3]解放军第九七医院脑外科,江苏省徐州221004 [4]江苏省苏北人民医院

出　　处：《中华航海医学与高气压医学杂志》2014年第1期11-14,共4页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的 观察高压氧（hyperbaric oxygen,HBO）综合治疗对急性脑挫裂伤患者血浆一氧化氮（NO）、内皮素-1（ET-1）含量的影响.方法 82例急性脑挫裂伤患者,按患方意愿分组成常规治疗组（常规组,42例）和HBO综合治疗组（HBO组,40例）;另选40名健康体检者作为正常对照组（对照组）.常规组给予必要的常规药物治疗,如使用脱水剂（20％甘露醇或甘油果糖）降低颅内压、糖皮质激素、亚低温疗法、神经细胞营养剂、止痛、止血、抗感染、维持水电解质平衡、防治外伤性癫痫等;HBO组在常规治疗的基础上加用HBO治疗2个疗程.常规组和HBO组于伤后8h和1、2、3、5、7、10、14、17、21d共10个时间点抽取静脉血,分别用硝酸还原酶法、放免分析法测定血浆NO、ET-1含量;对照组于体检时抽1次血,作相应指标检测.结果 常规组,伤后各时间点血浆ET-1平均含量[最高和最低分别为（156.36±35.20）、（78.42 ±23.02） ng/L]明显高于对照组[（40.95±1 1.89） ng/L],差异均有统计学意义（P＜0.01）,其中,8h和14d时出现2个高峰,分别达到（116.43 ±36.55）、（156.36 ±35.20） ng/L;伤后各时间点NO含量[最高和最低分别为（49.22 ±2.65）、（34.54 ±3.82） μmol/L]明显低于对照组[（60.59±3.38） μmol/L],差异均有统计学意义（P＜0.01）.HBO组,治疗1d后ET-1平均含量开始下降,1～14 d时[最高和最低分别为（58.92 ±13.50）、（51.95±14.32） ng/L]与对照组比较差异均有统计学意义（P＜0.01）;17、21 d时接近对照组,差异无统计学意义（P＞0.05）.但HBO组各时间点ET-1平均含量均明显低于常规组,差异均有统计学意义（P＜0.01）;各时间点NO平均含量[最高和最低分别为（61.28 ±3.46）、（42.26 ±2.46） μmol/L]均高于常规组,差异均有统计学意义（P＜0.05或P＜0.01）.结论 急性创伤性脑挫裂伤患者血浆ET-1的升高及NO的降低贯穿于脑损伤变化的全过程;HBOObjective To observe the effects of comprehensive hyperbaric oxygen （HBO） therapy on the plasma levels of nitric oxide （NO） and endothelin-1 （ET-1） in patients with acute brain contusion and laceration.Methods With the knowledge and consent of the patients,82 patients with acute brain contusion and laceration were randomly divided into 2 groups：the routine treatment group （n =42） and the HBO group （n =40）.Another 40 physical examinees were selected as the normal control group.The routine treatment group was given necessary routine drug therapy,including the applications of dehydrant （20％ mannitol or glycerol and fructose） for reducing intracranial pressure,glucocorticoid,mild hypothermia therapy,nerve cell nutrients,analgesia and hemostasis,anti-infection,the maintenance of electrolyte balance,as well as the prevention and treatment of traumatic epilepsy.The HBO group received 2 courses of HBO therapy,in addition to routine drug treatment.For the routine therapy group and the HBO group,blood samples were collected at 10 time points after injury：at hour 8 and at days 1,2,3,5,7,10,14,17,and 21.Plasma levels of NO and ET-1 were measured respectively with Griess methods and radioimmunoassay （RIA）.Blood samples of the control group were taken just once and elated measurements were also made accordingly.Results For the routine therapy group,the average peak and bottom levels of ET-1 at all the time points after injury were [（156.36 ± 35.20） ng/L and （78.42 ± 23.02） ng/L] respectively,which were significantly higher than that of the control group [（40.95 ± 11.89）ng/L],with statistical significance（P ＜0.01）.Two peak levels [（116.43 ± 36.55）ng/L and （156.36 ± 35.20）ng/L] were shown at hour 8 and day 14.The average peak and bottom levels of NO at all the time points after injury were [（49.22 ± 2.65） and （34.54 ± 3.82） μmol/L]respectively,which were significantly higher than that of the control group [（60.59 ± 3.38） mol/L],also with statistical

关 键 词：高压氧 脑挫裂伤 一氧化氮 内皮素-1 

分 类 号：R459.6[医药卫生—治疗学]