中华航海医学与高气压医学杂志
中華航海醫學與高氣壓醫學雜誌
중화항해의학여고기압의학잡지
CHINESE JOURNAL OF NAUTICAL MEDICINE AND HYPERBARIC MEDICINE
2014年
1期
11-14
,共4页
于连荣%李学慧%李志才%骆晓梅%江小伟%穆小萍%陈梅香%柳青
于連榮%李學慧%李誌纔%駱曉梅%江小偉%穆小萍%陳梅香%柳青
우련영%리학혜%리지재%락효매%강소위%목소평%진매향%류청
高压氧%脑挫裂伤%一氧化氮%内皮素-1
高壓氧%腦挫裂傷%一氧化氮%內皮素-1
고압양%뇌좌렬상%일양화담%내피소-1
Hyperbaric oxygen%Brain contusion and laceration%Nitric oxide%Endotelin-1
目的 观察高压氧(hyperbaric oxygen,HBO)综合治疗对急性脑挫裂伤患者血浆一氧化氮(NO)、内皮素-1(ET-1)含量的影响.方法 82例急性脑挫裂伤患者,按患方意愿分组成常规治疗组(常规组,42例)和HBO综合治疗组(HBO组,40例);另选40名健康体检者作为正常对照组(对照组).常规组给予必要的常规药物治疗,如使用脱水剂(20％甘露醇或甘油果糖)降低颅内压、糖皮质激素、亚低温疗法、神经细胞营养剂、止痛、止血、抗感染、维持水电解质平衡、防治外伤性癫痫等;HBO组在常规治疗的基础上加用HBO治疗2个疗程.常规组和HBO组于伤后8h和1、2、3、5、7、10、14、17、21d共10个时间点抽取静脉血,分别用硝酸还原酶法、放免分析法测定血浆NO、ET-1含量;对照组于体检时抽1次血,作相应指标检测.结果 常规组,伤后各时间点血浆ET-1平均含量[最高和最低分别为(156.36±35.20)、(78.42 ±23.02) ng/L]明显高于对照组[(40.95±1 1.89) ng/L],差异均有统计学意义(P＜0.01),其中,8h和14d时出现2个高峰,分别达到(116.43 ±36.55)、(156.36 ±35.20) ng/L;伤后各时间点NO含量[最高和最低分别为(49.22 ±2.65)、(34.54 ±3.82) μmol/L]明显低于对照组[(60.59±3.38) μmol/L],差异均有统计学意义(P＜0.01).HBO组,治疗1d后ET-1平均含量开始下降,1～14 d时[最高和最低分别为(58.92 ±13.50)、(51.95±14.32) ng/L]与对照组比较差异均有统计学意义(P＜0.01);17、21 d时接近对照组,差异无统计学意义(P＞0.05).但HBO组各时间点ET-1平均含量均明显低于常规组,差异均有统计学意义(P＜0.01);各时间点NO平均含量[最高和最低分别为(61.28 ±3.46)、(42.26 ±2.46) μmol/L]均高于常规组,差异均有统计学意义(P＜0.05或P＜0.01).结论 急性创伤性脑挫裂伤患者血浆ET-1的升高及NO的降低贯穿于脑损伤变化的全过程;HBO治疗可显著改变急性脑挫裂伤患者血浆ET-1和NO含量,减轻脑组织损伤,促进神经功能恢复,从而提高临床疗效.
目的 觀察高壓氧(hyperbaric oxygen,HBO)綜閤治療對急性腦挫裂傷患者血漿一氧化氮(NO)、內皮素-1(ET-1)含量的影響.方法 82例急性腦挫裂傷患者,按患方意願分組成常規治療組(常規組,42例)和HBO綜閤治療組(HBO組,40例);另選40名健康體檢者作為正常對照組(對照組).常規組給予必要的常規藥物治療,如使用脫水劑(20％甘露醇或甘油果糖)降低顱內壓、糖皮質激素、亞低溫療法、神經細胞營養劑、止痛、止血、抗感染、維持水電解質平衡、防治外傷性癲癇等;HBO組在常規治療的基礎上加用HBO治療2箇療程.常規組和HBO組于傷後8h和1、2、3、5、7、10、14、17、21d共10箇時間點抽取靜脈血,分彆用硝痠還原酶法、放免分析法測定血漿NO、ET-1含量;對照組于體檢時抽1次血,作相應指標檢測.結果 常規組,傷後各時間點血漿ET-1平均含量[最高和最低分彆為(156.36±35.20)、(78.42 ±23.02) ng/L]明顯高于對照組[(40.95±1 1.89) ng/L],差異均有統計學意義(P＜0.01),其中,8h和14d時齣現2箇高峰,分彆達到(116.43 ±36.55)、(156.36 ±35.20) ng/L;傷後各時間點NO含量[最高和最低分彆為(49.22 ±2.65)、(34.54 ±3.82) μmol/L]明顯低于對照組[(60.59±3.38) μmol/L],差異均有統計學意義(P＜0.01).HBO組,治療1d後ET-1平均含量開始下降,1～14 d時[最高和最低分彆為(58.92 ±13.50)、(51.95±14.32) ng/L]與對照組比較差異均有統計學意義(P＜0.01);17、21 d時接近對照組,差異無統計學意義(P＞0.05).但HBO組各時間點ET-1平均含量均明顯低于常規組,差異均有統計學意義(P＜0.01);各時間點NO平均含量[最高和最低分彆為(61.28 ±3.46)、(42.26 ±2.46) μmol/L]均高于常規組,差異均有統計學意義(P＜0.05或P＜0.01).結論 急性創傷性腦挫裂傷患者血漿ET-1的升高及NO的降低貫穿于腦損傷變化的全過程;HBO治療可顯著改變急性腦挫裂傷患者血漿ET-1和NO含量,減輕腦組織損傷,促進神經功能恢複,從而提高臨床療效.
