高压氧舱治疗颅脑外伤术后恶性脑水肿的临床效果研究  

Study on the analysis on the clinical effect of hyperbaric oxygen chamber in treating the postoperatively malignant brain edema of craniocerebral trauma

作　　者：王克 包志军 张俊 梁彦彬 WANG Ke;BAO Zhi-jun;ZHANG Jun(Department of Neurosurgery,The 3201 Hospital of Hanzhong,Hanzhong 723000,China;不详)

机构地区：[1]汉中三二〇一医院神经外科,陕西汉中723000

出　　处：《中国医学装备》2023年第12期125-129,共5页China Medical Equipment

基　　金：陕西省科学技术厅计划项目(2021SF-044)“高压氧对颅脑损伤神经功能恢复及临床研究”。

摘　　要：目的:研究NBYY-BXDR-001型高压氧舱治疗颅脑外伤术后恶性脑水肿的临床效果及对基质金属蛋白酶-9(MMP-9)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肌糖蛋白-C(TNC)及肿瘤坏死因子-α(TNF-α)水平的影响。方法:选取医院收治的84例颅脑外伤术后恶性脑水肿患者,根据术后高压氧治疗时间的不同将其分为观察组(45例,术后1~3d内行高压氧介入治疗)和对照组(39例,术后4~10d行高压氧介入治疗),比较两组患者血清MMP-9、NGAL、TNC及TNF-α水平,记录患者治疗前后格拉斯哥昏迷量表(GCS)评分和脑水肿持续时间,并记录两组患者病死率。结果:两组患者术后病死率差异无统计学意义。观察组整体疗效优于对照组,差异有统计学意义(Z=-2.203,P<0.05)。观察组患者术后1周、2周、3周及4周时GCS评分显著高于术后1d,差异有统计学意义(t=5.236,t=5.687,t=6.354,t=6.782;P<0.05)。两组患者术后1周、2周、3周及4周时血清MMP-9、NGAL、TNC及TNF-α水平均低于术后1d,差异有统计学意义(F_(观察组)=125.127,F=98.224,F=137.791,F=105.226;F_(对照组)=113.370,F=73.363,F=115.520,F=84.069;P<0.05)。术后2周、3周及4周时观察组GCS评分显著高于对照组,血清MMP-9、NGAL、TNC及TNF-α显著低于对照组,差异均有统计学意义(t_(MMP-9)=5.689,t=6.879,t=8.253;t_(NGAL)=8.658,t=9.657,t=8.658;t_(TNC)=6.587,t=6.354,t=6.859;t_(TNF-α)=7.898,t=8.654,t=8.256;P<0.05)。观察组脑水肿高峰时间和脑水肿持续时间较对照组显著缩短,差异有统计学意义(t=2.064,t=-2.084;P<0.05)。结论:高压氧早期介入治疗用于颅脑外伤术后恶性脑水肿患者有助于减轻术后脑水肿,提高治疗效果,与其调整血清MMP-9、NGAL、TNC及TNF-α水平有关。Objective:To study the clinical effect of NBYY-BXDR-001 hyperbaric oxygen chamber in treating the postoperatively malignant brain edema of craniocerebral trauma,and the effects of that on the levels of matrix metalloproteinase-9(MMP-9),neutrophil gelatinase-associated lipocalin(NGAL),tenascin-C(TNC)and tumor necrosis factor-α(TNF-α).Methods:A total of 84 patients with postoperatively malignant brain edema of craniocerebral trauma who admitted to the hospital were selected,and they were divided into an observation group(45 cases received the interventional treatment of hyperbaric oxygen within postoperative 1-3 days)and a control group(39 cases received interventional treatment of hyperbaric oxygen within postoperative 4-10 days)according to the different therapeutic times of postoperative hyperbaric oxygen.The levels of serum MMP-9,NGAL,TNC and TNF-αof the two groups of patients were compared.The Glasgow Coma Scale(GCS)scores and the duration of brain edema of patients before and after treatment were recorded,and the mortality rates of the two groups of patients also were recorded.Results:There was no statistically significant difference in postoperative mortality rates between the two groups.The overall efficacy of the observation group was significantly better than that of the control group,and the difference was statistically significant(Z=-2.203,P<0.05).The GCS scores of the patients of the observation group at the 1st week,2nd week,3rd week and 4th week after surgery were significantly higher than that at the 1st d after surgery,and the differences were statistically significant(t=5.236,t=5.687,t=6.354,t=6.782,P<0.05),respectively.The serum MMP-9,NGAL,TNC and TNF-αlevels of the two groups of patients at the 1st week,2nd week,3rd week and 4th week after surgery were significantly lower than those at the 1st day after surgery,and the differences were statistically significant(F_(observation group)=125.127,F=98.224,F=137.791,F=105.226,F_(control group)=113.370,F=73.363,F=115.520,F=84.069,P<0.05),respectivel

关 键 词：高压氧 颅脑外伤术 恶性脑水肿 基质金属蛋白酶-9(MMP-9) 中性粒细胞明胶酶相关脂质运载蛋白(NGAL) 

分 类 号：R651.1[医药卫生—外科学]