CAJ | 학술논문

目的：探讨早期高压氧治疗对重型颅脑损伤患者术后神经功能的影响。方法选取解放军第105医院和连云港市第一人民医院神经外科自2011年3月至2014年4月收治的78例术后恢复期的重型颅脑损伤患者，根据随机数字表法分为早期组38例和对照组40例，早期组在术后3 d内开始行高压氧治疗；对照组在手术7 d后开始高压氧治疗。术后动态复查颅脑CT，比较两组患者脑水肿持续时间；分别对两组患者术后1、2、3、4周意识状态进行格拉斯哥昏迷评分(GCS)，术后1、2、3个月进行美国国立卫生院神经功能缺损评分(NIHSS)。结果早期组脑水肿持续时间为(10.39±4.05) d，较对照组的(12.65±4.42) d明显减少，差异有统计学意义(t=23.45，P<0.05)。对照组术后l、2、3、4周GCS评分为(7.68±1.49)分、(9.38±1.51)分、(10.28±1.55)分、(11.13±1.68)分；早期组术后l、2、3、4周GCS评分为(8.63±1.28)分、(10.08±1.26)分、(11.03±1.31)分、(12.13±1.32)分，与对照组比较，早期组术后GCS评分明显升高，差异有统计学意义(F=11.23，P<0.05)。对照组术后1、2、3月NIHSS评分为(13.55±2.54)分、(9.05±2.46)分、(6.43±2.19)分；早期组术后1、2、3月NIHSS评分分别为(12.05±2.09)分、(7.90±2.14)分、(5.24±1.98)分，与对照组比较，早期组神经功能缺失明显减少，差异有统计学意义(F=25.32，P<0.05)。结论重型颅脑损伤患者术后行早期高压氧治疗可显著缩短脑水肿持续时间，改善术后意识状态，减轻神经功能缺损。
목적：탐토조기고압양치료대중형로뇌손상환자술후신경공능적영향。방법선취해방군제105의원화련운항시제일인민의원신경외과자2011년3월지2014년4월수치적78례술후회복기적중형로뇌손상환자，근거수궤수자표법분위조기조38례화대조조40례，조기조재술후3 d내개시행고압양치료；대조조재수술7 d후개시고압양치료。술후동태복사로뇌CT，비교량조환자뇌수종지속시간；분별대량조환자술후1、2、3、4주의식상태진행격랍사가혼미평분(GCS)，술후1、2、3개월진행미국국립위생원신경공능결손평분(NIHSS)。결과조기조뇌수종지속시간위(10.39±4.05) d，교대조조적(12.65±4.42) d명현감소，차이유통계학의의(t=23.45，P<0.05)。대조조술후l、2、3、4주GCS평분위(7.68±1.49)분、(9.38±1.51)분、(10.28±1.55)분、(11.13±1.68)분；조기조술후l、2、3、4주GCS평분위(8.63±1.28)분、(10.08±1.26)분、(11.03±1.31)분、(12.13±1.32)분，여대조조비교，조기조술후GCS평분명현승고，차이유통계학의의(F=11.23，P<0.05)。대조조술후1、2、3월NIHSS평분위(13.55±2.54)분、(9.05±2.46)분、(6.43±2.19)분；조기조술후1、2、3월NIHSS평분분별위(12.05±2.09)분、(7.90±2.14)분、(5.24±1.98)분，여대조조비교，조기조신경공능결실명현감소，차이유통계학의의(F=25.32，P<0.05)。결론중형로뇌손상환자술후행조기고압양치료가현저축단뇌수종지속시간，개선술후의식상태，감경신경공능결손。
Objective To investigate the effects of early hyperbaric oxygen treatment on patients with severe craniocerebral injury on the postoperative neurological function. Methods A total of seventy eight patients with severe traumatic brain injury in recovery period after surgical op-eration were selected for this study. According to the intervention time of hyperbaric oxygenation, they were randomly divided into early group (HBOT within 3 days after operation, n=38) and control group (HBOT without 7 days after operation, n=40). Dynamic head CT scan was performed for detecting and determine the duration of brain edema. Patients’ consciousness were assessed in 1, 2, 3, 4 weeks after the operation by GCS (Glasgow Coma Scale) and the neurological function were performed l, 2, 3 months after the operation by NIHSS (National Institutes of Health Stroke Scale). Results Compared with the control group (12.65 ± 4.42) d, the duration of brain edema in early group (10.39 ± 4.05) d was significantly reduced(P<0.05). The GCS scores were (7.68 ± 1.49), (9.38 ± 1.51), (10.28 ± 1.55), (11.13±1.68) after operation 1, 2, 3, 4 weeks in control group, respectively;and the early group were (8.63 ± 1.28), (10.08 ± 1.26), (11.03 ± 1.31), (12.13 ± 1.32), respectively. Compared with the control group, the GCS score in early group was significantly increased (P<0.05). The NIHSS scores were (13.55 ± 2.54), (9.05 ± 2.46), (6.43 ± 2.19) after operation 1, 2, 3 months in control group, respectively;and the early group were (12.05 ± 2.09), (7.90 ± 2.14), (5.24 ± 1.98). Compared with the control group, the neurological defections were significantly reduced in early group (P<0.05). Conclusion Early hyperbaric oxygen treatment on severe traumatic brain injury patients after surgery can shorten the dura-tion of brain edema significantly, improve the state of consciousness and reduce the neurological func-tion impairment.