200例脑出血术后早期高压氧治疗的疗效分析(1)
【摘要】目的分析200例脑出血术后高压氧治疗的机制及临床疗效。方法200例脑出血患者，其中98例自发性脑出血，102例外伤性脑出血。按治疗时间分为早期治疗组≤10 d 80例和晚期治疗组≥20 d 120例。两组患者高压氧治疗措施相同，治疗结果进行统计学分析。结果术后12个月按照COS预后计分评定，两组患者生活质量均较未行高压氧治疗的患者有明显提高。Cos 4分以上早期治疗良好率为67.5%。而≥20以上的治疗良好率为37.5%，P<0.01差异显著，有统计学意义。结论脑出血术后患者及早进行高压氧治疗可减轻术后脑水肿，降低颅内压。同时还可提高细胞的氧含量及氧储存量改善微循环，减少脑细胞的变形坏死。高压氧还可增加血肿周围及手术入路周围的受损细胞的供氧，加速受损细胞的恢复。高压氧还可加速残留脑水肿的清除，加速胶原纤维和毛细血管的再生，加速病灶的修复。因此早期高压氧治疗可以提高生活质量，减少致残率。
【关键词】脑出血术后；高压氧
The analysis of the therapeutic effect of 200 cases of early hyperbaric oxygen treatment after the operation of cerebral hemorrhage YANG Ming-zhi,CAI Yu-rong，WANG yan.The First Hospital of Huainan，Huainan 232007,China
, http://www.100md.com
【Abstract】ObjectiveTo analyze the mechanism and clinical effects of hyperbaric oxygen treatment after the operation of cerebral hemorrhage.MethodsAmong 200 cases of cerebral hemorrhage,98 cases are spontaneous cerebral hemorrhage whereas102 cases are traumatic cerebral hemorrhage.According to the treatment time,they are divided into early treatment group,which consists of 80 people and takes no more than ten days,and late treatment group,which consists of 120 cases and takes no less than 20 days.The two groups of patients take the same measure of hyperbaric oxygen treatment and the treatment outcome is statistically analyzed.RestultsTwelve months after the operation,the life quality of the two groups of patients is markedly improved than that of the patients who dont receive hyperbaric oxygen treatment according to the outcome scale of cos.As for the patients who have higher score than 4,the recovery rate is 67.5%.However,concerning the patients who have higher score than 20,the recovery rate is 37.5%.The probability is lees than 1 percent and the marked difference is statistically significant.ConclusionThe patients after the operation of cerebral hemorrhage receive the hyperbaric oxygen treatment can ease postsurgical brain edema and lower intracranial pressure.At the same time,it can increase the content and storage of the oxygen in the cell so as to improve the microcirculation as well as the deformation and necrosis of the brain cell.Hyperbaric oxygen can increase the supply of oxygen of the damaged cells around the hematoma and operative routes,and speed up the restoration of the damaged cells.Hyperbaric oxygen can accelerate the removal of residual brain edema and the regeneration of collagen fiber and capillary vessel as well as the restoration of focus of infection.Therefore, early hyperbaric oxygen treatment can raise life standard and reduce incidence of disability.
, 百拇医药
【Key words】After the operation of cerebral hemorrhage;Hyperbaric oxygen
由于人们生活质量的提高，饮食高脂肪及出门开车的人增多，自发性脑出血及颅脑外伤引起的脑出血亦呈逐年上升趋势。由于起病急、进展快，在急性脑血管疾病及脑外伤中它的病死率及致残率均极高。目前对脑出血的治疗包括保守治疗及手术治疗。通常大脑半球出血量超过30 ml以上，小脑出血量超过10 ml以上以及有意思障碍逐渐加深的均以手术治疗为主。脑出血的手术目的主要在于清除血肿、降低颅内压，使受压的神经元有恢复的可能，防止或减少出血后的一系列继发性病理变化，打破危及生命的恶性循环。虽然术后血肿压迫解除，但病理生理变化，生物化学的改变和各种损伤因子的作用仍继续存在。脑水肿、重度高颅压及顽固性中枢性高热发生率仍然很高，直接影响预后。再者手术造成脑组织的损伤使部分毛细血管断裂。加重了脑缺血缺氧性改变从而引起血脑屏障功能及结构的改变，使毛细血管通透性增加，引起血管源性脑水肿，常规治疗无法解决缺氧、水肿问题。而高压氧能迅速提高动脉血氧浓度，脑细胞氧分压较常压下提高14倍，氧的有效弥散半径增至100 uml。增加组织间氧弥散度，改善脑缺氧。加强血管收缩，减少脑血流量，降低血管通透性，减轻脑水肿，降低颅内压。抑制血小板及红细胞聚集，降低血粘度，增加椎动脉血供，改善脑干及网状激活系统的缺氧状态，促进意识恢复。减少自由基产生。减少细胞凋亡。抑制外伤后炎症反应，促进神经功能恢复。促进轴索再生及神经传导功能恢复[1]。可以明显提高治愈率，减少致残率。提高患者的生活质量是一种安全可靠，疗效显著的辅助治疗措施。, 百拇医药(杨明芝 蔡玉荣 王岩)
