| Objective: chronic subdural hematoma(CSDH)patients treated by burr hole surgery, encephalothlipsis release immediately. chronic cerebral hypoperfusion relieving. But with intracranial pressure reduce significantly, brain perfusion decrease rapidly, lead to ischemia reperfusion injury. This research attempt to detect the level of soluble vascular cell adhesion molecule-1(s VCAM-1)、soluble intercellular adhesion molecule-1(s ICAM-l) protein in serum of postoperative patients,to investigate whether hyperbaric oxygen(HBO) reduce ischemia reperfusion inflammatory reaction, And according to the thickness of hematoma residual cavity of the largest slice of postoperative cranial CT(TCTP),to detect the effect of HBO on postoperative brain’s re-expansion. To discuss whether HBO improve the recovery of CSDH from the molecular level to gross anatomic appearance.Methods: A prospective study was undertaken on the 157 unilateral CSDH patients admitted during 2012,oct to 2014, nov, patients divided into groups randomly as HBO and conventional treatment group(CVT group).82 cases in HBO group,75 cases in conventional treatment group.Control group include 10 cases of healthy aged people who accept the physical examine in medical examination center. All the 157 CSDH patients treated by burr hole surgery. Conventional treatment group treated by mass fluid replace,at the average mount of 2000 ml per day, orientate headed to affected side,pulled out the drainage tube depends on patient’s situation on the 3-5days after operation.HBO group start HBO therapy in the 24 hours after Conventional treatment, used one-man hyperbaric oxygen chamber(pure oxygen chamber), therapy pressure at 0.20 MPa, both of pressure-rise-time and drawdown-time is 20 minutes, pressure-maintenance time is 40 minutes, One therapy per day, 10-therapy as one course of treatment.2ml fasting venous blood were collected preoperative and in the 1st,4th,7th morning postoperative. Centrifuge after placed stably for 2hours,4000 rpm, 15 minutes.Upper layer of serum was taken into test tube after centrifugation, kept by the method of cryopreservation at-80oC in refrigerator. Choose the method of enzyme linked immune sorbent assay( ELISA)-sandwich technique, with the instruction of s VCAM-1 、 s ICAM-1 test kits. Compare the level of s VCAM-1、s ICAM-1 of serum between two groups during four time-phases.Measure the thickness of hematoma residual cavity largest slice of postoperative cranial CT, preoperative and in the 3rd day, 10 th day, 1st month postoperative, compare the differences between two groups during four time-phases, to detect the differences of brain’s re-expansion.Results:1.Before operation: there is no statistically significant difference of s VCAM-1、s ICAM-1 level between HBO group and CVT group(P>0.05). But these two groups have statistically significant difference from Control group(P<0.01).2.The 1st day after operation,s VCAM-1、s ICAM-1 level of HBO group and CVT group is higher than preoperative level in its self group, s VCAM-1、s ICAM-1 level of HBO group and CVT group has statistically significant difference from preoperative in each group(P<0.01).The 1st day after operation, there is no statistically significant difference of s VCAM-1 、s ICAM-1 level between HBO group and CVT group(P>0.05).3.The 4th day after operation,s VCAM-1、s ICAM-1 level of HBO group and CVT group is lower than the 1st day postoperative in each group, s VCAM-1、s ICAM-1 level of HBO group and CVT group has statistically significant difference(P<0.01) 。 The 4th day after oeration,s VCAM-1 、s ICAM-1 level of HBO group is much lower than CVT group. There is statistically significant difference of s VCAM-1、s ICAM-1 level between HBO group and CVT group(P<0.01).4.The 7th day after operation,s VCAM-1、s ICAM-1 level of HBO group and CVT group is lower than 4st day postoperative in each group, s VCAM-1、s ICAM-1 level of HBO group and CVT group has statistically significant difference(P<0.01).The 7th day after operation,s VCAM-1、s ICAM-1 level of HBO group is much lower than CVT group. There is statistically significant difference of s VCAM-1、s ICAM-1 level between HBO group and CVT group(P<0.01).5. Before operation, there is no statistically significant difference of the thickness of hematoma cavity of the largest slice of cranial CT between HBO group and CVT group(P>0.05).6.The 3rd day after operation, the thickness of hematoma residual cavity of the largest slice of postoperative cranial CT(TCTP) is less than preoperative, there is statistically significant difference(P<0.01).There is no statistically significant difference in TCTP between HBO group and CVT group(P>0.05)on the 3rd day after operation.7.The 10 th day after operation, TCTP of HBO group and CVT group is less than 3rd day postoperative in each group, TCTP of HBO group and CVT group has statistically significant difference(P<0.01). The 10 th day after operation, TCTP of HBO group is more less than CVT group. There is statistically significant difference of TCTP level between HBO group and CVT group(P<0.01).8. The 1st month after operation,TCTP of HBO group and CVT group is less than 10 th day postoperative in each group, TCTP of HBO group and CVT group has statistically significant difference(P<0.01).The 1st month after operation, TCTP of HBO group is more less than CVT group. There is statistically significant difference of TCTP level between HBO group and CVT group(P<0.05).Conclusions:1.After operation,s VCAM-1、s ICAM-1 level in serum of CSDH patients decrease significantly than preoperative,s VCAM-1、s ICAM-1 level in serum are indicator of ischemia reperfusion injury. The 1st day postoperative is the peak time of ischemia reperfusion injury.2.HBO can reduce s VCAM-1 、 s ICAM-1 level in serum, inhibit expression of adhesion molecules effectively, reduce the severity degree of ischemia reperfusion injury inflammatory reaction of encephalothlipsis.3.HBO therapy can effectively promote postoperative brain’s re-expansion of CSDH, and it can be regarded as conventional postoperative adjuvant therapy.4. HBO can reduce postoperative ischemia reperfusion injury of CSDH,and promote postoperative brain’s re-expansion of CSDH, the two effects are closely related. |
PDF Full Text Request