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目的研究高压氧(HBO)治疗对急性脑出血灶周水肿的影响,以期动态评估HBO的临床疗效。方法发病在24 h内入院的72例脑出血患者随机分为HBO组(36例)和对照组(36例)。两组均给予常规治疗,前者于病程第7天同时给予HBO治疗,每日1次,连续20 d。在病程第7天和第28天时,分别用T2WI图像和表观扩散系数(ADC)观测脑水肿的范围及程度。两组治疗前及治疗第28天时行卒中临床神经功能缺损(NIHSS)评分评定功能障碍的程度、改良巴氏指数(MBI)评定日常生活活动能力的变化。结果⑴病程第28天,HBO组的绝对水肿体积、相对水肿体积和ADC值均明显小于对照组,差异均有统计学意义(均P<0.05);⑵病程第28天,脑水肿仍有一定程度的存在;⑶第28天时NIHSS和MBI评定,HBO组两种量表评分的变化量均明显大于对照组,差异均有统计学意义(均P<0.05)。结论HBO治疗急性脑出血可明显减轻脑水肿的程度和缩小脑水肿的范围,且有利于患者神经功能的恢复。
Objective To study the effect of hyperbaric oxygen therapy (HBO) on perihematomal edema in patients with acute cerebral hemorrhage in order to evaluate the clinical efficacy of HBO. Methods 72 patients with intracerebral hemorrhage admitted within 24 h were randomly divided into HBO group (36 cases) and control group (36 cases). Both groups were given conventional treatment, the former in the course of the first 7 days were given HBO treatment once a day for 20 days. At the 7th day and the 28th day of the course of disease, the extent and degree of cerebral edema were observed by T2WI images and apparent diffusion coefficient (ADC) respectively. The NIHSS score of stroke before treatment and the 28th day of treatment were used to assess the degree of dysfunction and MBI to assess the changes of activities of daily living. Results (1) The absolute edema volume, relative edema volume and ADC value of HBO group were significantly lower than those of control group on the 28th day (all P <0.05); (2) On the 28th day of course, there was still a certain degree of cerebral edema (P <0.05). (3) On the 28th day, NIHSS and MBI assessed the changes of the two scales in HBO group were significantly greater than those in the control group (all P <0.05). Conclusion HBO treatment of acute cerebral hemorrhage can significantly reduce the extent of cerebral edema and reduce the scope of cerebral edema, and is conducive to the recovery of patients with neurological function.