CAJ | 학술논문

目的探讨高压氧(hyperbaric oxygen,HBO)联合盐酸纳洛酮对重型颅脑损伤后昏迷患者的临床疗效.方法 299例重型颅脑损伤后昏迷患者按患方意愿分成HBO组(94例)、盐酸纳洛酮组(82例)、HBO+盐酸纳洛酮组(123例),在常规治疗的基础上,分别给予HBO、盐酸纳洛酮、HBO+盐酸纳洛酮进行相同疗程的治疗,观察治疗前后动态脑电图(EEG)、格拉斯哥昏迷量表(GCS)评分、格拉斯哥预后量表(GOS)评分、远期生活质量评估量表(KPS)评分的变化,并对数据进行统计学处理.结果治疗3个月后,HBO+盐酸纳洛酮组的GCS评分(7.2±2.5)高于HBO组(6.5±2.1),2组比较差异有统计学意义(P<0.05);GOS评分(4.4±0.7)明显高于HBO组(4.1±0.8)及盐酸纳洛酮组(4.0±0.9),2组比较差异有统计学意义(P<0.01).治疗6个月后,HBO+盐酸纳洛酮组EEG功能分级高于盐酸纳洛酮组,2组比较差异有统计学意义(P<0.05);KPS评分明显高于HBO组及盐酸纳洛酮组,差异均有统计学意义(P<0.01).结论 HBO联合盐酸纳洛酮治疗重型颅脑损伤后昏迷患者较单纯应用HBO或盐酸纳洛酮治疗有更好的临床疗效.
목적 탐토고압양(hyperbaric oxygen,HBO)연합염산납락동대중형로뇌손상후혼미환자적림상료효.방법 299례중형로뇌손상후혼미환자안환방의원분성HBO조(94례)、염산납락동조(82례)、HBO+염산납락동조(123례),재상규치료적기출상,분별급여HBO、염산납락동、HBO+염산납락동진행상동료정적치료,관찰치료전후동태뇌전도(EEG)、격랍사가혼미량표(GCS)평분、격랍사가예후량표(GOS)평분、원기생활질량평고량표(KPS)평분적변화,병대수거진행통계학처리.결과 치료3개월후,HBO+염산납락동조적GCS평분(7.2±2.5)고우HBO조(6.5±2.1),2조비교차이유통계학의의(P<0.05);GOS평분(4.4±0.7)명현고우HBO조(4.1±0.8)급염산납락동조(4.0±0.9),2조비교차이유통계학의의(P<0.01).치료6개월후,HBO+염산납락동조EEG공능분급고우염산납락동조,2조비교차이유통계학의의(P<0.05);KPS평분명현고우HBO조급염산납락동조,차이균유통계학의의(P<0.01).결론 HBO연합염산납락동치료중형로뇌손상후혼미환자교단순응용HBO혹염산납락동치료유경호적림상료효.
Objective To investigate effect of HBO combined with naloxone hydrochloride in the treatment of coma following severe craniocerebral trauma.Methods Two hundred and ninety-nine patients with persisting coma following severe craniocerebral trauma were randomly divided into 3 groups: the hyperbaric oxygen group, the naloxone hydrochloride group and the HBO combined with naloxone hydrochloride group. On the basis of conventional therapy, patients were treated with HBO, or naloxone hydrochloride, or HBO combined with naloxone hydrochloride in the same course of treatment. Dynamic EEG, Glasgow coma scale (GCS) scores, Glasgow outcome scale (GOS) scores, long-term quality of Life Assessment Scale (KPS) scores were observed before and after treatment and statistical data were analyzed.Results After 3 months of treatment, GCS scores for the patients in the HBO combined with naloxone hydrochloride group were higher than those of the HBO group(P<0.05), and GOS scores for the patients in the HBO combined with naloxone hydrochloride group were significantly higher than those of the HBO group or the naloxone hydrochloride group. After 6 months of treatment, the EEG classification in patients of HBO combined with naloxone group was higher than that of the naloxone group, and KPS scores in patients of HBO combined with naloxone group were significantly better than those of the hyperbaric oxygen group and the naloxone hydrochloride group. After 6 months, the EEG classification, KPS scores for the patients in the HBO combined with naloxone hydrochloride group were significantly higher than those of the HBO group or the naloxone hydrochloride group(P<0.01).Conclusions HBO treatment combined with naloxone hydrochloride could produce better effect on patients with persistent coma following severe craniocerebral trauma, when comparisons were made with HBO and naloxone hydrochloride.