金纳多对一氧化碳中毒迟发性脑病患者一氧化氮及一氧化氮合酶的影响

Effects of Ginaton on nitric oxide and nitric oxide synthase in patients with delayed encephalopathy after carbon monoxide poisoning

目的观察金纳多治疗急性一氧化碳中毒迟发性脑病的疗效及对一氧化氮（NO）及一氧化氮合酶（NOS）的影响。方法选择河北医科大学哈励逊国际和平医院急救医学部2012年1月至2016年4月急性一氧化碳中毒迟发性脑病患者116例。按随机数字表法分为对照组和治疗组（各58例）。对照组给予高压氧、防治脑水肿及促进脑细胞代谢等治疗；治疗组在常规治疗基础上加用金纳多，连续使用2周。所有患者均于治疗前及治疗后2周检测神经元特异性烯醇化酶（NSE）、NO、NOS及诱导型一氧化氮合酶（iNOS）变化，同时观察两组患者简易精神状态检查量表（MMSE）评分变化及临床疗效。分析患者入院血NO水平与MMSE评分的相关性。结果治疗组总有效率81．03％，对照组总有效率62．07％，差异有统计学意义（X^22=5．124，P=0．024）；两组患者治疗前NO、NSE含量、NOS和iNOS活力及MMSE评分的差异无统计学意义（尸〉0．05）；治疗后两组患者的NO、NSE含量、NOS和iNOS活力较治疗前均降低，治疗组较对照组明显降低，差异有统计学意义（R0．05）；两组患者治疗后MMSE评分较治疗前明显提高，治疗组较对照组明显升高，差异有统计学意义（P〈0．05）。急性一氧化碳中毒迟发性脑病患者入院血NO水平与MMSE评分呈负相关（r=-0．268，P=-0．004）。结论金纳多治疗急性一氧化碳中毒迟发性脑病患者能有效地降低患者血NO、NSE含量和NO、iNOS活力，提高MMSE评分，促进神经功能恢复。

Objective To observe the effects of Ginaton on blood nitric oxide （NO） and nitric oxide synthase （NOS） in patients with delayed encephalopathy after acute carbon monoxide poisoning （DEACMP）. Methods A total of 116 patients with DEACMP who were treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2012 to April 2016 were enrolled and randomly divided into control group and treatment group using a random number table, with 58 patients in each group. The patients in the control group were given conventional treatment including hyperbaric oxygen, prevention and treatment of cerebral edema, and promotion of brain cell metabolism, and those in the treatment group were given Ginaton in addition to the conventional treatment. The course of treatment was 2 weeks for both groups. The levels of neuron,specific enolase （NSE）, NO, NOS, and inducible nitric oxide synthase （iNOS） were measured before treatment and at 2 weeks after treatment, and the change in Mini-Mental State Examination （MMSE） score and clinical outcome were observed in both groups. The correlation between the blood NO level on admission and the MMSE score was analyzed. Results There was a significant difference in the overall response rate between the treatment group and the control group （81.03% vs 62.07%, X^2 = 5.124, P= 0.024）. Before treatment, there were no significant differences in the levels of NO and NSE, the activity of NOS and iNOS, and MMSE score between the two groups（P〉0.05）. After treatment, both groups showed reductions in the levels of NO and NSE and the activity of NOS and iNOS, but the treatment group had significantly greater reductions compared with the control group （P〈0.05）. Both groups showed a significant increase in the MMSE score after treatment, while the treatment group had a significantly greater increase compared with the control group （P〈0.05）. In the patients with DEACMP, the blood NO level on admission was negatively correlated with the MMSE score （r=-0.268, P=0.004）. Conclusion In the treatment of patients with DEACMP, Ginaton can effectively reduce the levels of NO and NSE and the activity of NOS and iNOS, increase the MMSE score, and promote the recovery of neurological function.