The Effects Of Hyperbaric Oxygen Therapy On Disorders Of Consciousness In Paints With Traumatic Brain Injury :A Disffusion Tensor Imaging Study

Aim:1、To clarify the effect of hyperbaric oxygen therapy on patients with consciousness disorder after TBI;2、To investigate the correlation between DTI and CRS-R,and to provide evidence for the clinical application of hyperbaric oxygen(HBO).Method:Forty-eight patients with post-TBI consciousness disorders who met the inclusion criteria were selected and divided into a hyperbaric oxygen treatment group and a control group using a randomized controlled study design,with 24 cases in each group.The control group received conventional wake-up therapy,and the hyperbaric oxygen treatment group received additional hyperbaric oxygen therapy on the basis of the treatment in the control group.The treatment course was 30 times.HBO treatment pressure was 2.0ATA,time was 110 min,once a day,10 times for a course of treatment,a total of 30 times.All enrolled subjects were rated by the revised coma recovery scale and the Glasgow coma scale before and after intervention.The two groups were given the Glasgow Outcome Scale after 30 times of HBO treatment.In addition,DTI technique was used to compare the changes of white matter corresponding to the activated areas of the two groups before and after treatment,and FA value was used as the observation index to further analyze the correlation between neuroimaging and the revised coma recovery scale.SPSS21.0 software was used for analysis.If the measurement data conforms to the normal distribution,it is expressed as mean ± standard deviation.T test or one-way analysis of variance were used for the comparison between groups.Nonparametric test was used for those that did not conform to normal distribution.Pearson/Spareman was used to analyze the correlation between factors.Using bilateral test,P < 0.05 indicates that the difference is statistically significant.Result:1、According to the inclusion and exclusion criteria,42 qualified subjects were finally included,including 22 in the hyperbaric oxygen group and 20 in the control group.Before the intervention,there was no significant difference between the two groups in gender,age,GCS score and operation or not(P > 0.05).2、The CRS-R score and GCS score of subjects in the two groups before intervention were not statistically significant(P > 0.05).Compared with before intervention,the CRS-R score and GCS score of subjects in the two groups after intervention were significantly improved,and the difference was statistically significant(P < 0.05).After 1 month of hyperbaric oxygen intervention,the GOS score of the intervention group was higher than that of the control group,and the difference was statistically significant(P < 0.05).3、Compared with before intervention,intervention after hyperbaric oxygen group FA values of the marked increase in brain areas are: feet in the cerebellum,bridge cross beam,corpus callosum,dome,right brain corticospinal tract,right cerebellum on foot,after cerebral peduncle,internal capsule,right leg on the right side,double side under longitudinal fasciculus,hooked on the left beam(P < 0.05),while the corticospinal tract on the left,the left cerebellum on foot,on the left side of the cerebral peduncle,internal capsule on the left leg,hooked on the right side beam of FA value rise no significant statistical difference(P > 0.05).4、Pearson correlation analysis was conducted between the FA values of the brain areas with statistical differences between the two groups and the crs-r score,in which T1 in the knee and compression region of the corpus callosum(R =0.620**),T1 in the domes(R =0.528**),T1 in the posterior limb of the right internal capsule(R =0.439**),and T1 in the left uncinate tract(R =0.381*)were significantly correlated with the crs-r score.Conclusion:1、Conventional wakefulness therapy and hyperbaric oxygen combined with conventional wakefulness therapy can improve the degree of consciousness disorder in patients with tbi to varying degrees.2、Hyperbaric oxygen combined with conventional wakefulness therapy is better for improving the degree of consciousness disorder in patients with TBI.3、One of the mechanisms by which hyperbaric oxygen improves the consciousness disorder in tbi patients may be realized by regulating the structures of the white matter areas of the cerebellum,such as the feet,corpus callosum,dome,pontine crossed tract,right posterior limb and so on.