高压氧治疗对颅脑爆震伤患者认知功能障碍的影响

目的评价高压氧治疗对颅脑爆震伤患者认知功能障碍的影响。方法选取中国人民解放军联勤保障部队第九九〇医院2015-01―2020-03收治的符合标准的爆震致颅脑损伤患者36例,对照组采取常规治疗,观察组采用常规治疗+高压氧治疗,比较2组治疗前后有效率及认知功能改善情况。结果观察组有效率(94.44%)高于对照组(55.56%),差异有统计学意义(P0.05);观察组认知功能各项评分及总分与入院时、对照组相比较,差异有统计学意义(P0.05)。结论高压氧治疗可明显利于颅脑爆震伤患者的认知功能障碍的恢复,改善患者的预后。     

高压氧舱联合有氧训练对中度脑外伤患者认知功能的作用

目的探讨高压氧舱配合有氧运动训练对中度脑外伤患者认知功能的影响。方法选取中度脑外伤且确认有认知障碍患者62例,随机分成观察组31例和对照组31例。对照组患者给予常规药物治疗与有氧运动训练,观察组患者在对照组治疗基础上给予高压氧舱吸氧治疗。采用神经行为认知状况测试(neurobehavioral cognitive status exam,NCSE)和功能独立性评价量表(functional independence measure,FIM)评估2组患者认知功能水平,并比较2组综合疗效。结果 2组治疗后NCSE各单项评分及总分均明显升高(P0.05),且观察组患者各单项评分及总分均高于对照组(P0.05);2组治疗后FIM评分各单项评分和总分均明显升高(P0.05)。治疗后2组FIM评分对比,观察组括约肌控制和行走评分和对照组无显著差异(P0.05),其他单项评分和总评分均优于对照组(P0.05)。观察组显效率和有效率均大于对照组,但差异无统计学意义(P0.05)。结论高压氧舱配合有氧运动训练对中度脑外伤患者认知障碍症状的缓解及认知功能恢复有明显疗效。     

神经节苷脂联合高压氧治疗颅脑损伤后认知功能障碍的疗效分析

目的观察神经节苷脂联合高压氧治疗颅脑损伤后认知功能障碍的临床疗效,为临床治疗提供理论依据。方法选取2011-06—2014-06我院收治的颅脑损伤后存在认知功能障碍患者98例,将其分为观察组与对照组,每组49例。对照组给予神经节苷脂治疗,观察组在对照组基础上给予高压氧治疗。对2组患者临床疗效进行观察与比较。结果观察组总有效率83.7%高于对照组的61.2%,差异有统计学意义(P0.05);2组治疗前MMSE评分及Barthel评分比较差异均无统计学意义(P0.05);与治疗前比较,治疗后2组MMSE评分及Barthel评分均明显提高,差异均具有统计学意义(P0.05);与对照组比较,观察组治疗后MMSE评分及Barthel评分改善情况更显著,差异有统计学意义(P0.05)。结论神经节苷脂联合高压氧治疗颅脑损伤后认知功能障碍具有显著临床疗效,能使患者认知功能及日常生活活动能力有效改善,值得临床进一步推广应用。     

早期高压氧联合神经节苷脂治疗重型颅脑损伤的疗效观察

目的探讨早期应用高压氧联合神经节苷脂治疗重型颅脑损伤的临床价值。方法选取2011—2013年我院收治的重型颅脑损伤患者180例,随机平分为2组,分别行常规治疗与早期高压氧联合神经节苷脂治疗。结果治疗前2组GCS与Barthel评分相比无显著差异(P0.05),治疗1、2周时观察组GCS评分改善更为显著(P0.05),治疗3个月后观察组Barthel评分改善显著高于对照组(P0.05)。治疗结束后观察组治愈率显著提高(P0.05),重残率与病死率显著降低(P0.05)。结论早期高压氧联合神经节苷脂治疗重度颅脑损伤能够有效改善神经功能,提高治疗有效率,降低致残率与致死率,具有较高的临床价值。     

