高压氧治疗对中重型颅脑损伤患者血清C反应蛋白和肿瘤坏死因子-α的影响及疗效分析

目的 观察高压氧(HBO)治疗对外伤性中、重型颅脑损伤患者血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)的影响及其治疗效果.方法 将108例外伤性中、重型颅脑损伤患者按完全随机设计分组法分为对照组和高压氧组,每组54例.对照组行必要的神经外科处理及常规药物治疗;高压氧组在上述治疗的基础上,在病情稳定后加用高压氧治疗1个疗程,压力0.2 Mpa(2.0 ATA),每日1次,共10次.治疗前、后分别采用免疫比浊法和ELISA法检测血清CRP、TNF-α水平,采用格拉斯哥昏迷量表(GCS)进行评分;伤后6个月随访时采用格拉斯哥预后量表(GOS)进行评估.结果 治疗前,2组患者CRP、TNF-α水平及GCS评分比较,差异均无统计学意义(P＞0.05);治疗后,2组CRP、TNF-α水平均较治疗前明显降低(P＜0.05),GCS评分较治疗前均明显提高(P＜0.05);与对照组比较,高压氧组CRP、TNF-α水平降低及GCS评分提高更为明显(P＜0.05);伤后6个月GOS评估结果显示,高压氧组预后良好患者明显多于对照组(P＜0.05).结论 高压氧辅助治疗可明显降低颅脑损伤患者血清CRP、TNF-α水平,促进神经功能的恢复,提高临床疗效.

Abstract：

Objective To investigate effects of hyperbaric oxygen (HBO) therapy on C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) levels in patients with moderate or severe traumatic brain injury (TBI)and to analyze its therapeutic efficacy. Methods One hundred and eight patients with moderate or severe TBI were randomly divided into a control group (54 cases) and an HBO adjunctive therapy group (HBO group, 54 cases).Both groups received essential neurosurgical treatment and conventional drug treatment, and the HBO group was given one session of HBO therapy in addition. Serum CRP and TNF-α were detected, and the scores on the Glasgow coma scale (GCS) were measured before and after treatment. CRP was detected by turbidimetric immunoassay and TNF-α using ELISA. Glasgow outcome scale (GOS) scores were evaluated in a follow-up 6 months after injury. Results Average CRP, TNF-α and GCS measurements showed no statistically significant difference between the groups before treatment. After treatment, CRP and TNF-α were significantly lower and GCS scores significantly better in both groups, but patients in the HBO group were, on average, significantly better than the controls on all three measures.Six months later, GOS evaluation gave a significantly larger number of patients with a better prognosis in the HBO group compared with the controls. Conclusion HBO therapy can significantly decrease serum CRP and TNF-α after severe TBI, thus enhancing therapeutic efficacy.