醒脑静注射液联合高压氧治疗急性一氧化碳中毒的疗效及对肝肾功能、动脉血气指标、心肌损伤标志物的影响

Clinical efficacy of refreshing static injection combined with hyperbaric oxygen therapy for acute carbon monoxide poisoning and how it impacts on liver and kidney function,arterial blood gas index and myocardial injury marker

目的 观察醒脑静注射液联合高压氧治疗急性一氧化碳中毒(ACOP)的临床疗效及对肝肾功能、动脉血气指标、心肌损伤标志物的影响。方法 将66例ACOP患者按照随机数字表法分为2组,对照组33例予常规对症支持治疗(胞磷胆碱钠注射液+高压氧),治疗组33例在对照组治疗基础上加用醒脑静注射液。比较2组疗效;比较2组治疗前后肝肾功能指标变化;比较2组治疗前后动脉血气指标变化;比较2组治疗前后心肌损伤标志物、超敏C反应蛋白(hs-CRP)变化;比较2组治疗前后格拉斯哥昏迷量表(GCS)评分、美国国立卫生研究院卒中量表(NIHSS)评分、日常生活能力量表(ADL)评分变化;随访1个月,比较2组病死率和迟发性脑病(DEACMP)发生率。结果 治疗组总有效率96.97%(32/33),对照组总有效率72.73%(24/33),治疗组疗效优于对照组(P<0.05)。2组治疗后碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血尿素氮(BUN)、血肌酐(Cr)水平均较本组治疗前降低(P<0.05),治疗后治疗组ALP、ALT、AST、BUN、Cr水平均低于对照组(P<0.05)。2组治疗后动脉血氧分压[p(O_(2))]、氧合血红蛋白(OxyHb)水平均较本组治疗前升高(P<0.05),动脉血二氧化碳分压[p(CO_(2))]、血碳氧血红蛋白(COHb)水平均较本组治疗前降低(P<0.05),治疗后治疗组p(O_(2))、OxyHb水平均高于对照组(P<0.05),p(CO_(2))、COHb水平均低于对照组(P<0.05)。2组治疗后脑钠肽(BNP)、肌钙蛋白(cTnI)、降钙素原(PCT)、hs-CRP水平均较本组治疗前降低(P<0.05),治疗后治疗组BNP、cTnI、PCT、hs-CRP水平均低于对照组(P<0.05)。2组治疗后GCS评分、ADL评分均较本组治疗前升高(P<0.05),NIHSS评分较本组治疗前降低(P<0.05);治疗后治疗组GCS评分、ADL评分均高于对照组(P<0.05),NIHSS评分低于对照组(P<0.05)。治疗组病死率3.03%(1/33),DEACMP发生率3.03%(1/33);对照组病死率3.03%(1/33),DEACMP发生率24.24%(8/33),2组病死率比较差异无统计学意义(P>0.05),治疗组DEACMP发生率低于对照组(P<0.05)。结论 醒脑静注射液联合高压氧治疗ACOP,可改善患者肝肾功能、动脉血气指标,减轻心肌损伤和炎性反应,减轻神经损伤,降低DEACMP发生率。

Objective To observe the clinical efficacy of refreshing static injection combined with hyperbaric oxygen therapy(HBOT)for acute carbon monoxide poisoning(ACOP)and how it impacts on liver and kidney function,arterial blood gas index and myocardial injury marker.Methods Totally 66 ACOP patients were randomly assigned into the treatment group(n=33)and the control group(n=33);the control group was treated with conventional symptomatic supportive therapy(citicoline sodium injection+HBOT),and the treatment group with refreshing static injection based on the control group.The aim was to compare liver and kidney function indexes,arterial blood gas index,myocardial injury marker,high-sensitivity C-reactive protein(hs-CRP),Glasgow coma scale(GCS)score,National Institutes of Health Stroke Scale(NIHSS),activity of daily living(ADL)scale,mortality,incidence of delayed encephalopathy after acute carbon monoxide peisoning(DEACMP);the curative effect was assessed.Results The overall effective rate was higher in the treatment group(96.97%[32/33])compared with the control group(72.73%[24/33]),(P<0.01).After treatment,alkaline phosphatase(ALP),alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood urea nitrogen(BUN),serum creatinine(Cr)in groups were decreased(P<0.05),the reduction in the treatment group was more prevalent(P<0.05);arterial partial pressure of oxygen[p(O 2)]and oxygenated hemoglobin(OxyHb)in groups were increased(P<0.05),which were increased(P<0.05)in the treatment group relevant to the control group;arterial carbon dioxide partial pressure[p(CO 2)]and carbon monoxide hemoglobin(COHb)in groups were decreased(P<0.05),which were decreased in the treatment group compared with the control group(P<0.05);brain natriuretic peptide(BNP),cardiac troponin I(cTnI),procalcitonin(PCT),hs-CRP in groups were decreased(P<0.05),the treatment group was more common(P<0.05);GCS and ADL scores in groups were increased(P<0.05),while NIHSS scores were decreased(P<0.05);higher GCS and ADL scores,and lower NIHSS scores were detected in the treatment group than those in the control group(all P<0.05).The difference was not statistically significant in the mortality between the treatment group and the control group(3.03%[1/33]vs 3.03%[1/33],[P>0.05],respectively).The incidence of DEACMP was 3.03%(1/33)in the treatment group,lower than that of 24.24%(8/33)in the control group(P<0.05).Conclusion For ACOP patients,refreshing static injection combined with HBOT can improve liver and kidney function,arterial blood gas index,reduce myocardial injury and inflammatory response,relieve nerve injury,and reduce the incidence of DEACMP.