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目的探讨重型颅脑损伤患者高压氧治疗前后,外周血红细胞还原型谷胱苷肽(GSH)和丙二醛(MDA)的水平变化与高压氧(HBO)治疗效果及预后的关系。方法60例颅脑损伤患者作为高压氧治疗组(HBO组),行HBO+常规治疗;60例颅脑损伤患者作为疾病对照组,仅单纯常规治疗;60名健康体检者为正常对照组。分别于治疗前、中、后用哥拉斯哥结果评分(Glasgow outcome scale,GOS)对患者评定;用谷胱苷肽还原酶法测定GSH,采用硫代巴比妥酸比色法检测MDA。结果HBO组和疾病对照组治疗前GSH和MDA差异无统计学意义,P>0.05,但与正常对照组比较差异均有统计学意义,P<0.01;HBO组治疗1个疗程后,GSH水平升高,MDA水平下降,与相同哥拉斯哥昏迷评分(Glasgow coma scale,GCS)的疾病对照组比较,差异均有统计学意义,P<0.05;HBO组治疗3个疗程后,在GOS3～5分的患者中,与疾病对照组比较GSH和MDA水平差异均有统计学意义,P<0.05;HBO组和疾病对照组治疗后GOS评定结果比较,HBO组死亡率(10%,6/60)低于疾病对照组(20%,12/60),预后良好率(53.3%,32/60)高于疾病对照组(40%,24/60),P<0.01。结论高压氧能影响颅脑损伤患者红细胞GSH和MDA水平,提示检测患者外周血红细胞GSH和MDA水平,可作为观察HBO治疗效果和患者预后的辅助指标。
Objective To investigate the relationship between the levels of glutathione (GSH) and malondialdehyde (MDA) in peripheral blood erythrocytes and the therapeutic effect and prognosis of hyperbaric oxygen (HBO) before and after hyperbaric oxygen therapy in patients with severe craniocerebral injury. Methods Sixty patients with craniocerebral injury were treated with hyperbaric oxygen (HBO) and HBO + routine therapy. Sixty patients with craniocerebral injury were used as the control group. Only 60 healthy subjects were normal control group. Patients were assessed with Glasgow outcome scale (GOS) before, during, and after treatment respectively. GSH was measured by glutathione reductase method and MDA was detected by thiobarbituric acid colorimetry. Results The levels of GSH and MDA in HBO group and control group were not significantly different before treatment (P> 0.05), but there was significant difference between the HBO group and the control group (P <0.01). After 1 course of HBO treatment, the GSH level increased (P <0.05). After three courses of treatment with HBO, there was a significant difference in GOS3 ~ 5 (P <0.05). Compared with the control group, the mortality of HBO group (10%, 6/60) was significantly higher than that of the control group (P <0.05) The rate of good prognosis (53.3%, 32/60) was higher than that of the control group (40%, 24/60), which was lower than that of the control group (20%, 12/60) (P <0.01). Conclusion Hyperbaric oxygen can affect GSH and MDA levels of erythrocytes in patients with brain injury, suggesting that the detection of GSH and MDA levels in peripheral blood erythrocytes may be used as an auxiliary index to observe the therapeutic effect of HBO and the prognosis of patients.