摘要
目的探讨高压氧(HBO)联合轻度全身降温模式治疗脑损伤术后患儿的临床疗效。方法选取2019年7月至2022年2月山西省儿童医院小儿重症监护病房收治的脑损伤术后患儿112例作为研究对象。按照随机数字表法分为观察组和对照组,每组56例。2组患儿常规对症支持治疗后,对照组予以头部降温联合HBO治疗,观察组给予轻度全身降温联合HBO治疗。比较2组患儿治疗前后格拉斯哥昏迷评分(GCS)、功能独立性评定(FIM)评分、动脉血氧分压、经皮血氧饱和度的变化。采用简易智力状态检查量表(MMSE)和Loewenstein认知功能评定量表(LOTCA)对2组患儿治疗前后的认知能力进行评定。采用酶联免疫吸附法检测2组患儿治疗前后血清纤维凝胶蛋白(ficolin-3)水平,采用实时荧光定量PCR实验检测2组患儿治疗前后微小RNA-34a(miR-34a)的相对表达量。随访6个月,比较2组患儿的预后良好率。结果与治疗前比较,2组患儿治疗后GCS、FIM评分、MMSE评分、LOTCA评分、动脉血氧分压、经皮血氧饱和度及血清ficolin-3水平均明显升高(P<0.01),且观察组患儿治疗后均明显高于对照组(P<0.05或P<0.01);血清miR-34a相对表达量明显降低(P<0.01),且观察组患儿治疗后miR-34a相对表达量明显低于对照组(P<0.01)。在随访6个月后,观察组患儿预后良好率(52.83%)明显高于对照组(40.74%),差异有统计学意义(P<0.05)。结论HBO联合轻度全身降温模式治疗脑损伤术后患儿,能提高其脑组织氧含量,有效改善患儿的昏迷程度和认知功能,进一步提高认知能力和预后良好率。
Objective To investigate the clinical efficacy of hyperbaric oxygen(HBO)combined with mild systemic hypothermia in the treatment of postoperative brain injury in children.Methods A total of 112 children with postoperative brain injury admitted to the Pediatric Intensive Care Unit of Children's Hospital of Shanxi from July 2019 to February 2022 were selected as the research subjects.They were randomly divided into observation group and control group,with 56 cases in each group.After conventional symptomatic supportive treatment,the control group received head cooling combined with HBO therapy,while the observation group received mild systemic hypothermia combined with HBO therapy.The changes in Glasgow Coma Scale(GCS)score,Functional Independence Measure(FIM)score,arterial oxygen partial pressure,and blood oxygen saturation before and after treatment were compared between the two groups.The cognitive abilities of the children of two groups before and after treatment were assessed using the Mini Mental State Examination(MMSE)and Loewenstein Occupational Therapy Cognitive Assessment(LOTCA)Scale.Enzyme-linked immunosorbent assay was used to detect the serum ficolin-3 level,and real-time fluorescence quantitative polymerase chain reaction(RT-PCR)was used to detect the relative expression level of micro-RNA-34a(miR-34a)before and after treatment in both groups.A 6-month follow-up was conducted to compare the rate of favorable prognosis in the two groups.Results Compared with before treatment,the GCS,FIM score,MMSE score,LOTCA score,arterial oxygen partial pressure,and transcutaneous oxygen saturation score in both groups significantly increased after treatment(P<0.01);and the post-treatment scores in the observation group were significantly higher than those in the control group(P<0.05 or P<0.01).After treatment,the level of serum ficolin-3 in the observation group was significantly higher than that in the control group,while the relative expression level of miR-34a was significantly lower than that in the control group(P<0.05 or P<0.01).After the 6-month follow-up,the rate of favorable prognosis in the observation group(52.83%)was significantly higher than that in the control group(40.74%),with a statistically significant difference(P<0.05).Conclusion HBO combined with mild systemic hypothermia in the treatment of postoperative brain injury in children can increase cerebral tissue oxygen content,effectively improve the severity of coma and enhance functional abilities,thus further promoting cognitive abilities and improving the rate of favorable prognosis.
作者
刘晓莉
刘赵鹤
陈海珍
吴丽莉
王振芳
Liu Xiaoli;Liu Zhaohe;Chen Haizhen;Wu Lili;Wang Zhenfang(Rehabilitation Department of Children’s Hospital of Shanxi,Taiyuan 030000,China)
出处
《中华航海医学与高气压医学杂志》
CAS
CSCD
2024年第1期12-16,共5页
Chinese Journal of Nautical Medicine and Hyperbaric Medicine
关键词
脑损伤
患儿
高压氧
轻度全身降温
头部降温
Brain injury
Pediatric patient
Hyperbaric oxygen
Mild systemic hypothermia
Head cooling
