CAJ | 학술논문

目的观察早期康复治疗对重型创伤性脑损伤(severe traumatic brain injury,sTBI)患者的临床疗效. 方法采用随机数字表法将符合纳入标准的40例sTBI患者分为治疗组(20例)和对照组(20例).两组患者均给予脱水降颅压、止血、营养脑神经、抗炎、抑酸等常规治疗.治疗组在此基础上早期增加康复高压氧、正中神经电刺激、小脑顶核电刺激及床旁运动治疗.治疗期间连续监测两组患者颅内压及脑组织氧分压(partial pressure of brain tissue oxygen,PbtO2).治疗前、治疗后15d对患者,进行GCS评分,并行单光子发射CT扫描(single-photon emission computed tomography,SPE-CT)检查评价脑血流灌注情况. 结果治疗前两组患者GCS评分差异无统计学意义(P＞0.05).治疗后治疗组GCS评分为(10.18±3.75)分,对照组为(8.33±2.36)分(P＜0.05),其中治疗组改善更显著.治疗组脑血流灌注较治疗前明显改善.从治疗第5天开始,治疗组颅内压明显低于对照组(P＜0.05).从治疗第6天开始,治疗组PbtO2明显高于对照组(P＜0.05). 结论早期康复治疗可提高sTBI患者的临床疗效,对加速神经功能恢复具有积极作用.
목적 관찰조기강복치료대중형창상성뇌손상(severe traumatic brain injury,sTBI)환자적림상료효. 방법 채용수궤수자표법장부합납입표준적40례sTBI환자분위치료조(20례)화대조조(20례).량조환자균급여탈수강로압、지혈、영양뇌신경、항염、억산등상규치료.치료조재차기출상조기증가강복고압양、정중신경전자격、소뇌정핵전자격급상방운동치료.치료기간련속감측량조환자로내압급뇌조직양분압(partial pressure of brain tissue oxygen,PbtO2).치료전、치료후15d대환자,진행GCS평분,병행단광자발사CT소묘(single-photon emission computed tomography,SPE-CT)검사평개뇌혈류관주정황. 결과 치료전량조환자GCS평분차이무통계학의의(P＞0.05).치료후치료조GCS평분위(10.18±3.75)분,대조조위(8.33±2.36)분(P＜0.05),기중치료조개선경현저.치료조뇌혈류관주교치료전명현개선.종치료제5천개시,치료조로내압명현저우대조조(P＜0.05).종치료제6천개시,치료조PbtO2명현고우대조조(P＜0.05). 결론 조기강복치료가제고sTBI환자적림상료효,대가속신경공능회복구유적겁작용.
Objective To investigate the clinical effect of early rehabilitation treatment on patients with severe traumatic brain injury (sTBI).Methods Forty sTBI patients were divided into treatment group (n =20) and control group (n =20) according to the random number table.Conventional treatment was performed on all patients including dehydration to decrease intracranial pressure,hemorrhage control,neurotrophic treatment,antiinflammation therapy,and gastric acid control.In addition to these interventions,patients in treatment group received hyperbaric oxygen treatment,median nerve stimulation,fastigial nucleus stimulation,and bedside motor therapy in the early period.Intracranial pressure and partial pressure of brain tissue oxygen (PbtO2) were continuously monitored during the process of treatment.GCS was measured before and 15 days after treatment and single-photon emission computed tomography (SPE-CT) was used to evaluate cerebral perfusion.Results There was no statistical difference between the two groups with respect to GCS in advance of treatment (P ＞ 0.05),but GCS differed between treatment group and control group after treatment [(10.18 ± 3.75) points vs (8.33 ±2.36) points,P ＜0.05],with substantial improvement in treatment group.Significantly improved cerebral perfusion was seen in treatment group.On day 5 after treatment,intracranial pressure in treatment group lowered significantly compared with that in control group (P ＜ 0.05).On day 6 after treatment,PbtO2 was significantly higher in treatment group than in control group (P ＜ 0.05).Conclusion Early rehabilitation treatment leads to improved outcome and acts a positive effect on nerve function recovery.