创伤性颅脑损伤后HBO介入的时效性研究

发布时间：2018-04-27 15:23

本文选题：高压氧疗法 + 创伤性颅脑损伤　；参考：《南昌大学》2015年硕士论文

【摘要】：目的:探讨创伤性颅脑损伤患者高压氧介入的最佳时间。方法:选取2013年4月至2014年12月在中国人民解放军第94医院入院后经康复科常规药物治疗或常规药物治疗联合高压氧疗法治疗后的颅脑损伤患者269例进行回顾性分析,其中轻型颅脑损伤患者112例、中型颅脑损伤患者88例、重型颅脑损伤患者69例。根据其是否进行高压氧治疗分成2组,高压氧治疗组和非高压氧治疗组(常规疗法,不介入高压氧疗法)。根据其伤后介入高压氧疗法时间分为4组:A组(伤后15天内)、B组(伤后16~30天)、C组(伤后31天及其31天以上),D组(非高压氧治疗)。治疗组进行3个疗程高压氧治疗,非治疗组不进行高压氧治疗。患者治疗前进行GCS评分,治疗后进行GOS评分。分别就各组进行高压氧治疗后的治疗效果进行比较。结果:(1)比较高压氧治疗组与非高压氧治疗组,治疗后比较两组GOS评分及有效率,其差异有统计学差异(P0.05)。(2)A组患者治疗前GCS评分为9.72±3.56,B组患者治疗前GCS评分9.85±3.24,C组患者治疗前GCS评分9.78±3.72,D组患者治疗前GCS评分9.52±3.44。A组患者治疗后GCS评分为13.94±1.01,B组患者治疗后GCS评分12.61±1.09,C组患者治疗后GCS评分11.78±1.21,D组患者治疗后GCS评分10.73±1.08。(3)A组患者治疗后依照GOS系统评分:1分患者0人,2分患者1人,3分患者1人,4分患者17人,5分患者49人;B组患者治疗后依照GOS系统评分:1分患者0人,2分患者1人,3分患者9人,4分患者21人,5分患者41人;C组患者治疗后依照GOS系统评分:1分患者0人,2分患者4人,3分患者14人,4分患者10人,5分患者37人;D组患者治疗后依照GOS系统评分:1分患者0人,2分患者10人,3分患者19人,4分患者7人,5分患者28人。(4)单因素分析结果表明:职业、文化程度、致伤原因等差异对高压氧疗法治疗颅脑损伤没有统计学意义(P0.05)。年龄、病情差异对高压氧疗法治疗颅脑损伤有统计学意义(P0.05)。结论:(1)单因素分析结果表明:性别、职业、收入、文化程度,受伤方式对高压氧疗法介入创伤性颅脑损伤治疗的疗效没有影响。(2)颅脑损伤患者介入高压氧治疗时且患者损伤程度相等时,高压氧疗法介入治疗颅脑损伤患者越早,疗效愈佳。(3)颅脑损伤患者介入高压氧治疗,高龄患者预后较差。(4)中、重度颅脑损伤患者介入高压氧治疗,其预后效果较之常规治疗组有提高(P0.05),轻度颅脑损伤患者介入高压氧治疗,其预后效果较之常规治疗组没有差异(P0.05)
[Abstract]:Objective: To explore the best time for hyperbaric oxygen intervention in patients with traumatic brain injury. Methods: a retrospective analysis was made in 269 cases of craniocerebral injury after the admission from April 2013 to December 2014 in the ninety-fourth Hospital of the people's Liberation Army, which were treated with conventional medicine or conventional medication combined with hyperbaric oxygen therapy. 112 cases of brain injury, 88 cases of medium craniocerebral injury and 69 cases of severe craniocerebral injury were divided into 2 groups according to whether they were treated with hyperbaric oxygen therapy, the hyperbaric oxygen therapy group and the non hyperbaric oxygen therapy group (routine therapy, no hyperbaric oxygen therapy) were divided into 4 groups according to the intervention time of the interventional hyperbaric oxygen therapy after the injury: A group (15 days after injury), group B (16~ after injury) 30 days), group C (31 days after injury and more than 31 days), group D (non hyperbaric oxygen therapy). The treatment group was treated with 3 courses of hyperbaric oxygen, and the non treatment group did not carry out hyperbaric oxygen therapy. The patients were treated with GCS score before treatment, and after the treatment, the GOS scores were compared. Results: (1) compared with hyperbaric oxygen therapy (1) Group and non hyperbaric oxygen therapy group, after treatment compared two groups of GOS score and effective rate, the difference was statistically significant (P0.05). (2) group A patients before the treatment of GCS score was 9.72 + 3.56, B group before treatment GCS score 9.85 3.24, C group before treatment GCS score 9.78 + 3.72, D group patients before the treatment of GCS score 9.52 + 3.44.A group after treatment GCS scores after treatment The GCS score of group B was 12.61 + 1.09 after treatment in group B, and GCS score of group C was 11.78 + 1.21 after treatment. The GCS score in group D was 10.73 + 1.08. (3) A group after treatment. After treatment, the patients were 0, 2, 1 and 3 patients. The B group was graded according to GOS system. There were 0 patients, 1 in 2, 9 in 3, 21 in 4 and 41 in 5. After treatment, the patients in group C were divided into 1 patients, 0, 2, 3, and D patients were graded according to GOS system. 28 patients. (4) the results of single factor analysis showed that there was no statistical significance in the treatment of craniocerebral injury with hyperbaric oxygen therapy (P0.05). The difference in age and disease was significant (P0.05) in the treatment of craniocerebral injury (P0.05). (1) the results of single factor analysis showed that sex, occupation, income, cultural history Degree, the way of injury has no effect on the therapeutic effect of hyperbaric oxygen therapy on traumatic brain injury. (2) when patients with craniocerebral injury intervene hyperbaric oxygen therapy and the degree of injury is equal, the more early the patients with craniocerebral injury are treated with hyperbaric oxygen therapy, the better the curative effect. (3) the patients with craniocerebral injury intervened hyperbaric oxygen therapy, and the prognosis of the elderly patients is poor. 4) in the patients with severe craniocerebral injury, the prognosis of hyperbaric oxygen therapy was higher than that of the conventional treatment group (P0.05), and the patients with mild craniocerebral injury intervened hyperbaric oxygen therapy, and the prognosis was no difference compared with those in the conventional treatment group (P0.05).

【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.15

【参考文献】