中重型创伤性脑损伤患者不同压力高压氧治疗前后脑氧代谢指标变化与预后相关性

doi:10.19854/j.cnki.1008-2425.2025.04.0009

摘要/Abstract

摘要： 目的探讨中重型创伤性脑损伤患者不同压力高压氧治疗前后脑氧代谢指标变化与预后相关性。方法选择2020年1月~2023年12月我院收治的155例中重型创伤性脑损伤患者为研究对象,根据不同高压氧治疗压力、周期和频率分为低压短期组(n=47),高压短期组(n=36),低压长期组(n=44),高压长期组(n=28),比较四组患者的临床资料,分析CT肺动脉成像特征差异。根据预后情况将所有患者分为预后良好组(n=108)和不良组(n=47)并比较临床资料、治疗前后脑氧代谢指标(CMRO₂、Da-jvO₂、CEO₂、SjVO₂、A-VDO₂、CERVO₂)的变化;采用单因素和多因素Cox回归分析筛选中重型创伤性脑损伤患者预后不良的影响因素,并通过共线性检验诊断各变量之间的独立性;采用限制性立方样条模型(RCS)分析模型分析治疗后脑氧代谢指标变化与预后之间的关系。结果四组性别、年龄、BMI、DBP、SBP、RR、HR、SpO₂、Hb、SaO₂、治疗后脑氧代谢指标比较,差异均具有统计学意义(P＜0.05),且高压长期患者治疗后CMRO₂、Da-jvO₂、CEO₂、SjVO₂、A-VDO₂水平最高,CERVO₂水平最低。不同预后患者性别、年龄、BMI、不同压力高压氧、治疗后CMRO₂、Da-jvO₂、CEO₂、SjVO₂、A-VDO₂及CERVO₂比较,差异有统计学意义(P＜0.05),与良好组相比,不良组BMI、治疗后CMRO₂、Da-jvO₂、CEO₂、SjVO₂、A-VDO₂显著增高(P＜0.05),而治疗后CERVO₂显著降低(P＜0.05)。高压短期、低压长期、CMRO₂、Da-jvO₂、CEO₂、SjVO₂及A-VDO₂均是患者预后不良的独立影响因素。CMRO₂、Da-jvO₂、CEO₂、SjVO₂与患者预后不良风险呈正相关。结论不同压力高压氧治疗的中重型创伤性脑损伤患者治疗后脑氧代谢指标变化显著,临床上可通过对患者脑氧代谢指标变化进行监测,CMRO₂、Da-jvO₂、CEO₂、SjVO₂与患者预后不良风险呈正相关。

关键词: 中重型创伤性脑损伤, 不同压力高压氧治疗, 不同压力高压氧治疗, 预后相关性

Abstract: Objective To investigate the changes of cerebral oxygen metabolism indexes before and after hyperbaric oxygen therapy at different pressures and their correlation with prognosis in patients with moderate or severe traumatic brain injury. Methods 155 patients with moderate to severe traumatic brain injury admitted to our hospital from January,2020 to December,2023 were selected as the research objects.According to different hyperbaric oxygen treatment pressure,cycle and frequency,they were divided into low pressure short-term group (n=47),high pressure short-term group (n=36),low pressure long-term group (n=44),high pressure long-term group (n=28).The clinical data of the four groups were compared,and the differences in CT pulmonary angiography characteristics were analyzed.According to the prognosis,all patients were divided into A good prognosis group (n=108) and a poor prognosis group (n=47),and the changes in clinical data,cerebral oxygen metabolism indexes (CMRO₂,Da-jvO₂,CEO₂,SjVO₂,A-VDO₂,CERVO₂) before and after treatment were compared.Univariate and multivariate Cox regression analysis were used to screen the influencing factors of poor prognosis in patients with moderate to severe traumatic brain injury,and collinearity test was used to diagnose the independence between variables.Restricted cubic spline (RCS) analysis model was used to analyze the relationship between the changes of cerebral oxygen metabolism indexes after treatment and prognosis. Results There were statistically significant differences in gender,age,BMI,DBP,SBP,RR,HR,SpO₂,Hb,SaO₂,and cerebral oxygen metabolism indexes after treatment among the four groups (P<0.05),and the levels of CMRO₂,Da-jvO₂,CEO₂,SjVO₂,and A-VDO₂ were the highest in patients with long-term hypertension after treatment.The level of CERVO₂ was the lowest.There were statistically significant differences in gender,age,BMI,different pressure of hyperbaric oxygen,CMRO₂,Da-jvO₂,CEO₂,SjVO₂,A-VDO₂ and CERVO₂ after treatment in patients with different prognosis (P<0.05).Compared with the good group,BMI,CMRO₂,Da-jvO₂,CEO₂,SjVO₂,A-VDO₂ after treatment in the poor group were significantly increased (P<0.05),while CERVO₂ after treatment was significantly decreased (P＜0.05).Short-term high pressure,long-term low pressure,CMRO₂,Da-jvO₂,CEO₂,SjVO₂ and A-VDO₂ were all independent influencing factors for poor prognosis of patients.CMRO₂,Da-jvO₂,CEO₂ and SjVO₂ were positively correlated with the risk of poor prognosis. Conclusion The changes of cerebral oxygen metabolism indexes in patients with moderate or severe traumatic brain injury treated with different pressures of hyperbaric oxygen are significant after treatment.The changes of cerebral oxygen metabolism indexes in patients can be monitored clinically.CMRO₂,Da-jvO₂,CEO₂,and SjVO₂ are positively correlated with the risk of poor prognosis of patients.

Key words: Moderate to severe traumatic brain injury, Different pressure hyperbaric oxygen therapy, Different pressure hyperbaric oxygen therapy, Prognostic relevance

中图分类号:

R651

王剑雅, 王坤, 姜炜, 朱梦. 中重型创伤性脑损伤患者不同压力高压氧治疗前后脑氧代谢指标变化与预后相关性[J]. 立体定向和功能性神经外科杂志, 2025, 38(4): 242-251.

Wang Jianya, Wang Kun, Jiang Wei, Zhu Meng. Changes of cerebral oxygen metabolism index before and after different pressures in patients with moderate and severe traumatic brain injury[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2025, 38(4): 242-251.

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