创伤性脑损伤患者行早期高压氧治疗对认知功能障碍的影响及神经作用机制  

The effect of early hyperbaric oxygen therapy on cognitive impairment in patients with traumatic brain injury and its neural mechanism

作　　者：王金枝[1] 付新爱[1] 赵建华[2] WANG Jinzhi;FU Xinai;ZHAO Jianhua(Heze Municipal Hospital,Heze 274000,China;The First Affiliated Hospital of Xinxiang Medical College/Henan Provincial Alzheimer’s Dementia Neural Repair International Joint Laboratory Nanjing Medical Department,Xinxiang 453000,China)

机构地区：[1]菏泽市立医院,山东菏泽274000 [2]新乡医学院第一附属医院河南省老年性痴呆神经修复国际联合实验室南京医科,河南新乡453000

出　　处：《中国实用神经疾病杂志》2021年第1期54-59,共6页Chinese Journal of Practical Nervous Diseases

基　　金：山东省级重点基金(编号:16B20019)。

摘　　要：目的探讨早期高压氧治疗创伤性脑损伤(TBI)存在认知功能障碍的临床效果,并分析其神经作用机制。方法采用分层抽样法将菏泽市立医院2017-03—2019-01收治的78例TBI患者分为2组进行研究。对照组39例予以认知康复训练和常规基础治疗,研究组39例联合使用高压氧治疗。2组治疗2个疗程后采用蒙特利尔认知功能评估量表(MoCA)和简易智能精神状态量表(MMSE)评估患者的认知功能,对比观察2组治疗效果。同时分别从对照组和研究组中各抽取16例患者,于治疗前后分别实施扩散张量成像(DTI)技术分析患者的神经作用机制。结果 2组治疗前MoCA量表评分和MMSE量表评分比较无明显区别(t=0.130、0.252,P>0.05),治疗后研究组MoCA量表评分(22.64±3.18)分及MMSE量表评分(23.12±2.11)分与对照组(19.42±3.57)分和(20.19±4.41)分比较有显著性差异(t=4.206、3.743,P<0.05);2组胼胝体膝部、压部和体部、左侧和右侧内囊前肢、左前侧和右前侧放射冠以及左侧上纵束在内的8个脑白质区域内的FA值存在显著差异(t=4.810、4.416、4.099、4.674、4.217、5.521、6.018、5.152,P<0.05);但在左侧外囊和外侧外囊两个脑白质区域内的FA值无明显区别(t=0.291、0.245,P>0.05),对照组有明显差异的FA值与MoCA量表和MMSE量表评分相关性并不明显,研究组胼胝体、双侧内囊前肢和左侧上纵束的FA值与MoCA量表和MMSE量表评分呈正相关性(P<0.05),双侧放射冠的FA值虽然与两个量表评分之间存在微弱的相关性,但两者的相关性无统计学意义(P>0.05)。结论在常规认知功能训练的基础上联合使用早期高压氧治疗,可通过对大脑胼胝体、双侧内囊前肢和左侧上纵束等脑白质区结构和功能的调节,改善TBI患者的认知功能。Objective To explore the clinical effects of early hyperbaric oxygen therapy for patients with cognitive dysfunction in traumatic brain injury(TBI),and to analyze the neurological mechanism of patients.Methods A stratified sampling method was used to divide 78 TBI patients admitted to Heze Municipal Hospital from March 2017 to January 2019 into 2 groups for research.Thirty-nine patients in the control group received cognitive rehabilitation training and conventional basic treatment,and 39 patients in the study group received hyperbaric oxygen therapy.After two courses of treatment in the two groups,the Montreal Cognitive Assessment Scale for Cognitive Function Assessment(MoCA)and the Simple Mental State of Intelligence Scale(MMSE)were used to evaluate the cognitive function of the patients,and the treatment effects of the two groups were compared.At the same time,16 patients were selected from the control group and the study group,and diffusion tensor imaging(DTI)technology was used to analyze the neurological mechanism of the patients before and after treatment.Results The scores of MoCA scale and MMSE scale were not significantly different between the two groups before treatment(t=0.130,0.252,P>0.05).After treatment,the score of MoCA scale(22.64±3.18)and MMSE scale score of the study group(23.12±2.11)points were significantly different from those of the control group(19.42±3.57)and(20.19±4.41)points(t=4.206,3.743,P<0.05).The knees,pressure and body parts of the corpus callosum in the two groups are significantly differenct in the FA values in the 8 white matter regions of the left and right internal capsule forelimbs,the left and right anterior radial crowns,and the left upper longitudinal tract(t=4.810,4.416,4.099,4.674,4.217,5.521,6.018,5.152,P<0.05);but there is no significant difference in the FA values in the two white matter regions of the left outer capsule and the outer outer capsule(t=0.291,0.245,P>0.05);there is a significant difference in the control group.The FA value of the study group was not

关 键 词：创伤性脑损伤 高压氧 认知功能障碍 扩散张量成像 神经作用机制 

分 类 号：R651.15[医药卫生—外科学]