纳洛酮联合高压氧治疗对急性CO中毒患者血清S100β、nNOS的影响及其对神经功能的改善作用

Effect of naloxone combined with hyperbaric oxygen therapy on serum S100β and nNOS of patients with acute CO poisoning and their improvement effect on neurological function

目的:探究纳洛酮联合高压氧治疗对急性一氧化碳(CO)中毒患者血清中枢神经特异性蛋白(S100β蛋白)及神经元型一氧化氮合酶(nNOS)的影响及其对神经功能的改善作用。方法:选取德州市人民医院急诊科2017年9月至2018年6月收治的92例急性CO中毒患者作为研究对象,随机分为对照组和观察组(每组n=46)。对照组给予常规治疗+高压氧治疗,观察组在对照组基础上再联合纳洛酮治疗。比较2组患者临床疗效,治疗前后血清S100β、nNOS水平,格拉斯哥昏迷量表(GCS)及出院时格拉斯哥预后量表(GOS)评分。随访3个月记录迟发性脑病发生情况。结果:观察组临床治疗总有效率为95.65%,显著高于对照组的89.13%(P<0.05);且苏醒时间为(2.21±0.61)h,明显优于对照组的(4.03±1.16)h(P<0.05)。治疗后,2组患者的氧分压(PaO 2)、S100β及nNOS水平有明显改善(P<0.05);且观察组患者血清S100β及nNOS水平较对照组显著降低(P<0.05);GCS和GOS也显著高于治疗前(P<0.05),且在治疗3 d及7 d后GCS均高于对照组(P<0.05)。随访3个月观察组患者迟发性脑病发生率为2.17%,显著低于对照组的13.04%(P<0.05)。结论:纳洛酮联合高压氧治疗急性CO中毒疗效显著,能有效降低血清中S100β蛋白和nNOS水平,进而减轻脑组织及神经功能受损,有利于加快患者苏醒康复,减少迟发性脑病发病率、改善预后。

Objective To explore the effect of naloxone combined with hyperbaric oxygen therapy on serum central nervous specificity protein(S100β)and neuronal nitric oxide synthase(nNOS)levels of patients with acute carbon monoxide(CO)poisoning and their improvement effect on neurological function.Methods A total of 92 patients with acute CO poisoning admitted to the Department of Emergency of our hospital from September 2017 to June 2018 were selected and randomly divided into control group and observation group(n=46).The control group was given conventional therapy combined with hyperbaric oxygen therapy,while the observation group received naloxone on the basis of the treatment of the control group.The clinical efficacy,the serum S100βand nNOS levels before and after treatment,the Glasgow coma scale(GCS)scores and the Glasgow Outcome Scale(GOS)scores at discharge were compared between the two groups.The incidence of delayed encephalopathy was recorded during the 3-month follow-up.Results The total effective rate of treatment in the observation group(95.65%)was significantly higher than that in the control group(89.13%)(P<0.05).The average waking time of the observation group was(2.21±0.61)h,which was significantly shorter than that in the control group(4.03±1.16)h(P<0.05).After treatment,the blood oxygen(PaO2),S100β,and nNOS levels of the two groups were significantly improved(P<0.05),and the serum S100βand nNOS levels in the observation group were significantly lower than those in the control group(P<0.05).Moreover,the GCS and GOS scores in the observation group were also significantly better than those before treatment(P<0.05),and the GCS scores of the observation group were lower than those of the control group 3 days and 7 days after treatment(P<0.05).During the 3-month follow-up,the incidence of delayed encephalopathy in the observation group(2.17%)was significantly lower than that in the control group(13.04%)(P<0.05).Conclusion Naloxone combined with hyperbaric oxygen therapy has a remarkable effect in the treatment of acute CO poisoning,which can alleviate the damages of brain tissue and neurological function by effectively reducing serum S100βand nNOS levels,thus helping to speed up the waking up and recovery of patients,reducing the incidence of delayed encephalopathy,and improving the prognosis.