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早期强化康复训练结合高压氧治疗对创伤性脑损伤患者功能障碍及预后的影响

Effect of early intensive rehabilitation training combined with hyperbaric oxygen therapy on dysfunction and prognosis of patients with traumatic brain injury

    摘要
  • 摘要:
    目的  评估早期强化康复训练结合高压氧治疗对创伤性脑损伤患者功能障碍及预后的改善作用。
    方法  纳入明确诊断为创伤性脑损伤的患者160例，依据随机数字表法分为4组: 强化康复训练(1次/d)组(IRT1组)、强化康复训练(1次/d)联合高压氧治疗组(IRT1+HBO组)、强化康复训练(2次/d)组(IRT2组)和强化康复训练(2次/d)联合高压氧治疗组(IRT2+HBO组)，每组40例。最终共纳入151例患者, IRT1组39例、IRT1+HBO组38例、IRT2组37例、IRT2+HBO组37例。强化康复训练包括功能电刺激(20 min/d)、针灸治疗(30 min/d)、运动治疗(45 min/d)、职业治疗(30 min/d)、言语治疗(30 min/d)、认知行为治疗(30 min/d), 以1个月为1个疗程，共3个疗程。患者接受2.0倍绝对大气压的高压氧治疗, 1 h/d, 以20 d为1个疗程，每个疗程结束10 d后开始下一疗程。于患者入院后开始康复训练前(T0)、康复训练后1个月(T1)、康复训练后2个月(T2)、康复训练后3个月(T3)对患者进行简易智力状态检查量表(MMSE)、改良Barthel指数(MBI)、功能独立性评定量表(FIM)、Fugl-Meyer评定量表(FMA)评估。
    结果  IRT2+HBO组患者T1、T2时点MMSE评分高于IRT1组和IRT2组患者，差异有统计学意义(P < 0.05)。IRT2+HBO组患者T3时点MMSE评分高于IRT1组、IRT1+HBO组、IRT2组患者，差异有统计学意义(P < 0.05)。IRT2组和IRT2+HBO组患者T1、T2、T3时点MBI评分高于IRT1组和IRT1+HBO组患者，差异有统计学意义(P < 0.05)。IRT2+HBO组患者T1、T2、T3时点FIM评分高于IRT1组、IRT2组和IRT1+HBO组患者，差异有统计学意义(P < 0.05)。IRT2组和IRT1+HBO组T1、T2、T3时点FIM评分高于IRT1组患者，差异有统计学意义(P < 0.05)。IRT2组和IRT2+HBO组患者T1、T2、T3时点FMA评分高于IRT1组和IRT1+HBO组患者，差异有统计学意义(P < 0.05)。
    结论  早期强化康复训练结合高压氧治疗能够有效改善创伤性脑损伤患者认知功能、运动功能及日常活动能力。

     

    Abstract:
    Objective  To evaluate the role of early intensive rehabilitation training combined with hyperbaric oxygen therapy in improving dysfunction and prognosis of patients with traumatic brain injury.
    Methods  A total of 160 patients diagnosed as traumatic brain injury were randomly divided into four groups, namely intensive rehabilitation training (one time per day) group (IRT1 group), intensive rehabilitation training (one time per day) combined with hyperbaric oxygen therapy group (IRT1+HBO group), intensive rehabilitation training (two times per day) group (IRT2 group) and intensive rehabilitation training (two times per day) combined with hyperbaric oxygen therapy group (IRT2+HBO group), with 40 cases in each group. A total of 151 patients were finally included, including 39 cases in the IRT1 group, 38 cases in the IRT1+HBO group, 37 cases in the IRT2 group, and 37 cases in the IRT2+HBO group. Intensive rehabilitation training included functional electrical stimulation (20 minutes per day), acupuncture therapy (30 minutes per day), exercise therapy (45 minutes per day), occupational therapy (30 minutes per day), speech therapy (30 minutes per day) and cognitive behavioral therapy (30 minutes per day), with one month as a course of treatment for 3 courses in total. The patients received hyperbaric oxygen therapy at 2.0 times absolute atmospheric pressure for 1 hour per day, with 20 days as a course of treatment, and the next course of treatment began after 10 days in the end of each course. At the time points of before rehabilitation training (T0), 1 month after rehabilitation training (T1), 2 months after rehabilitation training (T2) and 3 months after rehabilitation training (T3) after hospital admission, the Mini-Mental State Examination (MMSE), the Modified Barthel Index (MBI), the Functional Independence Measure (FIM) and Fugl-Meyer Assessment Scale (FMA) were used to evaluate the patients.
    Results  Scores of MMSE at T1 and T2 in the IRT2+HBO group were significantly higher than those in the IRT1 group and the IRT2 group (P < 0.05). Score of MMSE at T3 in the IRT2+HBO group was significantly higher than that in the IRT1 group, the IRT1+HBO group and the IRT2 group (P < 0.05). Values of MBI at T1, T2 and T3 in the IRT2 group and the IRT2+HBO group were significantly higher than those in the IRT1 group and the IRT1+HBO group (P < 0.05). Scores of FIM at T1, T2 and T3 in the IRT2+HBO group were significantly higher than those in the IRT1 group, the IRT2 group and the IRT1+HBO group (P < 0.05). Scores of FIM at T1, T2 and T3 in the IRT2 group and the IRT1+HBO group were significantly higher than those in the IRT1 group (P < 0.05). Scores of FMA at T1, T2 and T3 in the IRT2 group and the IRT2+HBO group were significantly higher than those in the IRT1 group and the IRT1+HBO group (P < 0.05).
    Conclusion  Early intensive rehabilitation training combined with hyperbaric oxygen therapy can effectively improve the cognitive function, motor function and ability of daily activity in patients with traumatic brain injury.

     

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