早期高压氧联合康复训练对高血压脑出血钻孔置管引流术后患者神经功能康复及预后的影响研究  

Effect of early hyperbaric oxygen combined with rehabilitation training on neurological rehabilitation and prognosis of patients with hypertensive intracerebral hemorrhage after borehole drainage

作　　者：熊金丹 颜福根 李家志 马淮滨 Xiong Jindan;Yan Fugen;Li Jiazhi;Ma Huaibin(Department of Neurosurgery,Zhejiang Xin′an International Hospital,Zhejiang Jiaxing 314000,China)

机构地区：[1]浙江新安国际医院神经外科,浙江嘉兴314000

出　　处：《中国医师进修杂志》2021年第6期553-558,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨早期高压氧联合康复训练对高血压脑出血钻孔置管引流术后患者神经功能康复及预后的影响。方法回顾性分析浙江新安国际医院2018年1月至2020年3月收治的85例高血压脑出血患者的临床资料,均行微创钻孔置管引流术治疗。85例患者按入院先后顺序分为对照组(41例)和研究组(44例),对照组在患者术后生命体征平稳48 h后进行康复训练,研究组在对照组的基础上联合早期高压氧治疗。2个月后评价两组的疗效,比较两组治疗前后神经元特异性烯醇化酶(NSE)、S100β水平,比较两组治疗前后美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer运动功能量表(FMA)和Barthel指数评分及脑血流情况、格拉斯哥预后量表(GOS)的评分等级。结果两组治疗后NSE、S100β水平均降低,并且研究组NSE、S100β水平低于对照组[(14.38±1.47)μg/L比(18.04±2.95)μg/L、(0.24±0.03)μg/L比(0.32±0.04)μg/L],差异均有统计学意义(P<0.05)。两组治疗后NIHSS评分均下降,FMA评分和Barthel评分均上升,并且研究组NIHSS评分低于对照组[(9.18±1.02)分比(11.85±1.47)分],FMA和Barthel指数评分高于对照组[(68.38±8.93)分比(61.42±8.01)分、(63.25±7.65)分比(56.11±6.04)分],差异均有统计学意义(P<0.05)。两组治疗后脑血管平均血流量、平均流速均高于治疗前,周围阻力低于治疗前,并且研究组脑血管平均血流量、平均流速高于对照组[(17.85±2.48)ml/s比(15.12±2.01)ml/s、(20.61±2.88)cm/s比(17.04±2.47)cm/s],周围阻力低于对照组[(1328.95±114.29)kPa·s/m比(1558.13±157.21)kPa·s/m],差异均有统计学意义(P<0.05)。研究组预后良好率高于对照组[84.09%(37/44)比60.98%(25/41)],差异有统计学意义(χ^(2)=4.634,P<0.05)。结论早期高压氧联合康复训练能够促进高血压脑出血钻孔置管引流术后患者神经功能的恢复,显著改善患者脑血流和预后。Objective To study the effect of early hyperbaric oxygen combined with rehabilitation training on neurological rehabilitation and prognosis of patients with hypertensive intracerebral hemorrhage after borehole drainage.Methods Eighty-five patients with hypertensive intracerebral hemorrhage admitted to Zhejiang Xin'an International Hospital from January 2018 to March 2020 were enrolled,and all of them were treated with minimally invasive drilling and drainage and they were divided into two groups by the order of admission.The control group(41 cases)received rehabilitation training after 48 h of stable vital signs.The research group(44 cases)was treated on the base of the control group combined with early hyperbaric oxygen therapy.The levels of neuron-specific enolase(NSE),S100βand scores of National Institutes of Health Stroke Scale(NIHSS),Fugl-Meyer Assessment(FMA),Barthel index,cerebral blood flow,and Glasgow Outcome Scale(GOS)were observed in the two groups before and after treatment.Results After treatment,the levels of NSE and S100βin the two groups were decreased and those in the research group were lower than those in the control group:(14.38±1.47)μg/L vs.(18.04±2.95)μg/L,(0.24±0.03)μg/L vs.(0.32±0.04)μg/L,the differences were statistically significant(P<0.05).The scores of NIHSS in the two groups were decreased,while the scores of FMA and Barthel index were increased,while the scores of NIHSS in the research group was lower than that in the control group:(9.18±1.02)scores vs.(11.85±1.47)scores;the scores of FMA and Barthel index in the research group were higher than those in the control group:(68.38±8.93)scores vs.(61.42±8.01)scores,(63.25±7.65)scores vs.(56.11±6.04)scores,the differences were statistically significant(P<0.05).The average cerebrovascular blood flow and flow rate of patients in both groups were higher than those before treatment,and the peripheral cerebrovascular resistance of patients in both groups was lower than that before treatment,while the average cerebrovascular blo

关 键 词：颅内出血 高血压性 高压氧 康复 钻孔置管引流术 

分 类 号：R651.12[医药卫生—外科学]