摘要
目的探讨高压氧治疗急性中重度一氧化碳(CO)中毒疗效及预防迟发性脑病的临床价值。方法选取2016年1月~2019年12月接受治疗的中重度CO中毒患者120例为研究对象,进行前瞻性研究,按照数字表法分为对照组和观察组,每组60例。对照组给予常规治疗,观察组给予高压氧治疗,比较两组患者的治疗效果,治疗前后的氧化应激指标水平变化,治疗后的意识水平(GCS)评分、神经损伤程度(NFDS)评分、日常生活自理能力评分(BI)及迟发性脑病的发生情况。结果观察组治疗的总有效率(91.67%)高于对照组(76.67%)(P<0.05)。治疗后,两组患者的肌电图诱发电位FZ位点、PZ位点的事件相关电位P300的潜伏期、振幅均改善,且观察组改善情况优于对照组(P<0.05)。治疗后,两组超氧化物歧化酶(SOD)水平升高,丙二醛(MDA)、神经元特异性烯醇化酶(NSE)水平下降,且观察组SOD水平显著高于对照组,MDA、NSE水平显著低于对照组(均P<0.05)。治疗后,观察组的GCS评分、BI评分明显高于对照组,NFDS评分低于对照组(均P<0.05)。治疗过程中对照组出现1例失眠,1例恶心、呕吐,不良反应发生率为3.33%;观察组出现1例食欲不振,不良反应发生率为1.67%;两组比较,差异无统计学意义(P>0.05)。3个月后随访结果显示,观察组出现2例迟发性脑病,占比3.33%;对照组出现8例迟发性脑病,占比13.33%;两组比较,差异有统计学意义(χ^2=3.927,P=0.048)。结论高压氧治疗急性中重度CO中毒疗效较好,可促进脑细胞血液循环,有效缓解患者的氧化应激状态,能降低神经功能损伤程度及迟发性脑病的发生率,促进认知功能和日常生活能力的恢复,不良反应少,具有临床应用价值。
Objective To explore effects of hyperbaric oxygen therapy in the treatment of acute moderate to severe carbon monoxide poisoning and in prevention of delayed encephalopathy. Methods 120 patients with CO poisoning treated in the Affiliated Hospital of North Sichuan Medical College from January 2016 to December 2019 were enrolled in the prospective study. They were divided into control group and observation group by number table method with 60 patients in each group. The control group was given routine treatment and the observation group was given hyperbaric oxygen therapy. The therapeutic effects, changes in oxidative stress indexes before and after treatment, level of consciousness [Glasgow coma score(GCS)], extent of neurological damage [neurological deficit score(NFDS)], activities of daily living [Barthel Index(BI)] scores and incidence of delayed encephalopathy were compared between the two groups. Results The total response rate in the observation group(91.67%) was significantly higher than that in the control group(76.67%)(P>0.05). There was no significant difference in the latency or amplitude of the event-related potential P300 at the electromyogram evoked potential FZ site and PZ site between the two groups before treatment(P>0.05). After treatment, the above indexes were improved, and the improvement was better in the observation group than the control group(P<0.05). Before treatment, there were no significant differences in oxidative stress indexes between the two groups(P>0.05). After treatment, superoxide dismutase(SOD) levels increased, while malondialdehyde(MDA) and neuron-specific enolase(NSE) levels decreased. SOD levels in the observation group were significantly higher than those in the control group, while MDA and NO levels were significantly lower than the control group(P<0.05). Before treatment, there were no significant differences in GCS scores, NFDS score or BI scores between the two groups(P>0.05). After treatment, GCS scores and BI scores of the observation group were significantly higher than the control group, while NFDS scores were significantly lower than the control group(P>0.05). During treatment, there was 1 case with insomnia and 1 case with nausea and vomiting in the control group, with an incidence of adverse reactions of 3.33%. There was only 1 case with anorexia in the observation group, and the incidence of adverse reactions was 1.67%(P>0.05). 3 months later, follow-up results showed 2 cases of delayed encephalopathy in the observation group, accounting for 3.33%, and 8 cases in the control group, accounting for 13.33%(χ^2=3.927, P=0.048). Conclusion Compared with routine treatment, the effect of hyperbaric oxygen therapy is better in the treatment of acute moderate to severe carbon monoxide poisoning. The latter can promote brain blood circulation, effectively alleviate patients’ oxidative stress status, reduce the degree of neurological damage, and promote the recovery of cognitive function and activities of daily living, with few side effects. It also can reduce the incidence of delayed encephalopathy.
作者
廖媛媛
王惠君
杨娟
黄欣
郭蕊
LIAO Yuanyuan;WANG Huijun;YANG Juan;HUANG Xin;GUO Rui(Department of Neurosurgery,The Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China)
出处
《西部医学》
2020年第12期1816-1820,共5页
Medical Journal of West China
基金
四川省卫生健康委员会科研课题(19PJ038)。
关键词
高压氧
CO中毒
疗效
神经功能
氧化应激指标
Hyperbaric oxygen
CO poisoning
Curative effect
Neurological function
Oxidative stress index