高压氧对重型颅脑外伤患者血清和肽素的影响

目的探讨高压氧对重型颅脑外伤患者血清和肽素水平的影响及临床意义。方法选取重型颅脑损伤患者76例,随机将其分为对照组及研究组,研究组在对照组基础上予以高压氧治疗。比较研究组在高压氧治疗后、对照组于常规治疗后第1、2、3周结束次日血清和肽素水平;比较两组患者治疗后GCS评分变化。结果高压氧治疗作用下,与对照组相比较研究组患者血清和肽素水平在高压氧治疗后第1、2、3周结束时均降低(P0.05)。治疗3周后两组患者的GCS评分均较治疗前提高(P0.05),高压氧组患者GCS评分提高更加明显(aP0.05)。结论高压氧治疗能降低重型颅脑外伤患者血清和肽素水平并促进重型颅脑外伤患者康复,高压氧治疗有助于重型颅脑外伤患者康复可能与高压氧治疗下患者血清和肽素水平降低相关。     

高压氧治疗急性缺血性脑卒中的介入时机及疗效分析

目的探讨高压氧不同时机介入治疗急性缺血性脑卒中的疗效。方法选取258例急性缺血性脑卒中患者,按照是否实施高压氧治疗分为对照组和治疗组,治疗组按照高压氧治疗介入的时机分为3组:治疗Ⅰ组(发病第1天内)、治疗Ⅱ组(发病第1~3天内)和治疗Ⅲ组(发病3d后),对照组给予普通氧和基础治疗,治疗组给予高压氧和基础治疗,高压氧治疗3个疗程后观察2组神经功能变化和临床疗效。结果对照组及治疗组治疗前后平均神经功能缺损评分相比均明显下降,差异有统计学意义(P0.05),高压氧介入时间越早下降越明显;治疗后4组间神经功能缺损评分两两比较,治疗Ⅲ组与对照组无明显差异,其他组间比较差异均有统计学意义(P0.05)。3个治疗组亚组有效率与对照组相比,差异均有统计学意义(P0.05),治疗Ⅰ组有效率为89.04%,明显高于其他3组。结论高压氧治疗可促进急性缺血性脑卒中患者的神经功能恢复,治疗时机越早疗效越显著。     

不同术式对重症对冲性颅脑损伤术后对侧血肿厚度及中线位移程度的影响

目的观察不同术式治疗对冲性颅脑损伤对侧血肿厚度及中线位移程度的影响。方法选取2011-07—2013-09在我院诊治的90例重症对冲性颅脑损伤患者,按随机数字表法分为Ⅰ、Ⅱ、Ⅲ3组各30例,分别给予额颞部单侧血肿清除联合去骨瓣减压术、额颞部双侧血肿清除联合单侧或双侧去骨瓣减压术和先行受伤部位硬膜外血肿清除术,3组即可或稍后行对侧硬膜外清除术,比较3组对侧血肿厚度及中线位移程度。结果治疗后3组的GSC评分、对侧血肿厚度及中线位移程度均较治疗前明显改善(P0.05),组间比较,Ⅰ、Ⅲ组GSC评分较Ⅱ组明显升高(P0.05),Ⅰ、Ⅱ组对侧血肿厚度及中线位移程度与Ⅲ组相比改善程度明显下降(P0.05)。结论临床应用不同术式治疗对冲性颅脑损伤均可不同程度的改善血肿厚度和中线位移,对受伤部位硬膜外血肿先行清除可取得更好效果。     

