| 陈郁文,蒋滢梓,刘 苏,黄春玲,朱 菁,朱晓红.不同疗程高压氧治疗对重度创伤性脑损伤患者意识障碍和认知功能障碍的疗效分析[J].中国康复医学杂志,2022,(10):1326~1331 |
| 不同疗程高压氧治疗对重度创伤性脑损伤患者意识障碍和认知功能障碍的疗效分析 点此下载全文 |
| 陈郁文 蒋滢梓 刘 苏 黄春玲 朱 菁 朱晓红 |
| 南通大学附属医院康复医学科，江苏省南通市，226001 |
| 基金项目：国家自然科学基金项目（81702223）；南通市科技计划项目（MS22019006） |
| DOI：10.3969/j.issn.1001-1242.2022.10.006 |
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| 摘要： |
| 摘要
目的：观察不同疗程的高压氧（hyperbaric oxygen，HBO）治疗对重度创伤性脑损伤（traumatic brain injury，TBI）患者意识状态和认知功能的影响，并分析其可能的分子机制。
方法：选取67例重度TBI患者，分为对照组（33例）和HBO组（34例）。治疗前、治疗10、20、30d运用CRS-R量表评估意识状态，采用RLAS-R量表评估认知功能，采用ELISA法观察患者外周血神经元特异性烯醇化酶（neuron specific enolase，NSE）、胶质纤维酸性蛋白（glial fibrillary acidic protein，GFAP）、脑源性神经营养因子（brain-derived neurotrophic factor，BDNF）和血管内皮生长因子（vascular endothelial growth factor，VEGF）表达。
结果：两组患者治疗前无显著性差异；与对照组比较，HBO组患者治疗10、20、30d，CRS-R和RLAS-R评分均显著升高，在治疗20d和30d时，脱离最小意识状态患者显著增加；与治疗前比较，对照组和HBO组在治疗后的CRS-R和RLAS-R评分均显著改善，连续治疗20d与治疗30d无显著差异。HBO组患者治疗各时间点，血清GFAP和VEGF表达较对照组显著改善，连续治疗20d及以上NSE和BDNF表达较对照组显著改善。HBO组在治疗30d，GFAP、BDNF和VEGF表达量与治疗20d比较均无显著差异。
结论：HBO治疗通过下调NSE和GFAP的表达，上调BDNF和VEGF的表达改善重度TBI患者意识和认知功能，HBO治疗重度TBI需连续20d以上。 |
| 关键词：创伤性脑损伤 高压氧治疗 神经元特异性烯醇化酶 胶质纤维酸性蛋白 脑源性神经营养因子 血管内皮生长因子 |
| The effects of different courses of hyperbaric oxygen therapy on consciousness and cognitive function in patients with severe traumatic brain injury Download Fulltext |
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| Affiliated Hospital of Nantong University， Nantong， Jiangsu， 226001 |
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| Abstract: |
| Abstract
Objective： To investigate the effects of different courses of hyperbaric oxygen（HBO） therapy on consciousness and cognitive function in patients with severe traumatic brain injury（TBI） and to explore its possible molecular mechanisms.
Method： Patients with severe TBI treated at the Department of Rehabilitation Medicine， Affiliated Hospital of Nantong University from May 2020 to December 2021 were enrolled and divided into the control group （33 cases） and HBO group （34 cases）. Before treatment， after 10 days， 20 days and 30 days treatment， the Coma Recovery Scale-Revised （CRS-R） and the Rancho Los Amigos Scale-Revised （RLAS-R） were used to evaluate consciousness and cognitive function， and the expression of neuron specific enolase （NSE）， glial fibrillary acidic protein （GFAP）， brain-derived neurotrophic factor （BDNF）， and vascular endothelial growth factor （VEGF） in peripheral blood was measured by ELISA.
Result： Before treatment， there were no statistical differences between the two groups. Firstly， the scores of CRS-R and RLAS-R in the HBO group were significantly increased compared with the control group at 10， 20， and 30 days after treatment， and more patients emerged from minimally conscious state after 20 and 30 days HBO treatment. In the HBO group， the scores of CRS-R and RLAS-R significantly improved after 10 days continuous treatment， while there was no significant difference between 20 days and 30 days treatment. In addition， the concentrations of serum GFAP and VEGF in the HBO group were significantly improved at all observed times of treatment， and the concentrations of serum NSE and BDNF were significantly improved after treatment for 20 days or above compared with the control group. After 30 days treatment， the levels of GFAP， BDNF and VEGF in the HBO group have no significant differences with those after 20 days treatment.
Conclusion： HBO therapy may improve consciousness and cognitive function of severe TBI patients by modulating the levels of serum NSE， GFAP， BDNF and VEGF. Moreover， continuous HBO treatment for at least 20 days is more effective for patients with severe TBI. |
| Keywords:traumatic brain injury hyperbaric oxygen therapy neuron-specific enolase glial fibrillary acidic protein brain-derived neurotrophic factor vascular endothelial growth factor |
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