Sun Jianping, Zheng Jun, Wang Feng, Zhang Gengshen, Wu Jianliang
Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 05000, P.R. China.
Exp Ther Med. 2018 Jun;15(6):4651-4658. doi: 10.3892/etm.2018.6045. Epub 2018 Apr 10.
The aim of the present study was to was investigate the treatment efficacy of hyperbaric oxygen (HBO) combined with nimodipine on diffuse brain injury. AA total of 80 patients with diffuse brain injury were randomly divided into four groups: Group A, conventional treatment; Group B, conventional treatment + nimodipine; Group C, conventional treatment + HBO therapy and Group D, conventional treatment + nimodipine + HBO therapy. The Glasgow Coma Scale (GCS) score and serum tumor necrosis factor (TNF)-α and interleukin (IL)-1β levels were assessed before treatment and at 8, 24, 48 and 72 h after treatment. The bilateral middle cerebral arterial blood flow velocity (VmMCA) was measured by transcranial Doppler ultrasound. The results indicated that serum TNF-α and IL-1β were significantly decreased in all groups at 24, 48 and 72 h after treatment, compared with 8 h after treatment (P<0.05), with Group D exhibiting the largest decrease. The serum TNF-α, IL-1β and VmMCA peaked at 8 h and gradually decreased over the treatment period. VmMCA was decreased in Group B and D compared with Group A and C, and the decrease rate was higher in Group D compared with Group B (P<0.05). GCS scores were significantly increased in all groups at 24, 48 and 72 h after treatment compared with 8 h after treatment (P<0.05), with Group D exhibiting the largest increase. Serum TNF-α and IL-1β levels were positively correlated with VmMCA (P<0.05) and negatively correlated with GCS (P<0.05). Punctate hemorrhage was observed in all groups on CT before treatment, with a value of 66±3 HU. Punctate hemorrhage was observed to decrease over time in CT images, and CT values were significantly decreased in all groups at 8, 24, 48 and 72 h compared with before treatment (P<0.05). CT values were significantly lower in group D compared with groups A, B and C (P<0.05) at all time points. Serum TNF-α and IL-1β levels were positively correlated with CT value (P<0.05). In conclusion, HBO combined with nimodipine exhibited increased efficacy in the treatment of brain injury compared with either treatment alone.
本研究的目的是探讨高压氧（HBO）联合尼莫地平治疗弥漫性脑损伤的疗效。将80例弥漫性脑损伤患者随机分为四组：A组，常规治疗；B组，常规治疗+尼莫地平；C组，常规治疗+HBO治疗；D组，常规治疗+尼莫地平+HBO治疗。在治疗前以及治疗后8、24、48和72小时评估格拉斯哥昏迷量表（GCS）评分、血清肿瘤坏死因子（TNF）-α和白细胞介素（IL）-1β水平。采用经颅多普勒超声测量双侧大脑中动脉血流速度（VmMCA）。结果表明，与治疗后8小时相比，所有组在治疗后24、48和72小时血清TNF-α和IL-1β均显著降低（P<0.05），其中D组降低幅度最大。血清TNF-α、IL-1β和VmMCA在8小时达到峰值，并在治疗期间逐渐下降。与A组和C组相比，B组和D组的VmMCA降低，且D组的下降率高于B组（P<0.05）。与治疗后8小时相比，所有组在治疗后24、48和72小时GCS评分均显著升高（P<0.05），其中D组升高幅度最大。血清TNF-α和IL-1β水平与VmMCA呈正相关（P<0.05），与GCS呈负相关（P<0.05）。治疗前CT检查所有组均观察到点状出血，CT值为66±3 HU。CT图像显示点状出血随时间减少，与治疗前相比，所有组在8、24、48和72小时CT值均显著降低（P<0.05）。在所有时间点，D组的CT值均显著低于A、B和C组（P<0.05）。血清TNF-α和IL-1β水平与CT值呈正相关（P<0.05）。总之，与单独使用任何一种治疗方法相比，HBO联合尼莫地平治疗脑损伤的疗效更佳。
