早期高压氧治疗重型颅脑外伤疗效及抗感染作用的临床研究  

The clinical study on the curative effect and anti-inflammatory effect in the early hyperbaric oxygen treatment of severe craniocerebral trauma

作　　者：严汀华[1] 江金华[2] 卢穗万[3] 黄永清[3] 张经义[1] 邓志鸿[4] 林惠芳[1] 钟陈英 

机构地区：[1]福建省龙岩市第二医院高压氧科,364000 [2]福建省龙岩市第二医院内科,364000 [3]福建省龙岩市第二医院神经外科,364000 [4]第二军医大学第三附属医院肿瘤科,上海200438

出　　处：《中国医师进修杂志》2014年第14期60-63,共4页Chinese Journal of Postgraduates of Medicine

基　　金：福建省龙岩市医疗领域重点攻关项目（2013LY57）

摘　　要：目的 探讨早期高压氧治疗对重型颅脑外伤患者脑功能康复的临床疗效及抗感染作用.方法 将36例重型颅脑外伤患者按随机数字表法分成两组,对照组68例,给予神经外科常规治疗及综合治疗.高压氧组68例,在神经外科常规治疗、综合治疗的基础上行早期高压氧治疗.比较两组患者治疗前后格拉斯哥昏迷量表（GCS）评分、感染发生率、外周血白细胞计数变化情况及临床疗效,并于治疗后3,6,9个月进行格拉斯哥预后量表（GOS）评定.结果 对照组因各种原因退出研究16例,最终入选52例.高压氧组总有效率显著高于对照组[95.59％（65/68）比84.62％ （44/52）],差异有统计学意义（P＜0.05）.两组治疗前GCS评分比较差异无统计学意义（P＞0.05）,高压氧组治疗后1,2,3个疗程GCS评分均高于对照组[（6.41±2.19）分比（6.29±2.20）分,（8.24±2.26）分比（7.31±2.23）分,（11.25±2.57）分比（9.61±2.53）分],差异有统计学意义（P＜0.05）.高压氧组治疗后3,6,9个月GOS评分均明显高于对照组,差异有统计学意义（P＜0.05）.高压氧组泌尿系统、呼吸系统、血液系统及其他原因所致的总感染发生率低于对照组[22.06％（15/68）比44.23％（23/52）],差异有统计学意义（P＜0.05）.两组患者治疗前白细胞计数比较差异无统计学意义（P＞0.05）;高压氧组治疗后1,2,3个疗程白细胞计数均低于对照组,差异有统计学意义（P＜0.05）.结论 重型颅脑外伤患者在神经外科常规治疗、综合治疗的基础上结合早期高压氧治疗能提高恢复良好率,降低病死率和感染率,明显改善患者的生存质量.Objective To discuss the clinical curative effect and anti-inflammatory effect in the early hyperbaric oxygen treatment of severe craniocerebral trauma.Methods One hundred and thirty-six patients with severe craniocerebral trauma were divided into control group （68 cases） and hyperbaric oxygen group （68 cases） by random digits table method.The 2 groups were given the conventional therapy and combined modality therapy of neurosurgery.Hyperbaric oxygen group added hyperbaric oxygen.The Glasgow coma scale （GCS） score before and after treatment,rate of infection,changes of white blood cell count of peripheral blood and clinical curative effect were compared between the 2 groups,and the Glasgow outcome scale （GOS） were evaluated at 3,6,9 months after treatment.Results Sixteen patients were lost in control group,and control group had 52 patients.The total effective rate in hyperbaric oxygen group was significantly higher than that in control group [95.59% （65/68） vs.84.62% （44/52）],there was statistical difference （P 〈0.05）.There was no statistical difference in GCS score before treatment between the 2 groups （P 〉 0.05）,the GCS score in hyperbaric oxygen group after 1,2,3 courses were significantly higher than those in control group [（6.41 ±2.19） scores vs.（6.29 ±2.20） scores,（8.24 ±2.26） scores vs.（7.31 ±2.23） scores,（11.25 ± 2.57） scores vs.（9.61 ± 2.53） scores],there were statistical differences （P 〈 0.05）.The GOS score at 3,6,9 months after treatment in hyperbaric oxygen group were significantly higher than those in control group,there were statistical differences （P 〈 0.05）.The total rate of infection in hyperbaric oxygen group was significantly lower than that in control group [22.06% （15/68） vs.44.23% （23/52）],there was statistical difference （P〈 0.05）.There was no statistical difference in white blood cell count before treatment between the 2 groups （P 〉 0.05）,the white blood cell count after 1,2,3 courses in hyper

关 键 词：高压氧 颅脑损伤 白细胞 感染 

分 类 号：R651.15[医药卫生—外科学]