Sahni Tarun, Jain Madhur, Prasad Rajendra, Sogani Shanti K, Singh Varindera P
Department of Hyperbaric Oxygen Therapy, Indraprastha Apollo Hospital, Sarita Vihar, Delhi-Mathura Road, New Delhi, India.
Br J Neurosurg. 2012 Apr;26(2):202-7. doi: 10.3109/02688697.2011.626879. Epub 2011 Nov 15.
Traumatic brain injury (TBI) related impact results in a permanent need for help in performing daily activities. Standard treatment consists of removing the cause, restore perfusion, support metabolic requirement and limit inflammatory and oxidative damage. Hyperbaric oxygen therapy (HBOT) is one such newer promising treatment that enhances neurological recovery to some extent. HBOT is intermittent inhalation of 100% oxygen at greater than normal atmospheric pressure and is internationally accepted for its role in well-defined indications. It is hypothesised that HBO has a role in reviving 'idling neurons', also called the ischemic penumbra defined as area of reduced cerebral blood flow, abolished synaptic activity but preserved structural integrity. We carried out a retrospective analysis of medical records of 20 patients of TBI who had been treated with HBOT in addition to standard management. These were placed in Group A (test group) and received at least 30 sessions of HBO along with standard treatment. The patients were assessed along the Disability Rating Scale (DRS), Glasgow coma scale (GCS) and Rancho Los Amigos Scale (RLAS). Another 20 patients of TBI, matched in age and severity of brain injury, who received standard treatment but not HBOT, were selected as the control group (Group B). Assessment on the DRS showed maximum improvement in patients with scores of 22-24 (vegetative state).The percentage of patients in the test group fell from 45% to 5% whereas only 20% patients in Group B had similar progress. After the treatment, a significantly higher proportion of HBOT treated subjects showed a good response in cognitive functions, as measured by RLA. In group A, 90% patients had a score of ≤ 3 and in Group B 95% had a similar score, which improved to ≥ 3 in 60% patients versus 30% patients respectively. In both groups maximum patients are in 1-6 months post-injury category and within the groups this category showed the greatest recovery, with a greater improvement in the test group as compared to control group.
创伤性脑损伤（TBI）相关影响导致患者在日常活动中永久需要帮助。标准治疗包括消除病因、恢复灌注、支持代谢需求以及限制炎症和氧化损伤。高压氧治疗（HBOT）就是这样一种较新的、有前景的治疗方法，它在一定程度上可促进神经功能恢复。HBOT是在高于正常大气压的环境中间歇性吸入100%氧气，因其在明确适应症中的作用而被国际认可。据推测，高压氧在使“闲置神经元”复苏方面发挥作用，这些“闲置神经元”也被称为缺血半暗带，其定义为脑血流量减少、突触活动消失但结构完整性保留的区域。我们对20例除接受标准治疗外还接受了HBOT治疗的TBI患者的病历进行了回顾性分析。这些患者被纳入A组（试验组），除标准治疗外还接受了至少30次HBOT治疗。根据残疾评定量表（DRS）、格拉斯哥昏迷量表（GCS）和兰乔斯阿米戈斯量表（RLAS）对患者进行评估。另外选取20例年龄和脑损伤严重程度相匹配、接受标准治疗但未接受HBOT治疗的TBI患者作为对照组（B组）。DRS评估显示，得分在22 - 24分（植物状态）的患者改善最为明显。试验组中处于该状态的患者比例从45%降至5%，而B组仅有20%的患者有类似进展。治疗后，通过RLA测量发现，接受HBOT治疗的受试者在认知功能方面有良好反应的比例显著更高。A组中90%的患者得分≤3分，B组中95%的患者得分相似，分别有60%和30%的患者得分提高到≥三分。两组中大多数患者处于受伤后1 - 6个月类别，且在组内该类别恢复最为明显，试验组比对照组改善更大。
