不同压力高压氧治疗弥漫性轴索损伤患者的临床疗效分析
发布时间：2018-11-27 19:40
【摘要】：目的本研究采用队列研究方法,通过观察两种不同压力的高压氧治疗对弥漫性轴索损伤患者(Diffuse Axonal Injury,DAI)脑胼胝体压部和基底节区脑组织代谢情况及头部不同采样点脑电波相对功率的影响,进而探讨两种不同压力高压氧治疗对弥漫性轴索损伤患者的临床治疗价值及对预后的影响。方法收集解放军第105医院神经外科2014年10月至2015年10月收治的弥漫性轴索损伤患者50例,随机分为对照组10例、0.20MPa组20例和0.25MPa组20例。各组患者给予相同的常规治疗,0.20MPa组在常规治疗的基础上给予3个疗程压力为0.20 MPa的高压氧治疗,0.25MPa组在常规治疗的基础上给予3个疗程压力为0.25MPa的高压氧治疗。采用格拉斯哥昏迷指数(GCS)评估患者入院病情严重程度,美国卒中评分(NIHSS)评价患者神经功能缺损情况,应用氢质子磁共振波谱(1H-MRS)比较3组患者治疗前后脑胼胝体压部和基底节区NAA/Cr,Cho/Cr,m INs/Cr等指标的变化差异,采用脑电图定量观察各组患者头部不同采样点(国际标准10-20系统电极法,选取F3,F4,C3,C4,O1,O2为采样点)脑电波相对功率(δ+θ)/(α+β)治疗前后变化情况,并对所有患者随访6月,采用格拉斯哥转归评分(GOS)评估患者预后情况。结果治疗前,3组患者GCS评分及年龄、体重等指标比较差异无显著统计学意义(p0.05);经治疗6周后,0.25MPa组与0.20MPa组及对照组比较NIHSS评分差异均有统计学意义(p0.05或p0.01);0.25MPa组脑胼胝体压部和基底节区NAA/Cr,Cho/Cr,m INs/Cr等指标变化与0.20MPa组及对照组比较,差异均有统计学意义(p0.05或p0.01);治疗后各组患者头部不同采样点定量脑电图相对功率(δ+θ)/(α+β)值均持续减少,且0.25MPa组的改善程度较对照组及0.20MPa明显增大,差异有统计学意义(p0.05);随访6个月,GOS评分0.25MPa组0.20 MPa组对照组,组间相比,p均0.05;且各组患者脑电图相对功率与GOS评分均呈负相关(0.25MPa组、0.20Mpa组、对照组的Rs分别为0.856、0.863、0.935,P值均小于0.01)。结论对于弥漫性轴索损伤患者,与早期0.20MPa高压氧治疗相比,0.25MPa高压氧治疗可以更明显的改善患者胼胝体压部及基底节区脑组织代谢,加快患者脑电图慢波减少或快波增多的进程,促进脑功能恢复,改善预后。对DAI患者实施高压氧治疗时可选择0.25MPa的压力。
[Abstract]:Objective to investigate the effects of two different pressure hyperbaric oxygen therapy on (Diffuse Axonal Injury, in patients with diffuse axonal injury by cohort study. DAI) the changes of brain tissue metabolism in the splenium of corpus callosum and basal ganglia and the relative power of brain wave at different sampling points of the head. The clinical value and prognosis of two different pressure hyperbaric oxygen therapy in patients with diffuse axonal injury were discussed. Methods from October 2014 to October 2015, 50 patients with diffuse axonal injury were randomly divided into three groups: control group (n = 10), 0.20MPa group (n = 20) and 0.25MPa group (n = 20). The patients in each group were given the same routine treatment, and the 0.20MPa group was given three courses of hyperbaric oxygen therapy with a pressure of 0.20 MPa on the basis of routine treatment. 0.25MPa group was given three courses of hyperbaric oxygen therapy with 0.25MPa stress on the basis of routine therapy. Glasgow coma index (GCS) was used to assess the severity of admission, and (NIHSS) was used to evaluate the neurological impairment. Hydrogen proton magnetic resonance spectroscopy (1H-MRS) was used to compare the changes of NAA/Cr,Cho/Cr,m INs/Cr in corpus callosum and basal ganglia before and after treatment. EEG was used to quantitatively observe the changes of relative power (未 胃) / (伪 尾) of brain waves at different sampling points (international standard 10-20 system electrode method and F3F4F4C3C4C4O1O1O2 as sampling points) before and after treatment, and the changes of brain wave relative power (未 胃) / (伪 尾) were observed before and after treatment. All patients were followed up for 6 months and the prognosis was evaluated by Glasgow outcome score (GOS). Results before treatment, there was no significant difference in GCS score, age and body weight between the three groups (p0.05). After 6 weeks of treatment, the NIHSS scores in 0.25MPa group were significantly different from those in 0.20MPa group and control group (p0.05 or p0.01). The changes of NAA/Cr,Cho/Cr,m INs/Cr in the corpus callosum and basal ganglia in 0.25MPa group were significantly different from those in 0.20MPa group and control group (p0.05 or p0.01). After treatment, the relative power (未 胃) / (伪 尾) of quantitative EEG at different sampling points of the head of the patients in each group decreased continuously, and the improvement degree of the 0.25MPa group was significantly higher than that of the control group and the 0.20MPa group (p0.05). Follow up for 6 months, GOS score 0.25MPa group 0.20 MPa control group, compared with each other, p 0.05; There was a negative correlation between EEG relative power and GOS score in each group (the Rs of 0.25MPa group, 0.20Mpa group and control group were 0.8560.863n 0.935 P < 0. 01). Conclusion compared with early 0.20MPa hyperbaric oxygen therapy, 0.25MPa hyperbaric oxygen therapy can improve the metabolism of corpus callosum and basal ganglia in patients with diffuse axonal injury. To accelerate the process of slow wave reduction or rapid wave increase, promote the recovery of brain function and improve prognosis. The pressure of 0.25MPa can be chosen when hyperbaric oxygen therapy is performed in patients with DAI.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.15