计算机辅助认知训练对帕金森病患者认知功能的影响

目的观察计算机辅助认知训练对伴轻度认知功能障碍的帕金森病(Parkinson's disease with mild cognitive impairment,PD-MCI)患者认知功能的影响。方法选取PD-MCI患者111例,采用随机数字表法将其分为观察组(56例)及对照组(55例)。2组患者均给予常规抗PD药物治疗,同时对照组接受一般认知训练,观察组接受计算机辅助认知训练。于训练前、治疗6周后对2组蒙特利尔认知评测量表(MoCA)、统一PD评价量表(UPDRS)、汉密尔顿抑郁量表(HMDS)、PD生活质量量表-39(PDQ-39)等评分及P300进行评估。结果治疗前,2组MoCA总分、UPDRS-Ⅰ、UPDRS-Ⅱ、UPDRS-Ⅲ、HMDS和PDQ-39等评分组间差异均无统计学意义(P0.05)。治疗后,2组MoCA总分、UPDRS-Ⅰ、UPDRS-Ⅱ、HMDS和PDQ-39等评分均较治疗前显著改善(P0.05),观察组MoCA总分、UPDRS-Ⅰ、UPDRS-Ⅱ、HMDS和PDQ-39评分显著优于对照组(P0.05)。对MoCA评分进步一分析,治疗后2组视空间与执行功能、延迟记忆、注意力、抽象、语言、定向力等得分较治疗前显著提高(P0.05),且观察组视空间与执行功能、注意力、抽象、定向力等评分亦显著优于对照组(P0.05)。治疗前,2组P300潜伏期、波幅比较差异无统计学意义(P0.05);治疗后2组P300潜伏期显著缩短(P0.05),P300波幅明显增加(P0.05),且观察组P300潜伏期、波幅与对照组比较差异均有统计学意义(P0.05)。结论计算机辅助认知训练可显著改善PD患者的认知功能和抑郁症状,提高生活质量。     

小脑顶核电刺激合并高压氧治疗颅脑损伤

目的探讨小脑顶核电刺激合并高压氧治疗颅脑损伤恢复期患者的疗效。方法将颅脑损伤患者随机分为治疗组42例和对照组40例。治疗组接受小脑顶核电刺激并用高压氧治疗,对照组接受高压氧治疗,分别在治疗前后采用日常生活活动能力评分量表(ADL)进行功能评定,根据临床四级疗效标准进行疗效评定。结果治疗组治疗后ADL评分较前明显提高(P<0.01),且与对照组相比差异有统计学意义(P<0.05),治疗组总有效率80.95%明显高于对照组的52.22%(P<0.05)。结论小脑顶核电刺激合并高压氧能有效提高高压氧对颅脑损伤恢复期患者的疗效。     

颅脑损伤部位对患者认知影响的研究

目的探讨颅脑损伤部位对患者认知的影响。方法选取2013-01-2014-01在我院进行治疗的颅脑损伤患者120例。采用中文版蒙特利尔认知评估量表(MoCA)和简易智能状态检查量表(MMSE)对120例颅脑损伤患者进行认知功能测评,探讨颅脑损伤部位对患者认知的影响。结果不同部位损伤的颅脑外伤患者认知障碍的发生率差异有统计学意义(P0.05),其中额叶患者的认知功能障碍发生率最高为91%,而小脑损伤患者的认知功能障碍发生率最低为28%,各损伤部位MoCA总分、空间与执行、语言、想象力等比较差异均有统计学意义(P0.05)。MoCA评分用Logistic回归分析:顶叶、额叶、颞叶和基底节区的损伤与认知功能障碍的发生相关(P0.05),枕叶损伤、小脑与认知功能障碍的发生无关(P0.05)。结果不同颅脑损伤部位是影响患者认知损害特点及认知障碍的发生率。     

Changes of plasma C-reactive protein in patients with craniocerebral injury before and after hyperbaric oxygenation： A randomly controlled study

