高压氧治疗颅内破裂动脉瘤血管痉挛的疗效探讨

目的探讨高压氧(HBO)综合治疗发生血管痉挛的颅内动脉瘤的效果。方法 80例发生血管痉挛的破裂动脉瘤患者,经过手术或介入治疗后,随机分为高压氧(HBO)组(40例)和对照组(40例),在治疗前、治疗后1个月,超声多普勒记录大脑中动脉平均血流速度来反映血管痉挛情况;治疗前及治疗后36 d,均采用简明精神状态检查量表(MMSE)和日常活动能力量表(ADL)评估认知功能。结果两组病例均出现有严重血管痉挛患者死亡,对照组4例,高压氧组3例;治疗后,高压氧组血管痉挛较对照组低,差异呈显著性(P0.05),MMSE、ADL评分与对照组比较,差异均显著(P0.05)。结论早期联合高压氧的综合治疗可以缓解血管痉挛,改善血管痉挛导致的认知障碍。

Combined hyperbaric oxygen therapy for cerebral vasospasm induced by ruptured aneurysms

Objective The effect of hyperbaric oxygen therapy （HBO） on cerebral vasospasm after surgery in the patients of aneurysm is studied.Methods Eighty aneurysm patients suffered cerebral vasospasm after the surgery were randomly divided into HBO treatment group （40 cases） and conventional treatment group （40 cases）.The cerebral vasospasm was evaluated by average blood velocity of cerebral middle artery detected by transcranial Doppler sonography （TCD）.The cognitive function was determined by mini-mental state examination （MMSE） and activities of daily life （ADL） before and 36 d after the treatment in all the patients.Results Four patients from control group and 3 patients from observed group died of severe cerebral vasospasm.The average blood velocity of cerebral middle artery （MCA） was （150.5±19.47） cm/s and （116.8 ±7.05） cm/s before treatment and 30 d after treatment in control group,respectively.It was （149.9±17.28） cm/s and （106.7 ±6.91） cm/s before treatment and 30 d after treatment in HBO group,respectively.Compared with control group after treatment,the average blood velocity of cerebral middle artery was lower in HBO group.The difference was significant （P 〈0.05）.MMSE scores were （3 ± 1.9） points and （28 ± 4.6） points before treatment and 36 d after HBO in HBO group,respectively.The MMSE scores were （22 ± 2.4） points and （26 ± 1.8） points before and 30 d after the treatment in the conventional treatment group,respectively.ADL scores were （47 ± 2.8） points and （24 ± 2.2） points before and 36 d after HBO in HBO group,respectively.ADL scores were （46 ±3.8） points and （35 ±2.4） points before and 36 d after the treatment,respectively.There was significant difference in MMSE and ADL scores 36 d after the treatment between HBO and conventional treatment groups （P 〈0.05）.Conclusion The severe cerebral vasospasm after aneurysmal subarachnoid hemorrhage （SAH） may cause the death.Cognitive dysfunction caused by aneurismal vasospasm may be improved by combined HBO treatment in aneurysmal SAH patients.