基于主成分模型评估高压氧结合早期强化康复训练对创伤性脑损伤患者的疗效  

Effect of hyperbaric oxygen combined with early intensive rehabilitation training on outcomes of patients with traumatic brain injuries based on principal component analysis

作　　者：李郭茜 王琦威 欧阳文湘 刘莎莎 唐文静 朱有栋 Li Guoqian;Wang Qiwei;Ouyang Wenxiang;Liu Shasha;Tang Wenjing;Zhu Youdong(Department of Bone and Joint Rehabilitation,Hunan Provincial Rehabilitation Hospital,Changsha 410003,China)

机构地区：[1]湖南省康复医院康复科,长沙410003

出　　处：《创伤外科杂志》2025年第4期284-291,共8页Journal of Traumatic Surgery

基　　金：湖南省残疾人联合会康复科研项目(2023XK0301)。

摘　　要：目的 综合分析提取反映高压氧结合早期强化康复训练治疗创伤性颅脑损伤(TBI)效果的关键指标,形成一个全面、客观的疗效评估体系。方法 回顾性分析2021年1月—2022年12月湖南省康复医院诊治的101例TBI患者作为研究对象,均给予高压氧结合早期强化康复训练,观察治疗前后患者电生理指标、美国国立卫生研究院卒中量表(NIHSS)评分、上肢和下肢Fugl-Meyer运动功能量表(FMA)评分、蒙特利尔认知评估量表(MoCA)评分、简易智力状态检查量表(MMSE)评分、GCS的变化。结果 治疗后,患者中枢运动传导时间(CMCT)、皮质潜伏期较治疗前降低(P<0.05),波幅较治疗前升高,上肢、下肢FMA评分较治疗前升高(P<0.05),MoCA、MMSE评分较治疗前升高(P<0.05),NIHSS评分较治疗前降低(P<0.05),两组GCS较治疗前均升高(P<0.05)。主成分分析结果显示,神经认知与功能恢复、神经损伤与下肢功能、意识状态以及认知功能与皮质反应四个方面与患者疗效紧密关联,依据综合权重系数对各指标的重要性进行排序结果显示,上肢FMA治疗前后差值、MMSE治疗前后差值、皮质潜伏期治疗前后差值权重系数分别为0.241、0.198、0.134,均>0.1,对患者疗效影响较大。结论 高压氧结合早期强化康复训练治疗TBI患者,可改善电生理强度、运动功能、认知功能、神经功能,缩短住院时间,改善患者预后。Objective Principal component analysis was conducted to comprehensively analyze and extract key indicators that can reflect the treatment effect of hyperbaric oxygen combined with early intensive rehabilitation training,so as to form a comprehensive and objective efficacy evaluation system.Methods A total of 101 traumatic brain injury patients treated in our hospital from Jan.2021 to Dec.2022 were selected as study subjects.For all of them,hyperbaric oxygen and early intensive rehabilitation training were conducted.The changed electrophysiological indexes,and scores before and after treatment of National Institute of Health stroke scale(NIHSS),Fugl-Meyer assessment(FMA)scale of both upper and lower extremities,Montreal cognitive assessment(MoCA),mini-mental state examination scale(MMSE),and Glasgow coma scale(GCS)were recorded and compared.Results After treatment,the central motor conduction time and cortical latency largely decreased(both P<0.05);amplitude increased(P<0.05),NIHSS scores decreased(P<0.05),and upper limb FMA,lower limb FMA,MoCA,MMSE and GCS scores raised(all P<0.05).The results of the principal component analysis showed that neurocognition and functional recovery,nerve injury and lower limb function,consciousness status or cognitive function and cortical response were closely related to the therapeutic outcomes of patients.According to the ranking of the importance of each indicator based on the comprehensive weight coefficient,the top three factors were upper limb FMA,MMSE,and cortical latency,with the weight coefficients of their differentials before and after treatment being 0.241,0.198,and 0.134,respectively(all exceeding 0.1),showing a significant impact on patient outcomes.Conclusion Hyperbaric oxygen therapy and early intensive rehabilitation training for traumatic brain injury patients can effectively improve the electrophysiological intensity,motor function,cognitive function,and neurological function,shorten the length of hospital stay and comprehensively improve outcomes.

关 键 词：创伤性颅脑损伤 康复训练 高压氧治疗 预后 

分 类 号：R651.1[医药卫生—外科学]