高压氧配合治疗重型颅脑损伤疗效的研究.docVIP

高压氧配合治疗重型颅脑损伤疗效的研究 　　摘 要 目的：探讨高压氧对重型颅脑损伤的疗效。方法：将64例重型颅脑损伤患者随机分为两组，常规治疗组32例行神经外科常规治疗，包括脱水、降颅压、止血、抗感染、营养脑细胞等对症处理。常规外科治疗+高压氧治疗组32例除与常规治疗组相同治疗外，患者经临床抢救，生命体征平稳后，加用高压氧治疗3个疗程后进行GCS、GOS评分。结果：两组患者治疗前GCS、GOS评分比较，差异无统计学意义(P＞0.05)，治疗3个疗程后HBO组患者GCS评分明显提高与常规组比较差异有显著统计学意义(P＜0.01)，GOS评分较常规组升高，差异有统计学意义(P＜0.05)。结论：高压氧在配合治疗重型颅脑损伤有较好的疗效。 　　关键词 高压氧 重型颅脑损伤 疗效 　　doi:10.3969/j.issn.1007-614x.2012.07.044 　　Abstract Objectives:To discuss the therapeutic effect of hyperbaric oxygenation(HBO)on severe craniocerebral injury.Methods:64 patients with severe craniocerebral injury were divided into 2 groups Common therapy group(32 patients)received standardized treatment of neurosurgery including dehydration,lowering the intracranial hypertension,bleeding control,anti-infection,neurotrophic therapy,et al.Common therapy group+HBO group(32 patients)received 3 course of HBO treatment after common therapy when they were in stable condition with vital signs stable after the first aid.Then GCS,GOS were used to assess the condition.Before the treatment there were no significant difference between the two groups.After the treatment GCS of HPO group rised sharply and had significant difference with common therapy group(P＜0.01).GOS rised higher than common therapy group.There were statistical differences between two groups(P＜0.05).Conclusion:HBO has therapeutic effect on severe craniocerebral injury. 　　Key Words Severe craniocerebral injury;Hyperbaric oxygenation;Therapeutic effect 　　重型颅脑损伤定义为Glasgow昏迷量表(GCS)评分8分或以下，是死亡和致残的主要原因［1］，特别是年青人。2009～2010年收治重型颅脑损伤患者64例，随机分为两组，分别进行常规的外科治疗和常规外科治疗+高压氧治疗，报告如下。 　　资料与方法 　　本组患者64例，男56例，女8例，年龄14～74岁，平均43土5岁。损伤性质：重度脑挫裂伤36例，颅内血肿12例。原发性脑干损伤9例，弥漫性轴索损伤6例。GCS计分，重型(6～8分)48例。特重型(3～5分)16例。其中单纯血肿清除16例，血肿清除加去骨瓣减压42例，挫裂伤脑组织清除加去骨瓣减压21例，保守治疗17例。昏迷64例，去大脑强直23例，肢体偏瘫31例，气管切开28例。 　　方法：对照组给予神经外科常规治疗：根据病情给予脱水剂、止血药、抗生素、脑细胞营养药、适当应用皮质激素、促醒药物及头部降温等治疗；伴有精神症状给予适量的镇静药或冬眠疗法；有手术指征行急诊手术。HBO治疗组除行与常规治疗组相同治疗外，患者经临床抢救生命体征平稳后，在常规治疗的基础上，进行高压氧治疗(脑脊液漏及气颅者除外)，最早为伤后2天最晚为伤后7天加用高压氧治疗。采用多人医用加压空气舱，患者平卧担架入舱。