高压氧联合亚低温对急性一氧化碳中毒迟发型脑病患者炎症因子、免疫功能及预后的影响

Effects of hyperbaric oxygen combined with sub-low temperature therapy on inflammatory factors,immunologic function and prognosis in patients with delayed encephalopathy after acute carbon monoxide poisoning

目的探讨高压氧联合亚低温治疗对急性一氧化碳中毒迟发型脑病(DEACMP)患者炎症因子、免疫功能及预后的影响。方法选取2018年10月至2020年12月该院急诊科收治的DEACMP患者80例,根据不同的治疗方式分为对照组和观察组,每组40例。两组患者均给予常规治疗,包括营养神经、脱水降颅压、清除自由基等,在此基础上,对照组给予高压氧治疗,观察组给予高压氧^(+)亚低温治疗。每组均接受3个月治疗,评估两组患者临床疗效,观察两组患者治疗前后血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平,T淋巴细胞亚群水平,脑电图(EEG)异常率变化情况。结果观察组总有效率明显高于对照组(90.0%vs.72.5%,P<0.05);两组治疗后血清TNF-α、IL-6水平均明显低于治疗前,且观察组明显低于对照组(P<0.001);与治疗前比较,治疗后两组CD3^(+)、CD4^(+)细胞百分比、CD4^(+)/CD8^(+)细胞比值均明显升高(P<0.001),CD8^(+)细胞百分比均明显降低(P<0.05),且观察组CD3^(+)、CD4^(+)细胞百分比、CD4^(+)/CD8^(+)细胞比值均明显高于对照组(P<0.001),CD8^(+)细胞百分比明显低于对照组(P<0.001);两组治疗后EEG异常率均明显低于治疗前(P<0.05),且观察组明显低于对照组(67.5%vs.87.5%,P<0.05)。结论高压氧联合亚低温治疗DEACMP疗效明显,可有效减轻患者炎症反应,提高免疫功能,降低EEG异常率,改善患者预后,具有良好的临床实用价值。

Objective To explore the effects of hyperbaric oxygen combined with sub-low temperature therapy on inflammatory factors,immunologic function and prognosis in the patients with delayed encephalopathy after acute carbon monoxide poisoning(DEACMP).Methods A total of 80 patients with DEACMP treated in the emergency department of this hospital from October 2018 to December 2020 were selected and divided into the observation group and control group according to different treatment methods,40 cases in each group.The two groups were given the routine treatment,including nourishing nerves,dehydration to reduce intracranial pressure,scavenging free radicals,etc,on this basis,the control group was given the hyperbaric oxygen treatment,while the observation group was treated with hyperbaric oxygen combined with sub-low temperature.Each group received the 3-month treatment,the curative effects in two groups were evaluated,the changes of serum levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6),T lymphocyte subsets and abnormal rate of electroencephalogram(EEG)before and after treatment were observed in the two groups.Results The total effective rate in the observation group was significantly higher than that in the control group(90.0%vs.72.5%,P<0.05).The serum levels of TNF-α and IL-6 after treatment in the two groups were significantly lower than those before treatment,moreover,the serum levels of TNF-α and IL-6 in the observation group were significantly lower than those in the control group(P<0.05).The percentage of CD3^(+),CD4^(+)cells and CD4^(+)/CD8^(+)cells ratio after treatment in the two groups were significantly increased(P<0.001),the percentage of CD8^(+)cells was significantly decreased(P<0.05),when compared with the indicators before treatment.Moreover,after treatment the percentage of CD3^(+),CD4^(+)cells and CD4^(+)/CD8^(+)cells ratio in the observation group were significantly higher than those in the control group(P<0.001),the percentage of CD8^(+)cells was significantly lower than that of the control group(P<0.001).The abnormal rate of EEG after treatment in the two groups was lower than that before treatment(P<0.05),moreover,the abnormal rate of EEG in the observation group was significantly lower than that in the control group(67.5%vs.87.5%,P<0.05).Conclusion The hyperbaric oxygen combined with sub-low temperature in treating DEACMP has significant effect,could effectively reduce the inflammatory response,increase the immune function,reduce the EEG abnormal rate and improve the prognosis,which has good clinical practical value.