去骨瓣减压术后早期高压氧治疗重型颅脑损伤临床观察  

Clinical observation of early hyperbaric oxygen therapy on patients with severe craniocerebral injury affer decompressive craniectomy

作　　者：饶克成[1] 李明 高飞[1] 蔡春雨[1] 

机构地区：[1]南阳市第二人民医院神经外科,河南南阳473000 [2]郑州大学人民医院神经外科,河南郑州450003

出　　处：《中国实用神经疾病杂志》2017年第23期63-66,共4页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金(81372405;81172415)

摘　　要：目的探讨早期高压氧对重型颅脑损伤术后患者血清TNF?α、IL-6及肢体运动功能的影响。方法选取南阳市第二人民医院2012-06—2015-06收治的75例重型颅脑损伤患者,所有患者给予开颅去骨瓣减压术,随机分为观察组(n=38)与对照组(n=37),术后给予常规治疗,观察组给予早期高压氧治疗。术前及术后第1、3、7天采用酶联免疫吸附法检测血清TNF?α、IL-6含量;术前及术后3个月采用Fugl-Meyer评分评定肢体运动功能。结果术前2组血清TNF?α、IL-6含量比较,差异均无统计学意义(P>0.05);2组术后血清TNF?α、IL-6含量逐渐升高,第3天时达最高峰,后逐渐降低;观察组术后第1、3、7天血清TNF?α、IL-6含量均明显低于同期对照组,差异均有统计学意义(P<0.05)。术前2组Fugl-Meyer评分差异无统计学意义(P>0.05),术后3个月观察组Fugl-Meyer评分明显高于对照组,差异有统计学意义(P<0.05)。结论高压氧疗法可有效降低重型颅脑损伤患者的颅内压,减轻炎症反应,改善脑组织的微循环和有氧代谢,提高肢体运动功能。Objective To explore the effect of early hyperbaric oxygen therapy on serum TNF-α, IL-6 and limb motor func- tion in patients with severe craniocerebral injury. Methods Seventy-five patients with severe craniocerebral injury from Jun. 2012 to ]un. 2015 in our hospital were selected. All the patients applicd decomprcssive craniectomy and routine treatment after the oper- ation, and were divided into observation group （n = 38） and control group （n = 37）. The observation group received early hyperbar- ic oxygen treatment after the operation. The serum levels of TNF-and IL-6 were measured by enzyme linked immunosorbent assay before the operation and 1,3,7-day after operation. The motor function of the limbs was evaluated by Fugl-Meyer score before and 3 months after the operation. Results There was no significant difference in serum TNF-α and IL-6 levels before operation be- tween the two groups （P 〉 0.05）. In the two groups, the serum TNF-α, IL-6 contents increased gradually postoperative, and reached the peak at third day, then gradually decreased. The serum levels of TNF-aand IL-6 in the observation group were signifi- cantly lower than those in the control group at the 1,3,7-day after operation, the difference was statistically significant （P〈0. 05）. There was no significant difference in the Fugl-Meyer score between the two groups （P〉0. 05）. The Fugl-Meyer score in the observation group was significantly higher than that in the control group 3 months after the operation, the difference was sta- tistically significant （P〈 0.05 ）. Conclusion Hyperbaric oxygen therapy can effectively reduce intracranial pressure in severe eraniocerebral injury patients, reduce inflammation, improve cerebral mierocirculation and oxygen metabolism, and can improve the patients＂ limb motor function.

关 键 词：重型颅脑损伤 高压氧疗法 TNF-α IL-6 血清 FUGL-MEYER评分 

分 类 号：R651.15[医药卫生—外科学]