一氧化碳迟发性脑病患者应用神经节苷酯和纳美芬治疗前后MDA、SOD的变化

Changes of MDA and SOD in patients with delayed encephalopathy after acute carbon monoxide poisoning before and after treatment of ganglioside and nalmefene

目的观察神经节苷酯联合纳美芬治疗一氧化碳中毒迟发性脑病（delayed encephalopathy after acute carbon monoxide poisoning, DEACMP）的临床疗效。方法将DEACMP患者86例随机分为治疗组和对照组，对照组予以常规营养神经、脑保护、活血化瘀药物和高压氧治疗，治疗组在此基础上，予以神经节苷酯联合纳美芬治疗。神经节苷酯100mg／d，静滴，1次／d。纳美芬0．3mg／次，静注，1次／d，连续14d。治疗前及治疗后检测丙二醛（MDA）、血清超氧化物歧化酶（SOD）水平并进行简易精神状态检查量表（MMSE）评分。观察两组的临床疗效。结果治疗组和对照组的总有效率分别为81．39％、65．12％，两组比较差异有统计学意义（P〈0．05）。治疗前对照组与治疗组MMSE、MDA、SOD水平比较差异无统计学意义（P〉0．05）。治疗后14d，对照组与治疗组MDA、SOD水平较治疗前改善，而治疗组血清SOD水平升高和MDA下降幅度更大，与对照组比较差异有统计学意义（P〈0．05）。治疗后治疗组MMSE评分明显高于对照组，差异有统计学意义（P〈0．05）。结论早期神经节苷酯联合纳美芬治疗急性一氧化碳中毒迟发性脑病，治疗效果显著，不良反应少。

Objective To observe the efficacy of ganglioside combined with nalmefene in the treatment of delayed encephalopathy after acute carbon monoxide poisoning （DEACMP）. Methods A total of 86 DEACMP patients were randomly divided into a treatment group and a control group. The control group was treated with circulation-promoting drugs and hyperbaric oxygen, and underwent routine nerve nutrition and brain protection. The treatment group was intravenously drip-infused with 100 mg/d ganglioside and 0.3 mg nalmefene, once per day, for 14 consecutive days. Then, the levels of malondialdehyde （MDA） and serum superoxide dismutase （SOD） were detected before and after treatment, while the patients were scored using the minimum mental state examination （MMSE）. Both groups were compared for clinical efficacy. Results The total effective rate was 81.39% for the treatment group, which was statistically different from that of the control （65.12%） （P 〈0.05）. Both groups showed no significant difference in SOD, MDA and MMSE before treatment （P 〉0.05）. Two weeks after treatment, improved levels of MDA and SOD were observed in both groups, while changes in the treatment group were remarkably higher than those of the control （P 〈 0.05）. After treatment, the treatment group produced a markedly increase in MMSE score, compared with the control （P 〈0.05）. Conclusion The use of ganglioside combined with nalmefene is effective in early treatment of DEACMP, with less adverse reaction.