BACKGROUND: Plasma inflammatory factor, such as C-reactive protein, whose content is regarded as a sensitively pathological marked protein and quantitative indexes of central nervous system injury, has been paid more and more attention in clinic. OBJECTIVE: To observe the effects and clinical significance of C-reactive protein in patients with craniocerebral injury after hyperbaric oxygenation. DESIGN: Randomized controlled study. SETTING: Departments of Neurosurgery, Laboratory and Hyperbaric Oxygen, the Second Affiliated Hospital, Medical College of Shantou University. PARTICIPANTS: A total of 60 patients with craniocerebral injury were selected from Department of Neurosurgery, the Second Affiliated Hospital, Medical College of Shantou University from October 2006 to April 2007. There were 37 males and 23 females and the mean age was 26 years. All subjects were certainly diagnosed as history of craniocerebral injury. Patients hospitalized at 24 hours after injury, Glasgow Coma Score ranged from 3 to 12 points, and all patients were certainly diagnosed with CT or MR scanning. Patients and their relatives provided confirmed consent. All the subjects were randomly divided into hyperbaric oxygenation group and control group with 30 in each group. METHODS: Patients in the control group were treated with routinely neurosurgical therapy after hospitalization; however, based the same basic treatment in the control group, patients in the hyperbaric oxygenation group received hyperbaric oxygenation by using iced-wheel four-door 2-cabin air-compression chamber (made in Yantai) from 24 hours to 10 days after operation or injury. After entering the cabin, patients who had a clear consciousness breathed the oxygen by using face mask; contrarily, patients directly breathed the oxygen. Therapeutic project: Expression was increased for about 15–20 minutes, maintained for about 70–80 minutes, and decreased for 20 minutes. Otherwise, pressure was maintained from 0.2 to 0.25 MPa. Hyperbaric oxygenation took an hour for once a day and 10 times were regarded as a course. Venous blood was collected before treatment and on the next day of the first course end. Content of C-reactive protein in plasma was measured with immune turbidimetry in hyperbaric oxygenation group; in addition, content of C-reactive protein in plasma was directly measured with the same method at the corresponding time in the control group. If the content was less or equal to 8 mg/L, it was regarded as normal value. Effects of the two groups were evaluated based on Glasgow Coma Score before and after treatment. MAIN OUTCOME MEASURES: Content of plasma C-reactive protein and Glasgow Coma Score in the two groups before and after treatment. RESULTS: All 60 patients were involved in the final analysis. ① Content of plasma C-reactive protein: The two contents were obviously higher than normal value after craniocerebral injury. There was no significant difference in the two groups before treatment (P > 0.05), but both contents were decreased after treatment, and there was significant difference between HBOT group and control group after treatment (t =4.756, P < 0.01). In addition, there was significant difference in hyperbaric oxygen therapy group before and after treatment (t =5.236, P < 0.01). ② Glasgow Coma Score: There was no significant difference in the two groups before treatment (P > 0.05), but scores were increased in both groups after treatment (t =9.92, 2.51, P < 0.01, 0.05); on the other hand, therefore, there was significant difference between the two groups after treatment (t =9.21, P < 0.01). CONCLUSION: Hyperbaric oxygenation can remarkably decrease content of plasma C-reactive protein in patients with craniocerebral injury at the phase of stress.     

高压氧治疗在重型颅脑损伤的临床效果及多方机制综合分析

目的探讨重型颅脑损伤患者在常规治疗基础上加用高压氧(HBO)治疗对临床效果的影响,并分析其作用机制。方法根据患者的入院顺序将87例重型颅脑损伤患者分为HBO组44例和常规组43例,两组患者入院后均给予手术、降低颅内压、营养脑细胞、抗感染等常规治疗,HBO组在患者病情稳定后给予HBO治疗,观察两组患者治疗后伤后第1、5、10天血清白介素-6(IL-6)、肿瘤坏死因子(TNF-ɑ)、C反应蛋白(CRP)、丙二醛(MDA)、超氧化物歧化酶-1(SOD-1)、颅内压(ICP)等指标的变化情况。结果伤后第5、10天,随着HBO治疗作用,HBO组患者的血清炎症指标(IL-6、TNF-ɑ、CRP)、抗氧化指标(MDA、SOD-1)、颅内压(ICP)水平均优于常规组患者(P0.05)。伤后第5、10天HBO组患者的大脑中动脉Vs、Vm检测值均优于常规组患者(P0.05)。治疗后,两组患者的GCS评分与治疗前比较,(P0.05),HBO组患者提高更加显著(P0.05)。治疗结束6个月后,HBO组患者的预后良好率63.64%高于常规组的41.86%(P0.05)。结论重型颅脑损伤患者在常规治疗基础上加用HBO治疗可以显著改善患者的炎症反应、大脑血流状态、机体低氧状态、抗氧化水平,从而改善治疗效果。     

