高压氧治疗重型颅脑损伤后临床、脑电地形图、血浆内皮素、经颅多普勒超声的研究

目的研究高压氧（ＨＢＯ）治疗重型颅脑损伤（ＳＥＩ）的疗效及机制。方法治疗组３５例，对照组２０例，观察ＨＢＯ前后脑电地形图（ＢＥＡＭ）血浆内皮素（ＥＴ）及经颅多普勒超声（ＴＣＤ）查大脑中动脉收缩期流速，平均流速及搏动指数（ＭＣＡ－Ｖｓ，Ｖｍ，ＰＩ）等７项参数。结果治疗组的临床（ＧＣＳ），ＢＥＡＭ，预后（ＧＯＳ）均明显迅速改善，与对照组有显著性差异。治疗组在ＨＢＯ１疗程后的ＥＴ值从（９１．２４±１２．１８）ｎｇ／Ｌ降到（６８．８８±１４．３７）ｎｇ／Ｌ（Ｐ＜０．０１），与对照组相应时相比较，ＥＴ降至（８３．１２±１２．２２）ｎｇ／Ｌ，也有显著性差异（Ｐ＜０．０５）。相应的ＴＣＤ的ＭＣＡ－Ｖｍ从（６４．２±４．８）ｃｍ／ｓ降至（５１．６±４．２）ｃｍ／ｓ（Ｐ＜０．０１），ＭＣＡ－Ｖｓ，ＰＩ的下降同样有极显著性差异（Ｐ＜０．０１）。结论ＨＢＯ能迅速改善重型颅脑损伤者的意识状态、ＢＥＡＭ异常率及生存质量。研究表明与急性期血浆ＥＴ下降和ＭＣＡ血管痉挛缓解有关，表现在ＭＣＡ血流速度和血管阻力的改善，从而减轻脑缺血缺氧，降低颅压，这是ＨＢＯ改善预后的重要机制之一。

Studies of Brain Electrical Activity Map, Endothelin, Transcranial Doppler After Hyperbaric Oxygen Therapy in Severe Craniocerebral Injured Patients

Objective To study the efficacy and mechanism of hyperbaric oxygen (HBO) therapy for severe craniocerebral injury (SCI). Methods Patients were divided into therapeutic group treated with HBO (35 patients) and control group (20 patients). Alterations of brain electrical activity map (BEAM), plasma endothelin (ET), transcranial Doppler (TCD) were detected before and after HBO therapy. Results BEAM improved obviously and ET reduced greatly in the therapeutic group compared those in the control group (P<001). Conclusions HBO could improve the consciousness state, BEAM and prognosis of SCI patients as a result of the relaxation of the cerebral vascular spasm and the reduction of ET, which may contribute to the abatement of the cerebral ischemia and hypoxia. This is one of the important mechanisms of BHO therapy to improve prognosis for SCI patients.