목적 관찰고압양(hyperbaric oxygen,HBO)종합치료대급성뇌좌렬상환자혈장일양화담(NO)、내피소-1(ET-1)함량적영향.방법 82례급성뇌좌렬상환자,안환방의원분조성상규치료조(상규조,42례)화HBO종합치료조(HBO조,40례);령선40명건강체검자작위정상대조조(대조조).상규조급여필요적상규약물치료,여사용탈수제(20％감로순혹감유과당)강저로내압、당피질격소、아저온요법、신경세포영양제、지통、지혈、항감염、유지수전해질평형、방치외상성전간등;HBO조재상규치료적기출상가용HBO치료2개료정.상규조화HBO조우상후8h화1、2、3、5、7、10、14、17、21d공10개시간점추취정맥혈,분별용초산환원매법、방면분석법측정혈장NO、ET-1함량;대조조우체검시추1차혈,작상응지표검측.결과 상규조,상후각시간점혈장ET-1평균함량[최고화최저분별위(156.36±35.20)、(78.42 ±23.02) ng/L]명현고우대조조[(40.95±1 1.89) ng/L],차이균유통계학의의(P＜0.01),기중,8h화14d시출현2개고봉,분별체도(116.43 ±36.55)、(156.36 ±35.20) ng/L;상후각시간점NO함량[최고화최저분별위(49.22 ±2.65)、(34.54 ±3.82) μmol/L]명현저우대조조[(60.59±3.38) μmol/L],차이균유통계학의의(P＜0.01).HBO조,치료1d후ET-1평균함량개시하강,1～14 d시[최고화최저분별위(58.92 ±13.50)、(51.95±14.32) ng/L]여대조조비교차이균유통계학의의(P＜0.01);17、21 d시접근대조조,차이무통계학의의(P＞0.05).단HBO조각시간점ET-1평균함량균명현저우상규조,차이균유통계학의의(P＜0.01);각시간점NO평균함량[최고화최저분별위(61.28 ±3.46)、(42.26 ±2.46) μmol/L]균고우상규조,차이균유통계학의의(P＜0.05혹P＜0.01).결론 급성창상성뇌좌렬상환자혈장ET-1적승고급NO적강저관천우뇌손상변화적전과정;HBO치료가현저개변급성뇌좌렬상환자혈장ET-1화NO함량,감경뇌조직손상,촉진신경공능회복,종이제고림상료효.
Objective To observe the effects of comprehensive hyperbaric oxygen (HBO) therapy on the plasma levels of nitric oxide (NO) and endothelin-1 (ET-1) in patients with acute brain contusion and laceration.Methods With the knowledge and consent of the patients,82 patients with acute brain contusion and laceration were randomly divided into 2 groups:the routine treatment group (n =42) and the HBO group (n =40).Another 40 physical examinees were selected as the normal control group.The routine treatment group was given necessary routine drug therapy,including the applications of dehydrant (20％ mannitol or glycerol and fructose) for reducing intracranial pressure,glucocorticoid,mild hypothermia therapy,nerve cell nutrients,analgesia and hemostasis,anti-infection,the maintenance of electrolyte balance,as well as the prevention and treatment of traumatic epilepsy.The HBO group received 2 courses of HBO therapy,in addition to routine drug treatment.For the routine therapy group and the HBO group,blood samples were collected at 10 time points after injury:at hour 8 and at days 1,2,3,5,7,10,14,17,and 21.Plasma levels of NO and ET-1 were measured respectively with Griess methods and radioimmunoassay (RIA).Blood samples of the control group were taken just once and elated measurements were also made accordingly.Results For the routine therapy group,the average peak and bottom levels of ET-1 at all the time points after injury were [(156.36 ± 35.20) ng/L and (78.42 ± 23.02) ng/L] respectively,which were significantly higher than that of the control group [(40.95 ± 11.89)ng/L],with statistical significance(P ＜0.01).Two peak levels [(116.43 ± 36.55)ng/L and (156.36 ± 35.20)ng/L] were shown at hour 8 and day 14.The average peak and bottom levels of NO at all the time points after injury were [(49.22 ± 2.65) and (34.54 ± 3.82) μmol/L]respectively,which were significantly higher than that of the control group [(60.59 ± 3.38) mol/L],also with statistical significance(P ＜0.01).For the HBO group,the average peak and bottom levels of ET-1 at day 1 after therapy began to drop,the peak and bottom levels of ET-1 at day 1-14 after therapy were [(58.92 ± 13.50)ng/L and(51.95 ± 14.32)ng/L] respectively,and statistical significance could he noted,as compared with those of the control group(P ＜0.01).ET-1 at day 17 and 21 reached the same levels of the control group,but without statistical significance (P ＞ 0.05).However,the average levels of ET-1 for the HBO group at various time points were all significantly lower than those of the routine treatment group,with statistical significance(P ＜ 0.01).The average peak and bottom levels of NO at various time points were [(61.28 ± 3.46) μmol/L and (42.26 ± 2.46) μmol/L],which were all significantly higher than those of the routine therapy group,with statistical significance (P ＜ 0.05 or P ＜ 0.01).Conclusions The increase of ET-1 concentration in the plasma of patients with acute brain contusion and laceration and the decrease of NO concentration were involved in the changes of brain injury during the processes after brain injury.HBO therapy could significantly change plasma ET-1 and NO levels,which might help to alleviate cerebral injury,promote recovery of neural function,thus improving therapeutic effects clinically.
