重型颅脑损伤开颅术后高压氧治疗的临床研究

目的对重型颅脑损伤开颅术后患者早期进行高压氧治疗,以评估治疗这类患者的效果。方法采用病例对照研究,选择我院2009年1月1日~2010年10月1日重型颅脑损伤行开颅术后5~9天的患者60例,高压氧治疗组和对照组（非高压氧治疗组）各30例,观察患者入院时及高压氧治疗前、后1、2、3、4周的GCS评分;比较高压氧治疗开始前、高压氧治疗4周、入院后3月的随访GOS分级提高的患者数;比较高压氧治疗4周和入院后3月内的气管套管拔除例数。结果两组患者高压氧治疗后1周GCS评分比较无统计学差异（P〉0.05）,高压氧后2、3、4周GCS评分比较均有统计学差异（P〈0.05）;两组两阶段的GOS预后评分提高患者例数比较均有统计学差异（P〈0.05）;两组患者高压氧治疗4周内拔除气管套管例数有统计学差异（P〈0.05）,入院后3月时无统计学差异（P〉0.05）。结论高压氧治疗对重型颅脑损伤开颅术后患者早期意识改善及预后有疗效;对重型颅脑损伤开颅术后且气管切开患者气道恢复早期治疗作用较后期突出。

Clinical research of hyperbaric oxygen therapy on the patients after craniotomy with severe traumatic brain injury

Objective To evaluate the effects of hyperbaric oxygen therapy（HBOT） on the patients after evacuation of intracranial hematoma or craniotomy with severe traumatic brain injury（STBI）.Methods Using case-control study,sixty patients in 5~9 days after surgery with STBI were registered during Jan 1,2009 to Nov 1,2010.They were randomly divided into two groups,thirty in HBOT group and thirty in non-HBOT group.Comparisons between groups were performed on their Glasgow Coma Scale（GCS） scores at the periods on admission,before the HBOT and 1,2,3 and 4 weeks after the HBOT,as well as the numbers of patients who had improvement in Glasgow Outcome Scale（GOS） scores before HBOT,4 weeks after the HBOT and 3 months after admission.The numbers of patients with incision of trachea whose trachea cannula were removed 4 weeks after HBOT and 3 months after admission were also compared between groups.Results There was no significant difference in GCS scores one week after HBOT between two groups（P0.05）,and significant differences between groups were found in GCS scores 2,3 and 4 weeks after HBOT（P0.05）.The numbers of patients who had improvement in GOS scores were significant difference between groups 4 weeks after the HBOT and 3 months after admission（P0.05）.There was significant difference in the numbers of patients whose trachea cannula were removed 4 weeks after the HBOT（P0.05）,but no significant difference was found 3 months after admission（P0.05）.Conclusion HBOT is effective to the improvement of consciousness and prognosis of the postoperative patient with STBI,and contribute to the removal of trachea cannula in the early phase more than in the late phase in severe TBI patients with both craniotomy and tracheotomy.