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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1、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1、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。
Objective To investigate the effect of early hyperbaric oxygen therapy on postoperative neurological function in patients with severe craniocerebral injury. Methods Seventy-eight patients with severe craniocerebral injury who received postoperative recovery from the Department of Neurosurgery, People’s Liberation Army No.105 Hospital and Lianyungang First People’s Hospital from March 2011 to April 2014 were divided into three groups according to random number table Cases and control group 40 cases, the early group within 3 d after the start of hyperbaric oxygen therapy; control group 7 days after surgery began hyperbaric oxygen therapy. Postoperative dynamic review of brain CT, compared the duration of brain edema in both groups; Glasgow Coma Scale (GCS), postoperative 1, 2, 3 Month National Institutes of Health neurological deficit score (NIHSS). Results The duration of brain edema in early stage was (10.39 ± 4.05) d, which was significantly lower than that in control group (12.65 ± 4.42) d, the difference was statistically significant (t = 23.45, P <0.05). The scores of GCS in the control group were (7.68 ± 1.49) points, (9.38 + 1.51) points, (10.28 ± 1.55) points and (11.13 ± 1.68) points respectively at 1, 2, (GCS) scores were (8.63 ± 1.28) points, (10.08 ± 1.26) points, (11.03 ± 1.31) points and (12.13 ± 1.32) points at 3 and 4 weeks respectively. Compared with the control group, GCS score of the early stage group was significantly higher , The difference was statistically significant (F = 11.23, P <0.05). The NIHSS scores of the control group were (13.55 ± 2.54), (9.05 ± 2.46) and (6.43 ± 2.19) points respectively at 1, 2 and 3 months after operation. The scores of NIHSS in the early, ± 2.09), (7.90 ± 2.14) and (5.24 ± 1.98) points respectively. Compared with the control group, the neurological deficits in the early stage group were significantly decreased (F = 25.32, P <0.05). Conclusions The patients with severe craniocerebral injury undergoing early hyperbaric oxygen therapy can shorten the duration of cerebral edema, improve the postoperative consciousness and reduce the neurological deficits.