高压氧治疗脑外伤的疗效及对外周血CD34+的影响

Effect of hyperbaric oxygen therapy on curative effect andperipheral blood CD34+ with brain injury

摘要:

目的  探索高压氧治疗脑外伤的疗效及对外周血CD34+的影响。方法  选取2015年2月-2016年5月在该院就诊的颅脑外伤患者147例，根据是否接受高压氧治疗分为观察组与对照组，治疗4个疗程后进行疗效判断。治疗前和治疗4个疗程后采用格拉斯哥昏迷评分（GCS）评估两组患者昏迷程度；重症颅脑外伤残疾评分（DRS）评估两组患者颅脑外伤残疾情况；治疗后6个月进行格拉斯哥预后分级（GOS）评定。于入院后，治疗第1、3、5、7、11及14天，采用流式细胞仪计数CD34+细胞绝对值。结果  治疗后总有效率观察组与对照组差异有统计学意义（P <0.05），观察组总有效率高于对照组；治疗后观察组与对照组GCS及DRS评分差异有统计学意义（P <0.05），观察组GCS评分高于对照组，DRS评分低于对照组；在治疗后6个月，观察组与对照组的GOS差异有统计学意义（P <0.05），观察组GOS评级高于对照组。观察组外周血CD34+计数随时间变化逐渐升高，从治疗第3天开始，观察组及对照组外周血CD34+计数差异有统计学意义（P <0.05），观察组较对照组外周血CD34+计数多，在治疗第7天时达到高峰，之后逐渐回落。结论  高压氧治疗可使脑外伤患者昏迷程度及颅脑外伤残疾情况减轻，改善预后。有可能与高压氧激活脑外伤患者骨髓干细胞动员，CD34+参与中枢神经损伤修复有关。

关键词:

CD34+;脑外伤;格拉斯哥昏迷评分;重症颅脑外伤残疾评分;格拉斯哥预后分级

Abstract:

Objective To explore effect of hyperbaric oxygen therapy on curative effect and peripheral blood CD34+ with brain injury. Methods 147 cases with traumatic brain injury in our hospital were collected from February 2015 to May 2016. Patients were divided into observation group and control group based on whether accepted the hyperbaric oxygen therapy or not. Therapeutic effects were assessed 4 courses after treatment. Extents of coma were assessed before treatment and 4 courses after treatment by glasgow coma scale (GCS). Brain injury disability was assessed by dementia rating scale. The prognosis was assessed with glasgow outcome scale (GOS) after the treatment of 6 months. Absolute numbers of CD34+ cell were tested on admission and day 1, 3, 5, 7, 11 and 14 after therapy by flow cytometer. Results The difference of the total effective rateafter treatment between observation group and the control group was significant (P < 0.05), the total effective rate was higher in the observation group than that in the control group. The difference of GCS and DRS scoresafter treatment between observation group and the control group was significant (P < 0.05), and the GCS scores were higher in the observation group than that in the control group. The DRS scores were lower in the observation group than that in the control group. The difference of GOS grade after the treatment of 6 months between the observation group and the control group was significant (P < 0.05), and the GOS grades were higher in the observation group than that in the control group. The peripheral blood CD34+ count of observationgroup was increased with time, and after 3-days treatment, the difference of peripheral blood CD34+ count after 3-days treatment between the observation group and the control group was significant (P < 0.05), and the peripheral blood CD34+ count was more in the observation group than that in the control group, and reached its peak in the 7 days after treatment, the peripheral blood CD34+ count drops was gradually afterwards. Conclusions Hyperbaric oxygen therapy can ease the extent of coma and brain injury disability, improve the prognosis. It may be associated with hyperbaric oxygen therapy activate bone marrow stem cell mobilization with brain injury patients, and CD34+ may participate in trauma recovery of central nervous.

Key words:

CD34+; cerebral ischemic; glasgow coma scale; dementia rating scale; glasgow outcome scale