高压氧治疗缺血缺氧性脑损伤后慢性意识障碍的疗效观察

陈炎; 虞容豪; 倪啸晓; 郭叶群; 郑波; 孙玲玲; 曹晋

doi:10.16016/j.1000-5404.202102116

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高压氧治疗缺血缺氧性脑损伤后慢性意识障碍的疗效观察

专题报道：意识障碍的基础与临床研究 | 更新时间：2026-01-09

- 高压氧治疗缺血缺氧性脑损伤后慢性意识障碍的疗效观察
- Efficacy of hyperbaric oxygen in treatment of prolonged disorders of consciousness after hypoxic-ischemic brain injury
- 第三军医大学学报 2021年43卷第15期页码：1449-1453
- 作者机构：
  
  1.510010 广州，解放军南部战区总医院高压氧康复科
  2.710000 西安，空军第九八六医院第七门诊部
- 作者简介：
  
  [曹晋，E-mail：40626967@qq.com CAO Jin, E-mail: 40626967@qq.com
- 基金信息：
  
  广东省医学科学技术研究基金(A2020416)
- DOI：10.16016/j.1000-5404.202102116
  中图分类号： R459.6;R743.31;R749.13
- 收稿：2021-02-22，
  
  修回：2021-06-03，
  
  纸质出版：2021-08-15
- 稿件说明：
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陈炎, 虞容豪, 倪啸晓, 等. 高压氧治疗缺血缺氧性脑损伤后慢性意识障碍的疗效观察[J]. 第三军医大学学报, 2021,43(15):1449-1453.

Yan CHEN, Ronghao YU, Xiaoxiao NI, et al. Efficacy of hyperbaric oxygen in treatment of prolonged disorders of consciousness after hypoxic-ischemic brain injury[J]. Journal of Third Military Medical University, 2021, 43(15): 1449-1453.
陈炎, 虞容豪, 倪啸晓, 等. 高压氧治疗缺血缺氧性脑损伤后慢性意识障碍的疗效观察[J]. 第三军医大学学报, 2021,43(15):1449-1453. DOI： 10.16016/j.1000-5404.202102116.

Yan CHEN, Ronghao YU, Xiaoxiao NI, et al. Efficacy of hyperbaric oxygen in treatment of prolonged disorders of consciousness after hypoxic-ischemic brain injury[J]. Journal of Third Military Medical University, 2021, 43(15): 1449-1453. DOI： 10.16016/j.1000-5404.202102116.

摘要

目的

探讨高压氧(hyperbaric oxygen，HBO)治疗对缺血缺氧性脑损伤(hypoxic-ischemic brain injure，HIBI)后慢性意识障碍(prolonged disorders of consciousness，pDOC)患者意识及预后的影响。

方法

回顾性分析2010年1月至2019年6月在解放军南部战区总医院住院治疗的HIBI后pDOC患者78例。按照治疗方法分为对照组(19例)和高压氧组(59例)；根据患者入院时病程是否超过3个月将高压氧组分为长病程组(21例)和短病程组(38例)。对照组给予常规治疗，高压氧组在常规治疗基础上应用HBO治疗。记录所有患者的性别、年龄、入院时格拉斯哥昏迷量表(Glasgow Coma Scale

GCS)评分、入院和出院时修订版昏迷恢复量表(Coma Recovery Scale-Revised

CRS-R)评分。出院1年后采用格拉斯哥结局量表(Glasgow Outcome Scale

GOS)进行随访。

结果

高压氧组患者出院时CRS-R(11.51±6.33)评分高于对照组(8.05±4.81)，意识改善患者比例(66.10%)高于对照组(26.32%)。出院1年后，高压氧组患者GOS评分(2.53±1.12)高于对照组(1.42±0.69)，病死率(20.34%)低于对照组(68.42%)，差异均有统计学意义(

0.05)。短病程组出院时CRS-R评分(12.45±6.73)高于对照组(8.05±4.81)，意识改善患者比例(71.05%)高于对照组(26.32%)，出院1年后GOS评分(2.58±1.13)高于对照组(1.42±0.69)，病死率(18.42%)低于对照组(68.42%)，差异均有统计学意义(

0.05)。长病程组出院时意识改善患者比例(57.14%)高于对照组(26.32%)，出院1年后GOS评分(2.43±1.12)高于对照组(1.42±0.69)，病死率(23.81%)低于对照组(68.42%)，差异均有统计学意义(

0.05)。

结论

HBO治疗可以改善HIBI后pDOC患者的意识，即使其病程超过3个月；HBO治疗可以改善远期预后，降低病死率。

Abstract

Objective

To investigate the effect of hyperbaric oxygen (HBO) therapy on consciousness and prognosis in patients with prolonged disorders of consciousness (pDOC) after hypoxic-ischemic brain injury (HIBI).

