[1]兰东,李乐,舒能媛,等.早期高压氧联合正中神经电刺激治疗重型颅脑损伤的疗效及对患者血流动力学、昏迷程度和神经功能的影响[J].新乡医学院学报,2024,(3):251-256.[doi:10.7683/xxyxyxb.2024.03.010]
　LAN Dong,LI Le,SHU Nengyuan,et al.Efficacy of early hyperbaric oxygen combined with median nerve electrical stimulation in the treatment of severe traumatic brain injury and its impact on hemodynamics,coma degree and neurological function[J].Journal of Xinxiang Medical University,2024,(3):251-256.[doi:10.7683/xxyxyxb.2024.03.010]
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早期高压氧联合正中神经电刺激治疗重型颅脑损伤的疗效及对患者血流动力学、昏迷程度和神经功能的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
期数:
2024年3
页码:
251-256
栏目:
临床研究
出版日期:
2024-03-05

文章信息/Info

Title:
Efficacy of early hyperbaric oxygen combined with median nerve electrical stimulation in the treatment of severe traumatic brain injury and its impact on hemodynamics,coma degree and neurological function
作者:
兰东; 李乐; 舒能媛; 王实朴; 王萍
（西部战区总医院急诊医学科，四川　成都　610083）
Author(s):
LAN Dong; LI Le; SHU Nengyuan; WANG Shipu; WANG Ping
(Department of Emergency Medicine,the General Hospital of Western Theater Command,Chengdu 610083,Sichuan Province,China)
关键词:
颅脑损伤; 高压氧; 正中神经电刺激; 血流动力学; 昏迷; 神经功能
Keywords:
traumatic brain injury; hyperbaric oxygen; median nerve electrical stimulation; hemodynamics; coma; neurological function
分类号:
R651.1
DOI:
10.7683/xxyxyxb.2024.03.010
文献标志码:
A
摘要:
目的　探讨早期高压氧联合正中神经电刺激治疗重型颅脑损伤的疗效及对患者血流动力学、昏迷程度、神经功能的影响。
方法　选择2020年3月至2021年10月西部战区总医院收治的78例重型颅脑损伤患者为研究对象，采用随机数字表法将患者分为对照组和观察组，每组39例。2组患者均行纠正水电解质和酸碱平衡、营养支持、抗感染、去骨瓣减压术等基础治疗，在此基础上，对照组患者给予早期高压氧治疗，观察组在对照组治疗基础上给予正中神经电刺激治疗。比较2组患者的临床疗效；治疗前和治疗后，采用双通道经颅多普勒超声检测2组患者大脑中动脉收缩期峰值血流速度（Vs）、平均血流速度（Vm）、搏动指数(PI)等血流动力学指标，格拉斯哥昏迷指数（GCS）评分评估2组患者的昏迷程度，美国国立卫生研究院卒中量表（NIHSS）评分评估2组患者的神经功能缺损情况，酶联免疫吸附法检测血清中枢神经特异性蛋白（S100-β）、神经胶质纤维酸性蛋白（GFAP）及髓鞘碱性蛋白（MBP）水平；记录2组患者治疗期间并发症发生情况，并比较并发症发生率。
结果　对照组和观察组患者的总有效率分别为79.49%（31/39）、92.31%（36/39）；观察组患者的总有效率显著高于对照组（χ2=8.971，P<0.05）。治疗前2组患者的Vm、Vs、PI比较差异均无统计学意义（P>0.05）。治疗后，2组患者的Vm、Vs显著高于治疗前，PI显著低于治疗前（P<0.05）；且观察组患者的Vm、Vs显著高于对照组，PI显著低于对照组（P<0.05）。治疗前，2组患者的GCS、NIHSS评分比较差异均无统计学意义（P>0.05）。治疗后，2组患者的GCS评分显著高于治疗前，NIHSS评分显著低于治疗前（P<0.05）；且观察组患者的GCS评分显著高于对照组，NIHSS评分显著低于对照组（P<0.05）。治疗前2组患者的S100-β、GFAP、MBP水平比较差异无统计学意义（P>0.05）。治疗后，2组患者的S100-β、GFAP、MBP水平显著低于治疗前（P<0.05），且观察组患者的S100-β、GFAP、MBP水平显著低于对照组（P<0.05）。治疗过程中，对照组和观察组患者并发症发生率分别为23.08%（9/39）、20.51%（8/39），2组患者并发症发生率比较差异无统计学意义（χ2=2.328，P>0.05）。
结论　早期高压氧联合正中神经电刺激治疗重型颅脑损伤的疗效较好，可以有效改善患者的血流动力学水平，减轻患者昏迷程度，提高患者神经功能，促使患者早日恢复意识，且不增加并发生症发生风险。
Abstract:
Objective　To explore the efficacy of early hyperbaric oxygen therapy (HBOT) combined with median nerve electrical stimulation (MNES) in the treatment of severe traumatic brain injury (sTBI) and its impact on hemodynamics,coma degree,and neurological function of patients.
