摘要
目的探讨高压氧治疗对颅脑损伤后急性期意识障碍患者凝血及神经功能相关指标的影响,为该病合理治疗方案的制订提供参考。方法选择南京紫金医院2021年9月至2023年4月收治的颅脑损伤后急性期意识障碍患者134例,采用随机数字表法将患者分为观察组和对照组,每组67例,其中对照组脱落4例、观察组脱落3例,2组最终分别纳入63、64例。对照组接受颅脑损伤常规治疗,观察组接受颅脑损伤常规治疗和高压氧治疗,2组治疗时间均为20 d。于治疗前和治疗后20 d,通过昏迷恢复修订量表(CRS-R)、格拉斯哥昏迷量表(GCS)、美国国立卫生研究院卒中量表(NIHSS)评估意识障碍和神经功能缺损程度,检测凝血指标D-二聚体(D-D)、纤维蛋白原(FIB)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR),以及血液神经功能相关指标髓鞘碱性蛋白(MBP)、胶质纤维酸性蛋白(GFAP)、神经元特异性烯醇化酶(NSE)、S100钙结合蛋白B(S100-B)。观察2组患者治疗期间的不良反应发生情况。结果治疗前,观察组和对照组各指标差异均无统计学意义(均P>0.05)。治疗后20 d,观察组CRS-R、GCS评分均高于对照组[(18.22±1.07)分vs.(15.54±0.98)分,(11.04±1.03)分vs.(7.92±0.88)分],NIHSS评分低于对照组[(14.12±1.08)分vs.(16.95±2.13)分],差异均有统计学意义(均P<0.05);观察组血清D-D、MBP、GFAP、NSE、S100-B水平均低于对照组[(0.24±0.06)mg/L vs.(0.39±0.12)mg/L,(7.12±0.89)μg/L vs.(12.45±1.26)μg/L,(2.13±0.35)ng/L vs.(3.66±0.57)ng/L,(8.21±1.10)μg/L vs.(10.86±1.43)μg/L,(0.33±0.02)μg/L vs.(0.75±0.21)μg/L],TT、APTT均短于对照组[(15.34±1.22)s vs.(17.08±1.45)s,(31.09±2.56)s vs.(33.56±3.09)s],差异均有统计学意义(均P<0.05);2组FIB、PT、INR比较,差异均无统计学意义(均P>0.05)。治疗期间,观察组不良反应总发生率(6.25%,4/64)与对照组(12.70%,8/63)比较,差异无统计学意义(P>0.05)。结论颅脑损伤后急性期意识障碍患者行高压氧治疗能够减轻意识障碍程度,改善凝血及神经功能,且具有良好的安全性。
Objective To discuss the effects of hyperbaric oxygen therapy on coagulation and neurological function-related indicators in patients with consciousness disorders in the acute phase following traumatic brain injury,so as to provide a reference for the formulation of a reasonable treatment plan for this condition.Methods A total of 134 patients with consciousness disorders in the acute phase following traumatic brain injury,admitted to Nanjing Zijin Hospital from September 2021 to April 2023,were selected and randomly divided into an observation group and a control group,with 67 patients in each group,according to the random number table method.The control group had 4 dropouts,and the observation group had 3 dropouts,resulting in 63 and 64 patients being included in each group,respectively.The control group received conventional treatment for traumatic brain injury,while the observation group received both conventional treatment and hyperbaric oxygen therapy.Both groups were treated for 20 days.Before and after 20 days of treatment,the Coma recovery scale-revised(CRS-R),Glasgow coma scale(GCS),and National Institutes of Health stroke scale(NIHSS)were used to assess the degree of consciousness disorder and neurological deficits.Coagulation indicators such as D-dimer(D-D),fibrinogen(FIB),prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),and international normalized ratio(INR)were measured,along with blood neurological function-related indicators including myelin basic protein(MBP),glial fibrillary acidic protein(GFAP),neuron-specific enolase(NSE),and S100 calcium-binding protein B(S100-B).Adverse reactions during the treatment period were also observed.Results Before treatment,there were no statistically significant difference in the indicators between the observation and control groups(all P>0.05).After 20 days of treatment,the CRS-R and GCS scores in the observation group were higher than those in the control group[(18.22±1.07)vs.(15.54±0.98),(11.04±1.03)vs.(7.92±0.88)],and the NIHSS score was lower[(14.12±1.08)vs.(16.95±2.13)],all with statistically significant differences(all P<0.05).The serum levels of D-D,MBP,GFAP,NSE,and S100-B in the observation group were lower than those in the control group[(0.24±0.06)mg/L vs.(0.39±0.12)mg/L,(7.12±0.89)μg/L vs.(12.45±1.26)μg/L,(2.13±0.35)ng/L vs.(3.66±0.57)ng/L,(8.21±1.10)μg/L vs.(10.86±1.43)μg/L,(0.33±0.02)μg/L vs.(0.75±0.21)μg/L],and TT and APTT were shorter[(15.34±1.22)s vs.(17.08±1.45)s,(31.09±2.56)s vs.(33.56±3.09)s],all with statistically significant differences(all P<0.05);there was no statistically significant difference in FIB,PT,and INR between the two groups(all P>0.05).During the treatment period,the total incidence of adverse reactions in the observation group(6.25%,4/64)was not statistically different from that in the control group(12.70%,8/63)(P>0.05).Conclusion Hyperbaric oxygen therapy in patients with consciousness disorders in the acute phase following traumatic brain injury can alleviate the degree of consciousness disorders,improve coagulation and neurological function,and has good safety.
作者
孙敏
岑园园
潘兴明
Sun Min;Cen Yuanyuan;Pan Xingming(Department of neurological rehabilitation,Nanjing Zijin Hospital,Nanjing 210000,China)
出处
《中华航海医学与高气压医学杂志》
2025年第3期254-258,共5页
Chinese Journal of Nautical Medicine and Hyperbaric Medicine
关键词
颅脑损伤
意识障碍
高压氧
凝血指标
神经功能
Traumatic brain injury
Consciousness disorders
Hyperbaric oxygen
Coagulation indicator
Neurological function
作者简介
通信作者:潘兴明,Email:471996209@qq.com。
