放射性脑病的高压氧治疗ppt课件.ppt

放射性脑病的高压氧治疗 神内一查房 2004年9月22日 放射性脑病影像所见 The MR images obtained in a 34-year-old man who underwent radiation therapy 2 years and 5 months ago. (a) Coronal T2-weighted GRASE image (4,550/90) shows hyperintense white matter change (straight white arrows) in the inferomedial part of the left temporal lobe. A gray matter lesion (curved arrow) also is seen. A lesion with heterogeneous signal intensity (black arrows) consistent with necrosis is seen in the right temporal lobe. There are also homogeneous hyperintense changes due to edema in the upper part of the right temporal lobe and the right external capsule (open arrows). There is a moderate midline shift and compression of the right lateral ventricle. (b) Axial T2-weighted fluid-attenuated inversion-recovery image (8,000/120/2,400) shows the hypointense necrosis (arrows) in the right temporal lobe surrounded by hyperintense edema. (c) On the coronal T1-weighted post-gadolinium-enhanced image (500/15), the area of necrosis (arrows) has marked enhancement. 放射性脑病影像所见 Sagittal T2-weighted GRASE image (4,550/90) obtained in a 59-year-old man who underwent radiation therapy 8 years ago shows a cyst (asterisk) in the left temporal lobe with a fluid-fluid level (arrow). Coronal T2-weighted GRASE image (4,550/90) obtained in a 54-year-old man who underwent radiation therapy 3 years ago shows radiation-induced injury in the form of a hyperintense change (arrow) confined to the central white matter of the left temporal lobe 一、治疗机理 慢性放射病主要病理改变： 组织的血管管壁增厚狭窄； 血栓堵塞所造成的缺血、缺氧性损坏。 高压氧治疗具有如下作用 迅速改善放射性损坏病灶组织氧的供应。改善病灶组织氧分压，氧含量和氧贮备，使病灶组织获得充足的氧； 病灶组织氧改善后，血管内皮细胞、成纤维细胞、成骨细胞等的有氧代谢增强、无氧酵解减弱，细胞能量增多、酸性代谢产物减少，利于细胞修复； 高压氧治疗具有如下作用 高压氧治疗可以促进毛细血管再生，促进侧循环建立，改善病灶区域供血，增加营养物质供应； 高压氧治疗可以改善细胞膜的通透性，改善毛细血管的通透性，减少渗出，可迅速消肿； 高压氧治疗具有如下作用 增强缺血、缺氧组织吞噬细胞的吞噬、消化细菌的能力；组织氧分压增高可以抑制细菌生长（厌氧菌、需氧菌）；高压氧可增强抗生素的杀菌、抑菌能力。故高压氧治疗可加速继发性感染的控制和坏死的骨组织清除。 高压氧治疗可以改善肾脏排泄、肝脏解毒、骨髓造血等功能。 二、治疗方法与注意事项 治疗方法 采取0.2～0.25MPa压力，每次吸氧60分钟，每日1次，疗程应较长，每个疗程10次，通常需3～4个疗程，最多可连续治疗6~10