[Abstract]:Objective to investigate the effects of two different pressure hyperbaric oxygen therapy on (Diffuse Axonal Injury, in patients with diffuse axonal injury by cohort study. DAI) the changes of brain tissue metabolism in the splenium of corpus callosum and basal ganglia and the relative power of brain wave at different sampling points of the head. The clinical value and prognosis of two different pressure hyperbaric oxygen therapy in patients with diffuse axonal injury were discussed. Methods from October 2014 to October 2015, 50 patients with diffuse axonal injury were randomly divided into three groups: control group (n = 10), 0.20MPa group (n = 20) and 0.25MPa group (n = 20). The patients in each group were given the same routine treatment, and the 0.20MPa group was given three courses of hyperbaric oxygen therapy with a pressure of 0.20 MPa on the basis of routine treatment. 0.25MPa group was given three courses of hyperbaric oxygen therapy with 0.25MPa stress on the basis of routine therapy. Glasgow coma index (GCS) was used to assess the severity of admission, and (NIHSS) was used to evaluate the neurological impairment. Hydrogen proton magnetic resonance spectroscopy (1H-MRS) was used to compare the changes of NAA/Cr,Cho/Cr,m INs/Cr in corpus callosum and basal ganglia before and after treatment. EEG was used to quantitatively observe the changes of relative power (未 胃) / (伪 尾) of brain waves at different sampling points (international standard 10-20 system electrode method and F3F4F4C3C4C4O1O1O2 as sampling points) before and after treatment, and the changes of brain wave relative power (未 胃) / (伪 尾) were observed before and after treatment. All patients were followed up for 6 months and the prognosis was evaluated by Glasgow outcome score (GOS). Results before treatment, there was no significant difference in GCS score, age and body weight between the three groups (p0.05). After 6 weeks of treatment, the NIHSS scores in 0.25MPa group were significantly different from those in 0.20MPa group and control group (p0.05 or p0.01). The changes of NAA/Cr,Cho/Cr,m INs/Cr in the corpus callosum and basal ganglia in 0.25MPa group were significantly different from those in 0.20MPa group and control group (p0.05 or p0.01). After treatment, the relative power (未 胃) / (伪 尾) of quantitative EEG at different sampling points of the head of the patients in each group decreased continuously, and the improvement degree of the 0.25MPa group was significantly higher than that of the control group and the 0.20MPa group (p0.05). Follow up for 6 months, GOS score 0.25MPa group 0.20 MPa control group, compared with each other, p 0.05; There was a negative correlation between EEG relative power and GOS score in each group (the Rs of 0.25MPa group, 0.20Mpa group and control group were 0.8560.863n 0.935 P < 0. 01). Conclusion compared with early 0.20MPa hyperbaric oxygen therapy, 0.25MPa hyperbaric oxygen therapy can improve the metabolism of corpus callosum and basal ganglia in patients with diffuse axonal injury. To accelerate the process of slow wave reduction or rapid wave increase, promote the recovery of brain function and improve prognosis. The pressure of 0.25MPa can be chosen when hyperbaric oxygen therapy is performed in patients with DAI.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.15
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