脑出血后铁调素对患者铁代谢及神经功能的影响观察

目的观察脑出血后铁调素对患者铁代谢及神经功能的影响。方法以69例高血压脑出血患者为观察组,以于我院行健康体检的69例健康者为对照组。检测2组对象的血清铁调素水平,检测观察组患者血清铁蛋白水平及神经功能指标[血清100β蛋白和血清神经元特异性烯醇化酶(NSE)],并参照改良Ranks’量表(mRS)评估观察组患者预后。根据检测结果,对比分析2组对象的血清铁调素和血清铁蛋白水平;并将观察组69例患者分为I组(Hep20μg/L),II组(Hep于20~30μg/L),III组(Hep≥30μg/L),对比观察3个亚组患者的神经功能指标水平及预后情况。结果观察组患者的平均血清铁调素、铁蛋白水平均高于对照组(P0.05)。在平均血清S100B蛋白和NSE指标值上,III组II组I组(P0.05)。在预后良好率上,I组II组III组(P0.05)。结论脑出血后患者铁调素水平显著升高,引起铁代谢失衡,且其升高趋势与患者神经功能缺损的严重程度及预后不良程度一致。     

脑膜瘤级别及其临床特点

目的 探讨脑膜瘤分级、发病规律、治疗及愈后.方法 回顾性分析经手术及病理证实的脑膜瘤791例,按照2007年WHO脑膜瘤分级标准将其分为Ⅰ、Ⅱ、Ⅲ级并进行对照分析.结果 WHO Ⅰ级脑膜瘤占同期手术治疗脑膜瘤的93.0％,WHOⅡ级占4.6％,WHOⅢ占2.4％.WHO Ⅰ、Ⅱ、Ⅲ级脑膜瘤男女之比分别为1∶2.46、1∶1.77及1∶1.11(P＞0.05).WHO Ⅰ级脑膜瘤的高发年龄为40～60岁,Ⅱ级为30～70岁,Ⅲ级为20 ～30岁、50 ～ 70岁.WHOⅡ、Ⅲ级脑膜瘤发生率与肿瘤的部位有关,凸面及矢状窦旁发生率较高,而鞍上及前颅窝发生率较低(P＜0.05).WHO Ⅰ、Ⅱ、Ⅲ级脑膜瘤手术切除级别差异无统计学意义(P＞0.05),WHO Ⅰ、Ⅱ、Ⅲ级脑膜瘤复发率分别为4.8％、38.7％及68.8％,差异有统计学意义(P＜0.05).结论 绝大多数脑膜瘤为WHO Ⅰ级,Ⅱ、Ⅲ级脑膜瘤发生率较低,Ⅱ级脑膜瘤男女之比高于Ⅰ级脑膜瘤,而Ⅲ级脑膜瘤男女之比更高.凸面及矢状窦旁WHOⅡ、Ⅲ级脑膜瘤发生率较高,而鞍上及前颅窝发生率较低.脑膜瘤切除级别与WHO脑膜瘤分级无关,术后复发与WHO分级相关.     

急性颅脑损伤病人脑干听觉诱发电位动态变化与预后的关系

目的探讨急性颅脑损伤病人脑干听觉诱发电位(BAEP)动态变化与预后的关系。方法动态检测73例急性颅脑损伤病人双侧BAEP,根据BAEP分级标准:Ⅰ级20例,Ⅱ级19例,Ⅲ级17例,Ⅳ级17例。观察BAEP分级变化与GOS的关系。结果颅脑损伤后1周不同BAEP分级预后良好率分别为Ⅰ级90%,Ⅱ级84.2%,Ⅲ级58.8%,Ⅳ级11.8%。BAEP改变与GOS变化存在线性相关关系(χ2回归=25.523,P0.01;χ2偏离=3.675,P0.05);BAEP好转者预后良好率(72.4%)较恶化者(23.1%)显著升高(χ2=8.922,P=0.003)。结论急性颅脑损伤病人BAEP变化与预后存在明显相关性。动态观察BAEP变化可能是评估急性颅脑损伤病人预后的一种有效方法。     