Methods

Clinical data of 78 pDOC patients after HIBI treated in the General Hospital of Southern Theater Command from January 2010 to June 2019 were collected and analyzed retrospectively. In accordance with their treatment

they were divided into control group (

=19) and HBO group (

=59). Then

the HBO group was further assigned into long-course subgroup (

=21) and short-course subgroup (

=38) according to whether the course of disease w

as longer than 3 months. The patients in the control group received only routine treatment

while those in the HBO group got HBO therapy on the basis of routine treatment. Gender

age

GOS score at admission

and Coma Recovery Scale-Revised (CRS-R) score at admission and discharge were recorded. Glasgow Outcome Scale was used for follow-up survey in 1 year after discharge.

Results

The HBO group had significantly higher CRS-R score at discharge (11.51±6.33

8.05±4.81)

larger proportion of those achieving better consciousness (66.10%

26.32%) when compared with the control group (

0.05). In 1 year after discharge

the GOS score was significantly higher (2.53±1.12

1.42±0.69) and lower mortality (20.34%

68.42%) in HBO group than the control group (

0.05). Moreover

in the short-course subgroup

the CRS-R score at discharge was obviously higher (12.45±6.73

8.05±4.81)

the proportion of patients with consciousness improved was larger (71.05%

26.32%)

the GOS score in 1 year after discharge was higher (2.58±1.13

1.42±0.69)

and lower mortality rate was lower (18.42%

68.42%) when compared with the control group (

0.05). And in the long-course subgroup

similiar results of above indicators were seen in comparison with the control group (57.14%

26.32%; 2.43±1.12

1.42±0.69; 23.81%

68.42%;

0.05).

Conclusion

HBO therapy can improve the consciousness of patients with pDOC after HIBI

even if the course exceeds 3 months. Further more

HBO therapy can improve long-term prognosis and reduce mortality rate in these patients.

关键词

Keywords

references

GIACINO J T, KATZ D I, SCHIFF N D, et al . Practice guideline update recommendations summary: Disorders of consciousness: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research[J ] . Neurology, 2018, 91(10): 450-460. DOI:10.1212/WNL.0000000000007382.

AVESANI R, DAMBRUOSO F, SCANDOLA M, et al . Epidemiological and clinical characteristics of 492 patients in a vegetative state in 29 Italian rehabilitation units. What about outcome?[J ] . Funct Neurol, 2018, 33(2): 97-103.

GRILL E, KLEIN A M, HOWELL K, et al . Rationale and design of the prospective German registry of outcome in patients with severe disorders of consciousness after acute brain injury[J ] . Arch Phys Med Rehabil, 2013, 94(10): 1870-1876. DOI:10.1016/j.apmr.2012.10.040.

THIBAUT A, SCHIFF N, GIACINO J, et al . Therapeutic interventions in patients with prolonged disorders of consciousness[J ] . Lancet Neurol, 2019, 18(6): 600-614. DOI:10.1016/S1474-4422(19)30031-6.

杨艺, 河江弘, 焦辉, 等. 高压氧治疗植物状态临床疗效及时间窗的Meta分析[J]. 中华神经医学杂志, 2015, 14(4): 501-505. DOI:10.3760/cma.j.issn.1671-8925.2015.04.014.

YANG Y, HE J H, JIAO H, et al . Time window of hyperbaric oxygen in treatment of persistent vegetable state and its treatment efficacy: a Meta analysis[J ] . Chin J Neuromed, 2015, 14(4): 501-505. DOI:10.3760/cma.j.issn.1671-8925.2015.04.014.

张奕, 高宇, 侯晓敏, 等. 高压氧综合治疗颅脑外伤后最小意识状态患者的临床分析[J]. 中华航海医学与高气压医志, 2016, 23(3): 184-187. DOI:10.3760/cma.j.issn.1009-6906.2016.03.005.

ZHANG Y, GAO Y, HOU X M, et al . Effects of comprehensive hyperbaric oxygen therapy on the patients with minimal consciousness following traumatic brain injury[J ] . Chin J Nautical Med Hyperbaric Med, 2016, 23(03): 184-187. DOI:10.3760/cma.j.issn.1009-6906.2016.03.005.

孙洋洋, 葛晓利, 戴李华, 等. 心肺复苏后缺血缺氧性脑损伤的高压氧治疗进展[J]. 中华航海医学与高气压医学杂志, 2018, 01: 61-63. DOI:10.3750/cma.j.issn.1009-6906.2018.01.022.

