CAJ | 학술논문

目的观察早期高压氧治疗重型颅脑损伤开颅术后患者的疗效,并分析格拉斯哥昏迷评分(GCS)6～8分及GCS 3～5分患者的疗效区别.方法采用病例对照研究,入选2009年2月6日至2010年11月25日的重型颅脑损伤患者61例,采用随机数字表法分为高压氧组30例和对照组31例,记录患者入院时、高压氧治疗前、完成高压氧治疗时的GCS;记录高压氧治疗前、完成高压氧治疗时及入院后3个月的格拉斯哥预后评分(GOS).结果高压氧组及GCS 3～5分的高压氧组患者完成高压氧治疗时GCS分别为(12.63±2.70)、( 11.64±2.50)分,与相应对照组的(10.61±3.01)、(8.44±1.67)分比较差异均有统计学意义(P＜0.05)；高压氧组及GCS 3～5分的高压氧组患者完成高压氧治疗时GOS改善程度(△ GOSf)及入院后3个月GOS改善程度(△GOS3M)平均秩次分别为35.37、12.14和35.87、13.09,与相应对照组的26.77、8.05和26.29、7.33比较差异均有统计学意义(P＜0.05)；但GCS6～8分的高压氧组患者的△COSf和△COS3M平均秩次,与相应对照组比较差异均无统计学意义(P＞0.05).结论对重型颅脑损伤开颅术后患者总体而言,早期高压氧治疗有促进意识恢复及改善预后的作用；且对特重型(GCS3～5分)患者疗效更为显著.
목적 관찰조기고압양치료중형로뇌손상개로술후환자적료효,병분석격랍사가혼미평분(GCS)6～8분급GCS 3～5분환자적료효구별.방법 채용병례대조연구,입선2009년2월6일지2010년11월25일적중형로뇌손상환자61례,채용수궤수자표법분위고압양조30례화대조조31례,기록환자입원시、고압양치료전、완성고압양치료시적GCS;기록고압양치료전、완성고압양치료시급입원후3개월적격랍사가예후평분(GOS).결과 고압양조급GCS 3～5분적고압양조환자완성고압양치료시GCS분별위(12.63±2.70)、( 11.64±2.50)분,여상응대조조적(10.61±3.01)、(8.44±1.67)분비교차이균유통계학의의(P＜0.05)；고압양조급GCS 3～5분적고압양조환자완성고압양치료시GOS개선정도(△ GOSf)급입원후3개월GOS개선정도(△GOS3M)평균질차분별위35.37、12.14화35.87、13.09,여상응대조조적26.77、8.05화26.29、7.33비교차이균유통계학의의(P＜0.05)；단GCS6～8분적고압양조환자적△COSf화△COS3M평균질차,여상응대조조비교차이균무통계학의의(P＞0.05).결론 대중형로뇌손상개로술후환자총체이언,조기고압양치료유촉진의식회복급개선예후적작용；차대특중형(GCS3～5분)환자료효경위현저.
Objective To evaluate the effect of hyperbaric oxygen therapy (HBOT) in patients with severe traumatic brain injury (STBI) after craniotomy,and evaluate the difference of HBOT effects on the patients whose Glasgow coma score (GCS) were 6-8 scores and 3-5 scores.Methods Using case-control study,61 neurosurgical in-patients with STBl from February 6,2009 to November 25,2010 were divided into two groups by random digits table,30 in HBOT group and 31 in control group.Their GCS at the periods on admission,before HBOT and when they finished HBOT were recorded,as well as the Glasgow outcome score (GOS) before HBOT,finished HBOT,and 3 months after admission (GOS3M).Results The GCS finished HBOT were (12.63 ±2.70) scores in HBOT group and (11.64 ±2.50) scores in GCS 3-5 subgroup,there were statistically differences than those in control group [ (10.61± 3.01 ),(8.44 ± 1.67)scores] (P ＜0.05).The mean rank of GCS finished HBOT improvement (△GOSf) and GOS scores 3months after admission ( △ GOS3M) in HBOT group was 35.37 and 35.87,which were significantly higher than those in control group (26.77 and 26.29) (P ＜0.05).Meanwhile,the mean rank of △GOSf and △ GOS3M in GCS 3-5 subgroup was 12.14 and 13.09,which were significantly higher than those in control group (8.05 and 7.33) (P ＜ 0.05 ).In GCS 6-8 subgroup,there was no significant difference in △ GOSf and △ GOS3M between HBOT group and control group (P ＞ 0.05).Conclusion Early HBOT is effective to improve the recovery of consciousness and prognosis of the postoperative patient with STBI,especially of the patients with the special STBI (GCS 3-5 scores ).