高压氧治疗对重型颅脑损伤的临床、脑电地形图和CT的影响

目的 探讨高压氧(HBO)治疗对重型颅脑损伤(SBI)患者的临床、脑电地形图(BEAM)及CT的影响.方法 选择符合SBI的住院患者46例,分为HBO组和对照组.对照组采用普通外科治疗,HBO组在普通外科治疗基础上应用HBO治疗.所有患者在HBO治疗前1～2 d、治疗第1个疗程及第3个疗程后进行格拉斯哥昏迷评分(GCS),同时进行CT和BEAM检查.伤后6个月进行格拉斯哥昏迷结果分级(GOS).结果 HBO组与对照组治疗后第1个疗程和第3个疗程GCS评分比较差异有统计学意义(P＜0.01,P＜0.01);HBO组与对照组良好率(GOSⅤ+GOSⅣ)与植物生存和死亡率(GOSⅡ+GOSⅠ)指标差异有统计学意义(P＜0.05,P＜0.01);HBO组与对照组第1个疗程和第3个疗程BEAM异常率比较差异有统计学意义(P＜0.05,P＜0.05);治疗后2组BEAM和CT异常率比较差异无统计学意义(P＞0.05,P＞0.05).但3例脑干损伤和1例脑挫裂伤患者CT与BEAM异常情况不符合,而BEAM异常情况符合临床.结论 HBO可提高SBI的治愈率,降低残死率;BEAM可能有助于发现CT正常但有临床异常表现的患者.

Effects of hyperbaric oxygen treatment on clinical outcome of severe brain injury,BEAM and CT

Objective To investigate effects of hyperbaric oxygen treatment on clinical outcome of severe brain injury (SBI),as well as brain electric activity mapping (BEAM) and CT. Methods Forty-six cases of SBI were randomly divided into 2 groups,the HBO treatment group and the control group. The control group: the treatment group was administered with ordinary surgical treatment,while the HBO group was given HBO in addition to ordinary surgical treatment. All the patients underwent Glasgow Coma Scale (GCS) assessment,CT and BEAM examinations,1～2 days before HBO treatment and after the first and the third sessions of HBO treatment. And the patients were assessed with GCS 6 months after injury. Results When compared with the control group,GCS score of the HBO treatment group increased significantly after the 1st and 3rd sessions of HBO treatment (P＜0.01,P＜0. 01 ). There were significant differences between the HBO treatnent group and the control group in the rate of fine state (GOS Ⅴ + GOS Ⅵ) (P＜0.05) and the rates of survival (being in the state of vegetable man) and death (GOS Ⅱ+ GOS Ⅰ) (P＜0.01). Significant differences could also be seen in the rate of abnormal BEAM,when comparisons were made between the 2 groups after the 1st and 3rd sessions ( P ＜ 0. 05,P ＜ 0. 05 ). No significant differences were found between the 2 groups in the rates of abnormal BEAM and CT(P ＞0. 05,P ＞0. 05),following treatment. However,CT and BEAM in 3 cases of brain stem injury and 1 case of brain contusion and laceration were not in conformity with clinical symptoms. Conclusions HBO could increase the cure rate of SBI,lower the rates of fatality and disability. BEAM could help to find out patients with normal CT but with abnormal clinical manifestations.