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目的探讨高压氧治疗后颅脑创伤继发大面积脑梗死患者预后的影响因素。方法选取2010年1月—2014年5月解放军第一七五医院收治的颅脑创伤继发大面积脑梗死患者71例,均接受常规治疗及高压氧治疗。通过查阅病历方法收集所有患者的临床资料,包括性别、年龄、治疗前脑梗死体积、治疗前美国国立卫生研究院卒中量表(NIHSS)评分、去骨瓣减压术类型、急性期强化高压氧治疗情况、高压氧治疗开始时间及高压氧治疗疗程;记录所有患者治疗后格拉斯哥预后量表(GOS)评分。结果不同预后患者性别、去骨瓣减压术类型及急性期行强化高压氧治疗者所占比例、高压氧治疗疗程比较,差异无统计学意义(P>0.05);不同预后患者年龄、治疗前脑梗死体积、治疗前NHISS评分、治疗前GOS评分、高压氧治疗开始时间比较,差异有统计学意义(P<0.05)。非条件多因素logistic逐步回归分析结果显示,年龄、高压氧治疗前脑梗死体积、高压氧治疗开始时间是高压氧治疗后颅脑创伤继发大面积脑梗死患者预后的影响因素(P<0.05)。结论高龄、高压氧治疗前脑梗死体积大的颅脑创伤继发大面积脑梗死患者高压氧治疗后预后较差,高压氧治疗的最佳开始时间为发病后24 h内。
Objective To investigate the influencing factors of the prognosis of patients with cerebral infarction secondary to craniocerebral trauma after hyperbaric oxygen therapy. Methods From January 2010 to May 2014, 71 patients with craniocerebral trauma secondary to large-area cerebral infarction admitted to the 175th Hospital of People’s Liberation Army of China were enrolled in this study. All patients underwent routine and hyperbaric oxygen therapy. Clinical data including sex, age, volume of infarction before treatment, NIH Stroke Scale (NIHSS) score, type of decompressive craniectomy, acute hyperbaric oxygenation Treatment, hyperbaric oxygen therapy start time and hyperbaric oxygen therapy course; record all patients after treatment Glasgow Outcome Scale (GOS) score. Results There was no significant difference in the gender, the type of decompressive craniectomy and the proportion of HBO patients in the acute phase and the hyperbaric oxygen therapy (P> 0.05). The prognosis of patients with different prognosis The volume of cerebral infarction, pre-treatment NHISS score, pre-treatment GOS score, hyperbaric oxygen treatment start time comparison, the difference was statistically significant (P <0.05). Unconditional multivariate logistic stepwise regression analysis showed that the age, the volume of anterior cerebral infarction treated with hyperbaric oxygen and the onset time of hyperbaric oxygen therapy were the influencing factors in the prognosis of patients with large area cerebral infarction secondary to traumatic brain injury after hyperbaric oxygen therapy (P <0.05) . Conclusions The treatment of hyperbaric oxygen after cerebral infarction in older patients and hyperbaric oxygen patients with large volume of traumatic brain injury secondary to large-area cerebral infarction has a poor prognosis. The best start time of hyperbaric oxygen therapy is within 24 h after onset.