SUN Y Y, GE X L, DAI L H, et al . Progress of hyperbaric oxygen treatment for ischemia-hypoxic brain injury after cardiopulmonary resuscitation[J ] . Chin J Nautical Med Hyperbaric Med, 2018, 01: 61-63. DOI:10. 3750/cma.j.issn.1009-6906.2018.01.022.

中国医师协会神经修复专业委员会意识障碍与促醒学组. 慢性意识障碍诊断与治疗中国专家共识[J]. 中华神经医学杂志, 2020, 19(10): 977-982. DOI:10.3760/cma.j.cn115354-20200701-00525.

Group of Disorders of Consciousness and Conscious-Promotion, Professional Committee of Neurorepair of Chinese Medical Doctor Association. Diagnoses and treatments of prolonged disorders of consciousness: an experts consensus[J]. Chin J Neuromed, 2020, 19(10): 977-982. DOI:10.3760/cma.j.cn115354- 20200701-00525.

LIM C, VERFAELLIE M, SCHNYER D, et al . Recovery, long-term cognitive outcome and quality of life following out-of-hospital cardiac arrest[J ] . J Rehabil Med, 2014, 46(7): 691-697. DOI:10.2340/16501977-1816.

HADANNY A, GOLAN H, FISHLEV G, et al . Hyperbaric oxygen can induce neuroplasticity and improve cognitive functions of patients suffering from anoxic brain damage[J ] . Restor Neurol Neurosci, 2015, 33(4): 471-486. DOI:10.3233/RNN-150517.

HADANNY A, ABBOTT S, SUZIN G, et al . Effect of hyperbaric oxygen therapy on chronic neurocognitive deficits of post-traumatic brain injury patients: retrospective analysis[J ] . BMJ Open, 2018, 8(9): e023387. DOI:10.1136/bmjopen-2018-023387.

EFRATI S, FISHLEV G, BECHOR Y, et al . Hyperbaric oxygen induces late neuroplasticity in post stroke patients: randomized, prospective trial[J ] . PLoS ONE, 2013, 8(1): e53716. DOI:10.1371/journal.pone.0053716.

TAL S, HADANNY A, SASSON E, et al . Hyperbaric oxygen therapy can induce angiogenesis and regeneration of nerve fibers in traumatic brain injury patients[J ] . Front Hum Neurosci, 2017, 11: 508. DOI:10.3389/fnhum.2017.00508.

EFRATI S, BEN-JACOB E. Reflections on the neurotherapeutic effects of hyperbaric oxygen[J]. Expert Rev Neurother, 2014, 14(3): 233-236. DOI:10.1586/14737175.2014.884928.

LIN K C, NIU K C, TSAI K J, et al . Attenuating inflammation but stimulating both angiogenesis and neurogenesis using hyperbaric oxygen in rats with traumatic brain injury[J ] . J Trauma Acute Care Surg, 2012, 72(3): 650-659. DOI:10.1097/TA.0b013e31823c575f.

WEI L X, REN Q, ZHANG Y J, et al . Effects of hyperbaric oxygen and nerve growth factor on the long-term neural behavior of neonatal rats with hypoxic ischemic brain damage[J ] . Acta Cir Bras, 2017, 32(4): 270-279. DOI:10.1590/s0102-865020170040000002.

赵继宗. 意识障碍临床诊疗的现状与进展[J]. 临床神经外科杂志, 2020, 17(1): 1-3, 7.

ZHAO J Z. Clinical diagnosis and treatment of consciousness disorders[J]. J Clin Neurosurg, 2020, 17(1): 1-3, 7.

DENG Z, CHEN W, JIN J, et al . The neuroprotection effect of oxygen therapy: a systematic review and meta-analysis[J ] . Niger J Clin Pract, 2018, 21(4): 401-416. DOI:10.4103/njcp.njcp_315_16.

CRAWFORD C, TEO L, YANG E, et al . Is hyperbaric oxygen therapy effective for traumatic brain injury? A rapid evidence assessment of the literature and recommendations for the field[J ] . J Head Trauma Rehabil, 2017, 32(3): E27-E37. DOI:10.1097/htr.0000000000000256.

HUANG L, APPLEGATE P M, GATLING J W, et al . A systematic review of neuroprotective strategies after cardiac arrest: from bench to bedside (part Ⅱ-comprehensive protection) [J ] . Med Gas Res, 2014, 4: 10. DOI:10.1186/2045-9912-4-10.

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