不同强度间歇训练对中重型创伤性脑损伤患者脑氧代谢及预后的影响研究

Study on the Effects of Intermittent Training of Different Intensities on Brain Oxygen Metabolism and Prognosis in Patients with Severe Traumatic Brain Injury

摘要:

目的:探究中重型创伤性脑损伤(TBI)患者在接受不同强度间歇训练治疗前后的脑氧代谢指标变化。方法:收集2022年1月-2024年1月在我院就诊的中重型TBI患者150例的临床资料,根据随机数字表法将患者分为对照组(n=50),中强度组(n=50)和高强度组(n=50)。用重复测量方差分析三组患者的脑氧代谢指标。采用广义估计方程(GEE)回归分析不同因素与中重型TBI患者预后的影响。结果:(1)治疗后三组脑氧代谢指标均较治疗前明显下降(P<0.05)。组间比较显示,高强度组在治疗后1周和1个月的动脉血氧含量(CaO?)、颈内静脉球部血氧含量(CjvO?)、脑氧摄取率(CERO?)和动脉-颈内静脉球部血氧含量差(Da-jvO?)水平均明显低于中强度组和对照组(P<0.001),中强度组明显低于对照组(P<0.05)。(2)治疗后1周及1个月,三组患者的GOS评分与ADL评分均较治疗前明显升高(P<0.05),且随时间呈上升趋势。组间比较显示,治疗后1周及1个月,高强度组的GOS评分与ADL评分均明显高于中强度组与对照组(P<0.05),中强度组评分明显高于对照组(P<0.05)。(3)训练强度是影响患者预后的关键因素,且高强度组的保护作用均优于中强度组(P<0.05)。结论:高强度间歇训练在降低脑氧代谢指标、提升患者预后评分方面表现出更显著的改善,且脑氧代谢指标与患者预后紧密相关。

Abstract:

Objective: Investigate changes in cerebral oxygen metabolism (COM) indicators in moderate-to-severe TBI patients post-interval training of varying intensities and their prognostic correlation. Methods: The clinical data of 150 patients with moderate to severe traumatic brain injury who visited our hospital from January 2022 to January 2024 were collected. The patients were divided into the control group (n=50), the moderate-intensity group (n=50), and the high-intensity group (n=50) according to the random number table method. The cerebral oxygen metabolism indicators of the three groups of patients were analyzed using repeated measures analysis of variance. The generalized estimating equation (GEE) was used to analyze the influence of different factors on the prognosis of patients with moderate to severe traumatic brain injury. Results: (1) After treatment, cerebral oxygen metabolism indicators of all three groups decreased significantly vs. baseline (P < 0.05). Inter-group comparisons showed that at 1 week and 1 month post-treatment, arterial oxygen content (CaO?), jugular venous bulb oxygen content (CjvO?), cerebral oxygen extraction rate (CERO?), and arterio-jugular venous bulb oxygen content difference (Da-jvO?) in the high-intensity group were significantly lower than those in the medium-intensity and control groups (P<0.001), with the medium-intensity group also significantly lower than the control group (P<0.05). (2) At 1 week and 1 month post-treatment, Glasgow Outcome Scale (GOS) and Activities of Daily Living (ADL) scores of all three groups were significantly higher vs. baseline (P<0.05) and increased progressively over time. Inter-group comparisons indicated that GOS and ADL scores in the high-intensity group were significantly higher than those in the medium-intensity and control groups at both time points (P<0.05), with the medium-intensity group also significantly higher than the control group (P<0.05). (3) The intensity of training is a key factor influencing the prognosis of patients, and the protective effect of the high-intensity group is superior to that of the medium-intensity group (P<0.05). Conclusion: High-intensity interval training effectively reduces COM indicators and improves prognosis, with COM closely linked to outcomes.