【关键词】脑出血术后；高压氧
The analysis of the therapeutic effect of 200 cases of early hyperbaric oxygen treatment after the operation of cerebral hemorrhage YANG Ming-zhi,CAI Yu-rong，WANG yan.The First Hospital of Huainan，Huainan 232007,China
, http://www.100md.com
【Abstract】ObjectiveTo analyze the mechanism and clinical effects of hyperbaric oxygen treatment after the operation of cerebral hemorrhage.MethodsAmong 200 cases of cerebral hemorrhage,98 cases are spontaneous cerebral hemorrhage whereas102 cases are traumatic cerebral hemorrhage.According to the treatment time,they are divided into early treatment group,which consists of 80 people and takes no more than ten days,and late treatment group,which consists of 120 cases and takes no less than 20 days.The two groups of patients take the same measure of hyperbaric oxygen treatment and the treatment outcome is statistically analyzed.RestultsTwelve months after the operation,the life quality of the two groups of patients is markedly improved than that of the patients who dont receive hyperbaric oxygen treatment according to the outcome scale of cos.As for the patients who have higher score than 4,the recovery rate is 67.5%.However,concerning the patients who have higher score than 20,the recovery rate is 37.5%.The probability is lees than 1 percent and the marked difference is statistically significant.ConclusionThe patients after the operation of cerebral hemorrhage receive the hyperbaric oxygen treatment can ease postsurgical brain edema and lower intracranial pressure.At the same time,it can increase the content and storage of the oxygen in the cell so as to improve the microcirculation as well as the deformation and necrosis of the brain cell.Hyperbaric oxygen can increase the supply of oxygen of the damaged cells around the hematoma and operative routes,and speed up the restoration of the damaged cells.Hyperbaric oxygen can accelerate the removal of residual brain edema and the regeneration of collagen fiber and capillary vessel as well as the restoration of focus of infection.Therefore, early hyperbaric oxygen treatment can raise life standard and reduce incidence of disability.
, 百拇医药
【Key words】After the operation of cerebral hemorrhage;Hyperbaric oxygen
由于人们生活质量的提高，饮食高脂肪及出门开车的人增多，自发性脑出血及颅脑外伤引起的脑出血亦呈逐年上升趋势。由于起病急、进展快，在急性脑血管疾病及脑外伤中它的病死率及致残率均极高。目前对脑出血的治疗包括保守治疗及手术治疗。通常大脑半球出血量超过30 ml以上，小脑出血量超过10 ml以上以及有意思障碍逐渐加深的均以手术治疗为主。脑出血的手术目的主要在于清除血肿、降低颅内压，使受压的神经元有恢复的可能，防止或减少出血后的一系列继发性病理变化，打破危及生命的恶性循环。虽然术后血肿压迫解除，但病理生理变化，生物化学的改变和各种损伤因子的作用仍继续存在。脑水肿、重度高颅压及顽固性中枢性高热发生率仍然很高，直接影响预后。再者手术造成脑组织的损伤使部分毛细血管断裂。加重了脑缺血缺氧性改变从而引起血脑屏障功能及结构的改变，使毛细血管通透性增加，引起血管源性脑水肿，常规治疗无法解决缺氧、水肿问题。而高压氧能迅速提高动脉血氧浓度，脑细胞氧分压较常压下提高14倍，氧的有效弥散半径增至100 uml。增加组织间氧弥散度，改善脑缺氧。加强血管收缩，减少脑血流量，降低血管通透性，减轻脑水肿，降低颅内压。抑制血小板及红细胞聚集，降低血粘度，增加椎动脉血供，改善脑干及网状激活系统的缺氧状态，促进意识恢复。减少自由基产生。减少细胞凋亡。抑制外伤后炎症反应，促进神经功能恢复。促进轴索再生及神经传导功能恢复[1]。可以明显提高治愈率，减少致残率。提高患者的生活质量是一种安全可靠，疗效显著的辅助治疗措施。, 百拇医药(杨明芝 蔡玉荣 王岩)