RESULTS OF A PROSPECTIVE RANDOMIZED TRIAL FOR TREATMENT OF SEVERELY BRAIN-INJURED PATIENTS WITH HYPERBARIC-OXYGEN

被引:135
作者
ROCKSWOLD, GL
FORD, SE
ANDERSON, DC
BERGMAN, TA
SHERMAN, RE
机构
[1] HENNEPIN CTY MED CTR,DEPT NEUROL,MINNEAPOLIS,MN 55415
[2] UNIV MINNESOTA,DEPT NEUROSURG,MINNEAPOLIS,MN 55455
[3] HENEPIN CTY ADM,DEPT PLANNING & DEV,MINNEAPOLIS,MN
关键词
HEAD INJURY; HYPERBARIC OXYGEN; INTRACRANIAL PRESSURE; CLINICAL TRIAL;
D O I
10.3171/jns.1992.76.6.0929
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
The authors enrolled 168 patients with closed-head trauma into a prospective trial to evaluate the effect of hyperbaric oxygen in the treatment of brain injury. Patients were included if they had a total Glasgow Coma Scale (GCS) score of 9 or less for at least 6 hours. After the GCS score was established and consent obtained, the patient was randomly assigned, stratified by GCS score and age, to either a treatment or a control group. Hyperbaric oxygen was administered to the treatment group in a monoplace chamber every 8 hours for 1 hour at 1.5 atm absolute; this treatment course continued for 2 weeks or until the patient was either brain dead or awake. An average of 21 treatments per patient was given. Outcome was assessed by blinded independent examiners. The entire group of 168 patients was followed for 12 months, with two patients lost to follow-up study. The mortality rate was 17% for the 84 hyperbaric oxygen-treated patients and 32% for the 82 control patients (chi-squared test, 1 df, p = 0.037). Among the 80 patients with an initial GCS score of 4, 5, or 6, the mortality rate was 17% for the hyperbaric oxygen-treated group and 42% for the controls (chi-squared test, 1 df, p = 0.04). Analysis of the 87 patients with peak intracranial pressures (ICP) greater than 20 mm Hg revealed a 2 1 % mortality rate for the hyperbaric oxygen-treated patients, as opposed to 48% for the control group (chi-squared test, 1 df, p = 0.02). Myringotomy to reduce pain during hyperbaric oxygen treatment helped to reduce ICP. Analysis of the outcome of survivors reveals that hyperbaric oxygen treatment did not increase the number of patients in the favorable outcome categories (good recovery and moderate disability). The possibility that a different hyperbaric oxygen treatment paradigm or the addition of other agents, such as a 21-aminosteroid, may improve quality of survival is being explored.
引用
收藏
页码:929 / 934
页数:6
相关论文
共 34 条
[1]   MULTIMODALITY EVOKED-POTENTIALS IN CLOSED HEAD TRAUMA [J].
ANDERSON, DC ;
BUNDLIE, S ;
ROCKSWOLD, GL .
ARCHIVES OF NEUROLOGY, 1984, 41 (04) :369-374
[2]  
ANDERSON DW, 1983, PUBLIC HEALTH REP, V98, P475
[3]  
BERGMAN TA, 1987, MINN MED, V70, P397
[4]  
CLARK JM, 1977, HYPERBARIC OXYGEN TH, P61
[5]   THE EFFECT OF HYPERBARIC-OXYGEN ON GLUCOSE-UTILIZATION IN A FREEZE-TRAUMATIZED RAT-BRAIN [J].
CONTRERAS, FL ;
KADEKARO, M ;
EISENBERG, HM .
JOURNAL OF NEUROSURGERY, 1988, 68 (01) :137-141
[6]  
GAMACHE FW, 1984, INFECT SURG, V3, P485
[7]   EFFECTS OF THE 21-AMINOSTEROID U74006F ON EXPERIMENTAL HEAD-INJURY IN MICE [J].
HALL, ED ;
YONKERS, PA ;
MCCALL, JM ;
BRAUGHLER, JM .
JOURNAL OF NEUROSURGERY, 1988, 68 (03) :456-461
[8]   EFFECT OF ALTERATIONS IN ARTERIAL CARBON DIOXIDE TENSION ON BLOOD FLOW THROUGH CEREBRAL CORTEX AT NORMAL AND LOW ARTERIAL BLOOD PRESSURES [J].
HARPER, AM ;
GLASS, HI .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1965, 28 (05) :449-+
[9]   RESPONSE OF CEREBROSPINAL FLUID PRESSURE TO HYPERBARIC OXYGENATION [J].
HAYAKAWA, T ;
KANAI, N ;
KURODA, R ;
YAMADA, R ;
MOGAMI, H .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1971, 34 (05) :580-+
[10]   IMPROVED REVERSIBILITY OF TRAUMATIC MID-BRAIN SYNDROME FOLLOWING USE OF HYPERBARIC-OXYGEN [J].
HOLBACH, KH ;
WASSMANN, H ;
KOLBERG, T .
ACTA NEUROCHIRURGICA, 1974, 30 (3-4) :247-256