不同壓力高壓氧治療彌漫性軸索損傷患者的臨床療效分析
發(fā)布時間：2018-11-27 19:40
【摘要】：目的本研究采用隊列研究方法,通過觀察兩種不同壓力的高壓氧治療對彌漫性軸索損傷患者(Diffuse Axonal Injury,DAI)腦胼胝體壓部和基底節(jié)區(qū)腦組織代謝情況及頭部不同采樣點腦電波相對功率的影響,進而探討兩種不同壓力高壓氧治療對彌漫性軸索損傷患者的臨床治療價值及對預(yù)后的影響。方法收集解放軍第105醫(yī)院神經(jīng)外科2014年10月至2015年10月收治的彌漫性軸索損傷患者50例,隨機分為對照組10例、0.20MPa組20例和0.25MPa組20例。各組患者給予相同的常規(guī)治療,0.20MPa組在常規(guī)治療的基礎(chǔ)上給予3個療程壓力為0.20 MPa的高壓氧治療,0.25MPa組在常規(guī)治療的基礎(chǔ)上給予3個療程壓力為0.25MPa的高壓氧治療。采用格拉斯哥昏迷指數(shù)(GCS)評估患者入院病情嚴重程度,美國卒中評分(NIHSS)評價患者神經(jīng)功能缺損情況,應(yīng)用氫質(zhì)子磁共振波譜(1H-MRS)比較3組患者治療前后腦胼胝體壓部和基底節(jié)區(qū)NAA/Cr,Cho/Cr,m INs/Cr等指標的變化差異,采用腦電圖定量觀察各組患者頭部不同采樣點(國際標準10-20系統(tǒng)電極法,選取F3,F4,C3,C4,O1,O2為采樣點)腦電波相對功率(δ+θ)/(α+β)治療前后變化情況,并對所有患者隨訪6月,采用格拉斯哥轉(zhuǎn)歸評分(GOS)評估患者預(yù)后情況。結(jié)果治療前,3組患者GCS評分及年齡、體重等指標比較差異無顯著統(tǒng)計學(xué)意義(p0.05);經(jīng)治療6周后,0.25MPa組與0.20MPa組及對照組比較NIHSS評分差異均有統(tǒng)計學(xué)意義(p0.05或p0.01);0.25MPa組腦胼胝體壓部和基底節(jié)區(qū)NAA/Cr,Cho/Cr,m INs/Cr等指標變化與0.20MPa組及對照組比較,差異均有統(tǒng)計學(xué)意義(p0.05或p0.01);治療后各組患者頭部不同采樣點定量腦電圖相對功率(δ+θ)/(α+β)值均持續(xù)減少,且0.25MPa組的改善程度較對照組及0.20MPa明顯增大,差異有統(tǒng)計學(xué)意義(p0.05);隨訪6個月,GOS評分0.25MPa組0.20 MPa組對照組,組間相比,p均0.05;且各組患者腦電圖相對功率與GOS評分均呈負相關(guān)(0.25MPa組、0.20Mpa組、對照組的Rs分別為0.856、0.863、0.935,P值均小于0.01)。結(jié)論對于彌漫性軸索損傷患者,與早期0.20MPa高壓氧治療相比,0.25MPa高壓氧治療可以更明顯的改善患者胼胝體壓部及基底節(jié)區(qū)腦組織代謝,加快患者腦電圖慢波減少或快波增多的進程,促進腦功能恢復(fù),改善預(yù)后。對DAI患者實施高壓氧治療時可選擇0.25MPa的壓力。
[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) / (偽 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) / (偽 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) / (偽 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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：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) / (偽 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) / (偽 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) / (偽 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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.15
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