医用臭氧自体血回输联合醒脑静治疗烧伤脓毒性脑病的临床效果  

Clinical effects of medical ozone autologous blood transfusion combined with Xingnaojing in the treatment of septic encephalopathy in burns

作　　者：叶向阳 李晓亮[1] 李琰光 李延仓[1] 肖宏涛[1] 张建[1] 赵孝开 夏成德[1] 田社民[1] 冯可[1] Ye Xiangyang;Li Xiaoliang;Li Yanguang;Li Yancang;Xiao Hongtao;Zhang Jian;Zhao Xiaokai;Xia Chengde;Tian Shemin;Feng Ke(Department of Burns,Zhengzhou First People′s Hospital,Zhengzhou 450004,China)

机构地区：[1]郑州市第一人民医院烧伤科,450004

出　　处：《中华烧伤杂志》2021年第6期568-574,共7页Chinese Journal of Burns

基　　金：河南省医学科技攻关项目(2018020728)。

摘　　要：目的探讨医用臭氧自体血回输联合醒脑静治疗烧伤脓毒性脑病的临床效果。方法采用回顾性队列研究方法。2015年8月—2019年5月,郑州市第一人民医院收治90例符合入选标准的烧伤脓毒性脑病患者,将46例[男25例、女21例,年龄(35±4)岁]采用醒脑静治疗的患者纳入单纯醒脑静组,将44例[男20例、女24例,年龄(34±5)岁]采用医用臭氧自体血回输联合醒脑静治疗的患者纳入臭氧自体血回输+醒脑静组。记录2组患者治疗前及治疗7 d心率、体温、平均动脉压、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、格拉斯哥昏迷评分(GCS)。治疗前及治疗1、3、7 d,检测血清中血脑屏障损伤标志物闭锁蛋白、一氧化氮合酶(NOS)、神经元特异性烯醇化酶(NSE)、中枢神经特异蛋白S100β、神经胶质细胞原纤维酸性蛋白(GFAP)和兴奋性氨基酸(EAA)的水平;行脑部CT灌注成像,计算感兴趣区的脑血流量(rCBF)、感兴趣区的血容量(rCBV)、感兴趣区的平均通过时间(rMTT)。对数据行χ2检验、重复测量方差分析、独立样本t检验及Bonferroni校正。结果治疗7 d,2组患者心率、体温、平均动脉压均较治疗前下降,且臭氧自体血回输+醒脑静组患者心率明显高于单纯醒脑静组(t=2.886,P<0.01),体温明显低于单纯醒脑静组(t=5.020,P<0.01),平均动脉压与单纯醒脑静组相近(t=0.472,P>0.05)。治疗7 d,臭氧自体血回输+醒脑静组患者APACHEⅡ评分明显低于单纯醒脑静组(t=3.797,P<0.01),GCS明显高于单纯醒脑静组(t=4.934,P<0.01)。治疗3、7 d,臭氧自体血回输+醒脑静组患者血清闭锁蛋白、NOS、NSE、S100β、GFAP、EAA明显低于单纯醒脑静组(t=2.100、2.090、2.691、2.013、2.474、2.635,2.225、4.011、3.150、2.691、3.145、2.781,P<0.05或P<0.01)。治疗1、3、7 d,臭氧自体血回输+醒脑静组患者rCBF、rCBV明显高于单纯醒脑静组(t=3.127、3.244,3.883、7.274,3.661、2.777,P<0.01)。治疗7 d,臭�Objective To investigate the clinical effects of medical ozone autologous blood transfusion combined with Xingnaojing in the treatment of septic encephalopathy in burns.Methods The retrospective cohort study was conducted.From August 2015 to May 2019,90 patients with burn septic encephalopathy and conforming to the inclusion criteria were admitted to Zhengzhou First People's Hospital.Forty-six patients(25 males and 21 females,aged(35±4)years)treated with Xingnaojing were included in Xingnaojing alone group,and forty-four patients(20 males and 24 females,aged(34±5)years)treated with medical ozone autologous blood transfusion combined with Xingnaojing were included in ozone autologous blood transfusion+Xingnaojing group.Heart rate,body temperature,mean arterial pressure,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and Glasgow coma score(GCS)of patients in 2 groups were recorded before treatment and on 7 d after treatment.The blood-brain barrier injury markers including occludin,nitric oxide synthase(NOS),neuron-specific enolase(NSE),central nervous system specific protein S100β,glial fibrillar acidic protein(GFAP),and excitatory amino acid(EAA)in serum of patients in 2 groups were detected before treatment and on 1,3,and 7 d after treatment.Computer tomography perfusion imaging for brain was performed in patients of 2 groups to calculate the region of interest cerebral blood flow(rCBF),region of interest blood volume(rCBV),and region of interest mean transit time(rMTT)before treatment and on 1,3,and 7 d after treatment.Data were statistically analyzed with chi-square test,analysis of variance for repeated measurement,independent sample t test,and Bonferroni correction.Results On 7 d after treatment,heart rate,body temperature,and mean arterial pressure of patients in 2 groups were decreased compared with those before treatment,heart rate of patients in ozone autologous blood transfusion+Xingnaojing group was obviously higher than that in Xingnaojing alone group(t=2.886,P<0.01),body temperatu

关 键 词：烧伤 血脑屏障 臭氧 脓毒性脑病 CT灌注成像 

分 类 号：R64[医药卫生—外科学] R318.08[医药卫生—临床医学]