中西医结合治疗一氧化碳中毒所致迟发性脑病临床研究

Clinical Study on Treatment of Delayed Encephalopathy Caused by Carbon Monoxide Poisoning with Integrative Medicine

目的:观察中药汤剂联合纳洛酮治疗一氧化碳中毒所致迟发性脑病患者的临床疗效。方法:将300例患者随机分为3组,中药组、西药组及联合组,每组各100例。中药组:(1)采用高压氧治疗;(2)采用中药汤剂治疗,中药汤剂药物组成:党参15 g,当归10 g,黄芪30 g,五味子10 g,枸杞15 g,何首乌25 g。随证加减:痰火扰心者加黄芩、胆南星各12 g;脾虚痰浊者加茯苓15 g,白术12 g,胆南星12 g;血瘀气滞者加红花、赤芍各9 g;脾肾亏损者加枸杞、杜仲、怀牛膝各12 g。每日1剂,早晚两次服用。西药组:(1)采用高压氧治疗;(2)采用纳洛酮治疗,每日3次,8 mg融于质量分数5%葡萄糖或生理盐水中,静脉滴注。联合组:(1)采用高压氧治疗;(2)采用中药汤剂治疗;(3)采用纳洛酮治疗。应用长谷川痴呆量表(hastgawa dementia scale,HDS)检测所有患者治疗前后智力变化以及P300潜伏期作为临床疗效判断标准。结果:300例患者均完成治疗,与中药组和西药组相比,联合组的临床疗效较优(χ2=46.892,P<0.001);HDS评分显著提高(P<0.05);P300潜伏期明显缩短(P<0.05)。结论:中药汤剂联合纳洛酮治疗一氧化碳中毒所致迟发性脑病临床疗效显著。

Objective：To observe the clinical effect of traditional Chinese medicine decoction combined with naloxone in treatment of delayed encephalopathy caused by carbon monoxide poisoning. Methods ：300 patients were randomly divided into three groups： traditional Chinese medicine group,western medicine group and combination group, with 100 cases in each group. Chinese medicine group：①Using hyperbaric oxygen therapy ;②Applying Chinese medicine decoction treatment. TCM Drug composition： Codonopsis 15 g, Angelica 10 g, Astragalus 30 g, Schisandra 10 g, Chinese wolfberry 15 g, Polygonum 25 g. According to TCM theory, add Radix scutellariae 12 g, Bile arisaema 12 g for patients with Phlegm and Fire Desturbing Heart Syndrome;add Poria 15 g, Bighead atractylodes rhizome12 g, Bile arisaema 12 g for patients with Spleen Deficiency and Phlegm Syndrome;add Flos carthami 9 g, Radix paeoniae rubra 9 g for patients with Blood Stasis and Qi Stagnation Syndrome ;add Wolfberry12 g, Eucommia ulmoides olive 12 g, Achyranthes bidentata 12 g for patients with Spleen and Kidney Deficiency. One dose for twice taking each day. Western medicine group：①Treated with hyperbaric oxygen ;②Treated with naloxone ,3 times a day ,with 8 nag in the mass fraction of 5% glucose or saline,intravenous infusion. Combination group：① Treated with hyperbaric oxygen;② Treatment with traditional Chinese medicine decoction ;③ Treated with naloxone. Hastigawa dementia scale （HDS） was used to detect the changes of intelli-gence before and after treatment and P300 latency was used as the criteria for clinical efficacy. Results ： These 300 patients all com- pleted the treatment. The clinical efficacy of the combination group was better than that of the traditional Chinese medicine group and the western medicine group （χ^2= 46. 892, P 〈 0.001 ）, with significantly higher score of the Hasegawa dementia scale （ P 〈0. 05 ） and the significantly shorter latency （ P 〈 0.05 ）. Conclusion ： Traditional Chinese medicine decoction combined with nalox- one in treatment of delayed encephalopathy caused by carbon monoxide poisoning has a significant clinical effect.