丁政,周苏键,彭慧平,等.早期高压氧干预对创伤性脑损伤后认知功能障碍影响的DTI研究[J].中华物理医学与康复杂志,2019,41(3):189-194
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| 早期高压氧干预对创伤性脑损伤后认知功能障碍影响的DTI研究 |
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| DOI：DOI:10.3760/cma.j.issn.0254-1424.2019.03.006 |
| 中文关键词: 高压氧 创伤性颅脑损伤 认知功能障碍 扩散张量成像 |
| 英文关键词: Hyperbaric oxygen Brain injury Cognitive dysfunction Diffusion tensor imaging |
| 基金项目:福建省自然科学基金项目（2016J01584）；福州总医院创新团队（2014CXTD08） |
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| 中文摘要: |
| 目的 观察早期高压氧治疗对创伤性脑损伤后认知功能障碍的临床治疗效果，并通过扩散张量成像（DTI）技术探讨其神经作用机制。 方法 采用随机数字表法将64例创伤性脑损伤后认知障碍患者分为对照组和高压氧组，每组32例。2组患者均给予常规基础治疗及认知康复训练，高压氧组在此基础上辅以高压氧治疗。于治疗前、治疗2个疗程后分别采用简易智能精神状态量表（MMSE）和蒙特利尔认知功能评估量表（MoCA）对2组患者认知功能进行评估。从2组患者中各随机抽取15例于治疗前、后进行常规T1WI平扫及DTI扫描，将影像学数据与量表评估结果进行相关性分析。 结果 治疗后2组患者MMSE评分及MoCA评分均较治疗前有不同程度提高，并且以高压氧组MMSE评分［（22.75±3.50）分］、MoCA评分［（21.47±3.39）分］的改善幅度较显著，与对照组间差异有统计学意义（P<0.05)；经Pearson相关性分析发现，对照组脑白质差异区各向异性分数值(FA)与MMSE评分、MoCA评分无显著相关性（P>0.05），高压氧组胼胝体、双侧内囊前肢、左侧上纵束FA值与MMSE评分及MoCA评分具有正相关性(P<0.05)。 结论 早期高压氧治疗联合常规认知训练能进一步改善创伤性脑损伤患者认知功能；其作用机制可能与调节胼胝体、双侧内囊前肢、左侧上纵束等脑白质区结构与功能有关。 |
| 英文摘要: |
| Objective To observe any effect of hyperbaric oxygen therapy on cognitive dysfunction caused by traumatic brain injury, and to explore possible neural mechanisms. Methods Sixty-four patients with cognitive impairment after a traumatic brain injury were randomly divided into a hyperbaric oxygen group (n=32) and a control group (n=32) using a random number table. Both groups accepted routine medical therapy and cognitive rehabilitation training, but the hyperbaric oxygen group additionally received hyperbaric oxygen treatment. Both groups′ cognitive functioning was assessed using the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) before and after the treatment. Fifteen patients were randomly selected from both groups to receive T1WI and diffusion tensor imaging scans. The correlation between the two evaluation results was analyzed. Results After the intervention, improvement was observed in the average MMSE and MoCA scores of both groups, with the improvement in both average scores in the hyperbaric oxygen group significantly greater than among the control group. There was no significant correlation between the fractional anisotropy (FA) values of damaged white matter and the average MMSE or MoCA score in the control group, but in the hyperbaric oxygen group there were significant positive correlations between the FA values of the corpus callosum, the anterior limb of the internal capsule and the left superior longitudinal fasciculus and the average MMSE and MoCA scores. Conclusions Hyperbaric oxygen therapy combined with rehabilitation training can further improve cognition after a traumatic brain injury. This is probably due to its adjusting the structure and function of the corpus callosum, of the anterior limb of the internal capsule and of the left superior longitudinal fasciculus. |
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