Department of Neurosurgery, Harrison International Peace Hospital (Hengshui City People's Hospital), Affiliated Hospital of Hebei Medical University, Renmin East Road, Hengshui City, Hebei Province, People's Republic of China.
Clinical Medicine Specialty of the First Clinical Medical College, Hebei North University, Changqing Road, Qiaoxi District, Zhangjiakou City, Hebei Province, People's Republic of China.
Arch Med Res. 2017 Oct;48(7):638-652. doi: 10.1016/j.arcmed.2018.03.001. Epub 2018 Mar 13.
Prognosis of spontaneous intracerebral hemorrhage (ICH) remains poor worldwide.
To investigate the effect and optimal protocol for hyperbaric-oxygen therapy (HBOT), and reduce incidence of upper gastrointestinal bleeding (UGIB) in ICH.
This prospective, randomized, controlled trial included 565 patients with acute severe ICH. Participants were randomly assigned to a sham-control group (Group A) and four intervention groups: Groups B and C with 2.0 atmospheres absolute (ATA) pressure and HBOT exposure for 60 or 90 sessions, respectively; and Groups D and E with 1.5 ATA for 60 or 90 sessions, respectively. All patients received emergency craniotomy with hematoma evacuation. Outcome measures were modified Barthel Index (MBI) and modified Rankin Scale (mRS) scores, mortality rates at follow-up six months. UGIB rates were assessed as potential side effect.
In four intervention groups, MBI and mRS scores were all significantly improved, and mortality rates were all significantly decreased compared with Group A (all p < 0.005). UGIB rates were 39.25, 60.00, 64.49, 36.79, and 34.26% in Groups A, B, C, D, and E, respectively. UGIB rates in Groups B and C were significantly increased compared with Groups A, D and E (all p < 0.005). None of UGIB were clinically significant.
HBOT significantly improves survival and functional outcomes of ICH. HBOT at 1.5 and 2.0 ATA had the same beneficial effect. A pressure of 1.5 ATA and 60 HBOT exposures represents an optimal protocol for HBOT. Further studies are needed to optimize the protocol per specific patient.
自发性脑出血（ICH）的预后在全球范围内仍然较差。
研究高压氧治疗（HBOT）的效果和最佳方案，降低 ICH 患者上消化道出血（UGIB）的发生率。
这是一项前瞻性、随机、对照试验，纳入了 565 例急性重症 ICH 患者。参与者被随机分配到假对照（A 组）和 4 个干预组：B 组和 C 组压力为 2.0 绝对大气压（ATA），HBOT 暴露分别为 60 或 90 次；D 组和 E 组压力为 1.5 ATA，HBOT 暴露分别为 60 或 90 次。所有患者均接受急诊开颅血肿清除术。观察指标为改良巴氏指数（MBI）和改良 Rankin 量表（mRS）评分，随访 6 个月的死亡率。UGIB 发生率作为潜在的副作用进行评估。
在 4 个干预组中，MBI 和 mRS 评分均显著改善，死亡率均显著降低（均 P<0.005）。A、B、C、D 和 E 组 UGIB 发生率分别为 39.25%、60.00%、64.49%、36.79%和 34.26%。B、C 组 UGIB 发生率明显高于 A、D、E 组（均 P<0.005）。无 UGIB 为临床显著。
HBOT 显著改善 ICH 患者的生存和功能结局。1.5 和 2.0 ATA 的 HBOT 具有相同的有益效果。1.5 ATA 的压力和 60 次 HBOT 暴露代表了 HBOT 的最佳方案。需要进一步研究以优化针对特定患者的方案。
