吡拉西坦注射液联合高压氧治疗对急性一氧化碳中毒患者神经功能及预后的影响

Effects of piracetam injection combined with hyperbaric oxygen on neurological function and prognosis of patients with acute carbon monoxide poisoning.

目的探讨吡拉西坦注射液联合高压氧治疗对急性一氧化碳中毒(ACOP)患者神经功能及预后的影响。方法选择2018年1月至2021年1月榆林市中医医院收治的98例ACOP患者为研究对象,按随机数表法将患者分为观察组和对照组,每组49例,两组患者均采取大量持续吸氧、降颅压、保护脑细胞、改善微循环等基础治疗,对照组患者在此基础上予以高压氧治疗,观察组患者在对照组治疗的基础上予以吡拉西坦注射液治疗,两组均持续治疗10 d,比较两组患者治疗后的疗效,以及治疗前后的神经功能[血清脑源性神经营养因子(BNDF)、中枢神经特异蛋白(S100-β)、胰岛素样生长因子(IGF-1)]和治疗期间的不良反应发生情况。两组患者均随访6个月,比较其预后情况。结果治疗期间,观察组患者死亡率为22.45%,略低于对照组的34.69%,差异无统计学意义(P>0.05),但观察组患者的总体疗效优于对照组,差异有统计学意义(P<0.05);治疗10 d后,两组患者的血清BNDF、IGF-1水平均较治疗前上升,血清S100-β水平均较治疗前下降,且观察组患者的血清BNDF、IGF-1水平分别为(3.21±0.54)ng/L、(104.37±21.19)mg/L,明显高于对照组的(2.54±0.51)ng/L、(94.68±23.07)mg/L,血清S100-β水平为(0.93±0.21)ng/L,明显低于对照组的(1.26±0.32)ng/L,差异均有统计学意义(P<0.05);治疗期间,两组患者的总不良反应发生率比较差异无统计学意义(P>0.05);治疗结束出院时,两组患者的痴呆/昏迷发生情况比较差异无统计学意义(P>0.05);治疗结束后6个月内,观察组患者死亡、迟发性脑病发生率分别为10.53%、7.89%,明显低于对照组的32.26%、32.26%,差异均具有统计学意义(P<0.05),而两组患者的重要器官衰竭、心肌梗死/恶性室性心律失常差异无统计学意义(P>0.05)。结论吡拉西坦注射液联合高压氧治疗ACOP有助于患者神经功能恢复,改善预后,且不会增加不良反应。

Objective To explore the effects of piracetam injection combined with hyperbaric oxygen on the neurological function and prognosis of patients with acute carbon monoxide poisoning(ACOP).Methods Ninety-eight patients with ACOP treated in Yulin Hospital of Traditional Chinese Medicine between January 2018 and January 2021 were selected and divided into an observation group(n=49)and a control group(n=49)by random number table method.Based on basic treatments including continuous oxygen inhalation,cranial pressure reduction,protection of brain cells,microcirculation improvement,the patients in the control group were given hyperbaric oxygen therapy,and the patients in the observation group received piracetam injection on the basis of treatment in the control group.Both groups were treated continuously for 10 d.The efficacy after treatment,and neurological function[serum brain-derived neurotrophic factor(BNDF),central nervous system specific protein(S100-β),insulin-like growth factor(IGF-1)]before and after treatment,and occurrence of adverse reactions during treatment were compared between the two groups.Both groups of patients were followed up for 6 months to compare the prognosis.Results During treatment,the mortality rate in the observation group was slightly lower than that in the control group(22.45%vs 34.69%,P>0.05),but the overall efficacy was better in the observation group than the control group(P<0.05).After 10 days of treatment,the levels of serum BNDF and IGF-1 of the two groups were increased compared with those before treatment,while the level of serum S100-βwas decreased compared with that before treatment;the levels of serum BNDF and S100-βwere(3.21±0.54)ng/L and(104.37±21.19)mg/L in the observation group,significantly higher than(2.54±0.51)ng/L and(94.68±23.07)mg/L in the control group;the level of serum S100-βwas(0.93±0.21)ng/L,significantly lower than(1.26±0.32)ng/L in the control group;the differences were statistically significant(P<0.05).During treatment,there was no statistically significant difference in the total incidence rate of adverse reactions between the two groups(P>0.05).At discharge after treatment,the difference in the occurrence of dementia/coma between the two groups was not statistically significant(P>0.05).Within 6 months after treatment,the incidence rates of death and delayed encephalopathy in the observation group were 10.53%and 7.89%,which were significantly lower than 32.26%and 32.26%in the control group(P<0.05).There were no statistically significant differences in the incidence of vital organ failure and myocardial infarction/malignant ventricular arrhythmia between the two groups(P>0.05).Conclusion Piracetam injection combined with hyperbaric oxygen for ACOP can promote neurological function recovery and improve the prognosis of patients,and will not increase the adverse reactions.