高压氧联合三级康复训练对老年高血压基底节区脑出血的疗效

目的分析高压氧联合三级康复训练对老年高血压基底节区脑出血患者预后的影响。方法选择郑州大学第一附属医院2015-06—2016-06收治的老年高血压基底节区脑出血患者92例,分为常规组与实验组,对2组均采取高压氧治疗,实验组在此基础上联合三级康复训练,对比2组治疗效果。结果 2组治疗后GCS、FMA、ADL评分相比治疗前均明显改善,且以实验组的改善程度更为显著(P0.05);2组治疗后的生存质量指标评分相比治疗前均明显提高,且以实验组的提高程度更为显著(P0.05);2组治疗后SAS与SDS评分相比治疗前均有所下降,且实验组下降幅度明显高于常规组(P0.05)。结论对老年高血压基底节区脑出血患者采取高压氧联合三级康复训练的治疗效果显著,可有效改善患者预后。     

高压氧对颅脑损伤患者认知功能障碍恢复的影响

目的观察高压氧对颅脑损伤患者认知功能障碍恢复的临床疗效。方法随机抽取颅脑损伤患者80名,在常规治疗的基础上行高压氧治疗。观察治疗前后神经功能、血液流变学及认知功能的变化,认知功能检查采用简易精神状态检查表（MMSE）、数字广度测验（DST）、日常生活能力（ADL）、汉密尔顿抑郁量表（HAMD）等神经心理学检查法,结果与对照组进行比较。结果治疗组神经功能、血液流变学及认知功能障碍较治疗前明显改善（P〈0.01）,与对照组比较亦有显著性差异（P〈0.01）。结论高压氧对颅脑损伤患者的脑组织有保护作用,能显著改善颅脑损伤患者认知功能障碍。     

脑梗死患者血清白蛋白、球蛋白水平及其比值变化研究

目的 探讨脑梗死患者血清白蛋白、球蛋白水平及其比值变化及对预后的影响.方法 选择自2006年6月至2010年6月于兴义市人民医院神经内科住院治疗的120例急性脑梗死患者为研究对象Ⅰ组,选择同期具有脑血管病风险因素且与Ⅰ组危险因素匹配的110例个体为研究对象Ⅱ组,选择同期体检健康的90例志愿者为研究对象Ⅲ组.比较3组对象血清白蛋白、球蛋白、白蛋白/球蛋白比值、纤维蛋白原、外周血细胞的差异.随访2年后比较3组对象中白蛋白/球蛋白比值≥1.45及白蛋白/球蛋白比值＜1.45个体的预后差异. 结果 Ⅲ组、Ⅱ组及Ⅰ组血清球蛋白、纤维蛋白原、白细胞水平依次升高,组间比较差异有统计学意义(P＜0.05);Ⅲ组、Ⅱ组及Ⅰ组血清白蛋白水平、白蛋白/球蛋白比值依次降低,组间比较差异有统计学意义(P＜0.05).随访2年后Ⅰ组、Ⅱ组、Ⅲ组再发脑血管病发生率分别为24.1％、18.5％及2.3％,组间比较差异有统计学意义(P＜0.05).Ⅰ、Ⅱ组白蛋白/球蛋白比值＜1.45亚组患者发生脑血管病事件风险是白蛋白/球蛋白比值≥1.45亚组患者的3.6倍. 结论 血清白蛋白、球蛋白水平及白蛋白/球蛋白比值与脑梗死发生密切相关,脑梗死及脑血管病危险人群白蛋白/球蛋白比值降低者较白蛋白/球蛋白比值正常者发生脑血管病事件风险增加.     

高压氧对慢性硬膜下血肿术后脑复张的影响

目的 探讨高压氧治疗对慢性硬膜下血肿钻孔引流术后脑复张的影响.方法 将215例慢性硬膜下血肿的患者分为两组.治疗组115例,在术后常规治疗的基础上行高压氧治疗.对照组100例,术后常规药物治疗.根据术后复查头颅CT血肿残腔最大层面的厚度(T),将脑复张的程度分为4级(Ⅰ级:T≤0.5 cm,Ⅱ级:0.5 cm＜T≤1 cm,Ⅲ级:1 cm＜T≤1.5 cm,Ⅳ级:T＞1.5 cm).比较2个月内两组患者脑复张程度的差异.结果 1个月时两组脑复张程度差异有统计学意义(P＜0.05),2个月时两组脑复张程度差异有统计学意义(P＜0.01),治疗组高于对照组.结论 高压氧治疗能有效促进慢性硬膜下血肿术后脑复张,可作为慢性硬膜下血肿术后常规辅助治疗措施.     

