Effects of Hyperbaric Oxygen Therapy on Serum Levels of Nitrogen Monoxide and Endothelin-1 and Corresponding Clinical Efficacy for Patients with Hypertensive Intracerebral Hemorrhage after Minimally Invasive Surgery

doi:10.12114/j.issn.1007-9572.2019.00.033

Abstract

Abstract: Background　Nitrogen monoxide（NO）and endothelin-1（ET-1），as the endothelial vasoactive factors，are mediators of pathophysiological changes of hemorrhagic focus as inflammation and neurological deficit may occur after minimally invasive surgery on patients with hypertensive intracerebral hemorrhage（HICH）．The clinical efficacy of hyperbaric oxygen（HBO）combined with synthesis rehabilitation therapy（SRT）is ambiguous in NO and ET-1 regulation.Objective　To explore the efficacy of SRT with HBO for patients with hypertensive intracerebral hemorrhage and to assess their serum levels of NO and ET-1.Methods　A total of 128 subjects suffering from HICH treated with minimally invasive surgery at 6 to 24 hours after onset in 940 Hospital of Joint Logistic Support Force of the Chinese People's Liberation Army and 64 healthy subjects were included in the study as the normal group from March 2010 to March 2017.The 128 patients were randomly divided into the control group（64 patients treated with normal SRT） and study group（64 patients treated with SRT and HBO therapy）．Serum levels of NO，ET-1 and NO/ET-1 ratio were detected in the control group and study group before and at day 1，7，14，21，30 and 37 after minimally invasive surgery，and in the normal group.Disability Rating Scale（DRS），United States National Institutes Of Health Stroke Scale（NIHSS），Mini-mental State Examination（MMSE），Barthel Index（BI）for the control group and study group were used before and at day 7，14，21，30，37，90 and 180 after surgery.Results　There were correlations between treatment methods or time and NO，ET-1，NO/ET-1 ratio（P<0.05）．The effect of treatment and time on NO，ET-1 and NO/ET-1 ratio were significant（P<0.05）．NO of the control group at day 0，1，7 and the study group at day 0，1，7，14，21，30 was higher than the normal group，and NO of the study group was higher than that of the control group at day 14，21，30（P<0.05）；the ET-1 of the study group at day 0，1，7，14 was higher than the normal group，and that at day 14，21，30 was lower than that of the control group（P<0.05）；the NO/ET-1 of the study group was lower than the normal group at day 1，7，and that at day 21 was higher than the normal group，and that at day 14，21，30 was higher than that of the control group（P<0.05）．Treatment method and time had interaction on DRS，NIHSS score，MMSE score and BI score（P<0.05）；treatment method and time had significant effect on DRS，NIHSS score，MMSE score and BI score（P<0.05）．In the study group，the DRS at day 21，30，37，90 was lower than that of the control group，the NIHSS score at day 21，30，37，90，180 was lower than that of the control group，and the MMSE score ，BI score at day 14，21，30，37，90，180 was higher than that of the control group（P<0.05）．Conclusion　By modulating serum levels of NO and ET-1 of HICH patients who are treated with minimally invasive surgery，HBO could improve their consciousness states，neurological functions，cognitive functions and quality of lives，with significant protection on cerebral functions.

Key words: Intracranial hemorrhage, hypertensive；Hyperbaric oxygenation；Nitric oxide；Endothelin-1；Treatment outcome；Surgical procedures, minimally invasive

摘要： 背景　高血压脑出血（HICH）微创术后仍存在较强的炎性反应及残留神经功能缺损，一氧化氮（NO）、内皮素1（ET-1）作为内皮源性血管活性因子介导了出血灶病理生理改变。微创术后早期结合高压氧（HBO）的综合康复治疗对NO、ET-1的影响及临床疗效尚不明确。目的　探讨HBO对HICH微创术后患者血清NO、血浆ET-1及疗效的影响。方法　选取2010年3月—2017年3月于中国人民解放军联勤保障部队第940医院住院治疗并于发病后6~24 h内行HICH微创血肿清除术的患者128例，采用随机数字表法将其分为研究组和对照组各64例，另选取同期本院体检健康者64例作为正常组。对照组采用常规康复治疗，研究组在常规康复治疗基础上进行HBO治疗。对照组和研究组于0（术前）、1（术后次日）、7、14、21、30、37 d以及正常组测定NO、ET-1，并计算NO/ET-1，对照组和研究组于0 、7、14、21、30、37、90、180 d采用功能障碍评分（DRS）、美国国立卫生研究院卒中量表（NIHSS）、简易精神状态评价量表（MMSE）、日常生活能力量表-巴氏指数（BI）评分进行评定。结果　处理方法与时间对NO、ET-1、NO/ET-1均有交互作用（P<0.05）；处理方法、时间对NO、ET-1、NO/ET-1的影响，主效应均显著（P<0.05）。其中，对照组0、1、7 d，研究组0、1、7、14、21、30 d的NO均高于正常组，研究组14、21、30 d的NO均高于对照组（P<0.05）；研究组0、1、7、14 d的ET-1均高于正常组，14、21、30 d的ET-1均低于对照组（P<0.05）；研究组1、7 d的NO/ET-1均低于正常组，21 d的NO/ET-1高于正常组，14、21、30 d的NO/ET-1均高于对照组（P<0.05）。处理方法与时间对DRS、NIHSS评分、MMSE评分、BI评分均有交互作用（P<0.05）；处理方法、时间对DRS、NIHSS评分、MMSE评分、BI评分的影响，主效应均显著（P<0.05）。其中，研究组21、30、37、90 d的DRS均低于对照组，21、30、37、90、180 d的NIHSS评分均低于对照组，14、21、30、37、90 d的MMSE评分、BI评分均高于对照组（P<0.05）。结论　HBO治疗可调节HICH微创术后NO、ET-1水平，可改善意识状态、神经功能、认知功能及生活质量，具有明显脑部保护作用。

关键词: 颅内出血, 高血压性；高压氧；一氧化氮；内皮素1；治疗结果；外科手术, 微创性

YAO Xiangrong,LYU Yunli,YOU Hong, et al. Effects of Hyperbaric Oxygen Therapy on Serum Levels of Nitrogen Monoxide and Endothelin-1 and Corresponding Clinical Efficacy for Patients with Hypertensive Intracerebral Hemorrhage after Minimally Invasive Surgery　[J]. Chinese General Practice, 2019, 22(26): 3184-3190. DOI: 10.12114/j.issn.1007-9572.2019.00.033.
姚向荣,吕云利,尤红等. 高压氧对高血压脑出血微创术后血清一氧化氮、血浆内皮素1及临床疗效的影响研究[J]. 中国全科医学, 2019, 22(26): 3184-3190. DOI: 10.12114/j.issn.1007-9572.2019.00.033.

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