Methods　A total of 78 patients with sTBI admitted to the General Hospital of Western Theater Command from March 2020 to October 2021 were selected as the research subjects.The patients were randomly divided into the control group and the observation group,with 39 patients in each group.The patients in both groups underwent basic treatments such as water,electrolyte and acid-base balance,nutritional support,anti-infection,and decompressive craniectomy.On this basis,patients in the control group received early HBOT,while patients in the observation group received both HBOT and MNES.Their clinical efficacy was compared between the two groups.Before and after treatment,dual-channel transcranial Doppler ultrasound was performed to detect hemodynamic indicators such as peak systolic blood flow velocity (Vs),mean blood flow velocity (Vm),and pulsatility index (PI) in the middle cerebral artery of patients in the two groups.The Glasgow Coma Scale (GCS) score was used to evaluate the degree of coma of patients in the two groups,the National Institutes of Health Stroke Scale (NIHSS) score was used to assess the neurological deficits of patients in the two groups,and the enzyme-linked immunosorbent assay was used to measure the levels of central nervous system specific protein (S100-β),glial fibrillary acidic protein (GFAP),and myelin basic protein (MBP).Complications during treatment of patients in the two groups were recorded,and their incidence was compared.
Results　The total effective rate of patients in the control and observation groups was 79.49% (31/39) and 92.31% (36/39),respectively.The total effective rate in the observation group was significantly higher than that in the control group (χ2=8.971,P<0.05).There was no significant difference in Vm,Vs,and PI between the two groups before treatment (P>0.05).After treatment,the Vm and Vs in both groups were significantly higher than those before treatment,while the PI was significantly lower than that before treatment (P<0.05);and the Vm and Vs in the observation group were signifi-cantly higher than that those in the control group,while the PI was significantly lower than that in the control group (P<0.05).There was no significant difference in GCS and NIHSS scores between the two groups before treatment (P>0.05).After treatment,the GCS score in both groups was significantly higher than that before treatment,while the NIHSS score was significantly lower than that before treatment (P<0.05);and the GCS score in the observation group was significantly higher than that in the control group,while the NIHSS score was significantly lower than that in the control group (P<0.05).There was no significant difference in S100-β,GFAP,and MBP levels between the two groups before treatment (P>0.05).After treatment,the S100-β,GFAP,and MBP levels in both groups were significantly lower than those before treatment (P<0.05),and the S100-β,GFAP,and MBP levels in the observation group were significantly lower than those in the control group (P<0.05).During treatment,the incidence of complications in the control and observation groups was 23.08% (9/39) and 20.51% (8/39),respectively,showing no significant difference (χ2=2.328,P>0.05).
Conclusion　Early HBOT combined with MNES shows good efficacy in treating sTBI,which can effectively improve the patients′ hemodynamic level,alleviate the severity of coma,enhance neurological function,and promote early recovery of consciousness,without increased risk of complications.

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更新日期/Last Update: 2024-03-05