MRS联合DWI观察实验性兔颅脑爆震伤后高压氧的治疗作用

目的 利用磁共振波谱技术及磁共振弥散加权成像探讨高压氧治疗颅脑爆震伤不同时间段脑局部代谢及水分子运动的变化.方法 90只新西兰大白兔按随机数字表法分成对照组、创伤组和高压氧治疗组,后2组采用600 mg TNT当量纸雷管在兔脑上方6.5 cm垂直距离爆炸制作颅脑爆震伤模型,高压氧治疗组待生命体征稳定后即给予不同疗程的高压氧治疗.于模型制作后1 d、3 d、7 d、14d、21 d等时间点观察兔存活情况,磁共振波谱观察乙酰天门冬氨酸(NAA)/肌酸(Cr)、NAA/胆碱(Cho)+Cr随时间发展的演变过程,磁共振弥散加权成像观察表观弥散系数(ADC)值随时间发展的演变过程.结果 创伤组NAA/Cr均值在损伤后明显下降,7 d后有所回升,高压氧治疗组NAA/Cr均值较创伤组高,比较差异有统计学意义(P＜0.05).创伤组NAA/Cho+Cr均值在损伤后即明显降低,高压氧治疗组NAA/Cho+Cr均值较创伤组高,比较差异有统计学意义(P＜0.05).创伤组兴趣区ADC值在1 d时明显下降,3 d后逐渐上升,高压氧治疗组ADC值均较创伤组高,比较差异有统计学意义(P＜0.05).结论 高压氧可通过改善局部神经元代谢、抑制脑水肿、增强局部胶质增生修复等改善颅脑爆震伤的预后,伤后早期干预可能更有利.

Abstract：

Objective To evaluate the role of magnetic resonance spectroscopy (MRS) and diffusion-weighted MRI (DWI) in detecting regional cerebral metabolic changes and changes of water molecular motion in rabbits after explosive brain injury at different time points of injury after being treated with hyperbaric oxygen therapy. Methods Ninety New Zealand white rabbits were divided into control group, trauma group and hyperbaric oxygen treatment group. The injured models in the later 2 groups were established using 600 mg TNT equivalent of paper detonators in the rabbit brain at the top of 6.5 cm vertical distance. Rabbits in the trauma group and hyperbaric oxygen treatment group were sub-divided into 1, 3, 7, 14 and 21 d treatment groups, respectively. The survival of these rabbits was observed at these time points. Hyperbaric oxygen treatments lasting for 1, 3, 7, 14 and 21 d were given to each hyperbaric oxygen treatment sub-groups, respectively. Performance under MRS was detected and dynamic changes of N-acetylaspartate (NAA)/creatine (Cr) ratio and NAA/choline(Cho)+Cr value were observed with MRS. DWI was employed to detect the dynamic changes of apparent diffusion coefficient (ADC) values. Results The NAA/Cr ratio in the trauma group markedly decreased right after the injury and slightly rose 7 d after the injury. Compared with that in the trauma group, the NAA/Cr ratio in the hyperbaric oxygen treatment group was significantly increased (P＜0.05). The NAA/Cho+Cr value in the trauma group was markedly decreased right after the injury, while that in the hyperbaric oxygen treatment group was obviously increased as compared with that in the trauma group (P＜0.05). ADC values in the region of interest of the trauma group was decreased after 1 d of treatment and gradually increased after 3 d of treatment; the ADC values in the hyperbaric oxygen treatment group was obviously higher than those in the trauma group (P＜0.05). Conclusion Hyperbaric oxygen might improve the prognosis by improving local metabolism of neurons, inhibiting brain edema, and enhancing local gliosis repair;, ultra-early intervention (within one week of injury) may be much favorable for animals/patients after explosive brain injury.