经颅直流电刺激对急性重度一氧化碳中毒患者神经损伤标志物及预后的影响

Effect of transcranial direct current stimulation on neurological injury markers and prognosis in patients with acute and severe carbon monoxide poisoning

目的观察经颅直流电刺激(tDCS)对急性重度一氧化碳中毒(ASCOP)患者神经损伤标志物及预后的影响。方法于2021年5月,选择2020年11月至2021年1月河北医科大学哈励逊国际和平医院急救医学部ASCOP患者103例,按患者是否接受tDCS治疗分为对照组和观察组,对照组(50例)给予氧疗(高压氧及吸氧)、降颅压、改善脑循环及细胞代谢、清除氧自由基及对症支持等常规治疗,观察组(53例)在常规治疗基础上加用2周的tDCS加强治疗。所有患者入院后进行至少24 h脑电双频指数(BIS)监测,记录整点时刻BIS数值并计算24 h平均值,收集患者入院、3 d、7 d及出院检测神经元特异性烯醇化酶(NSE)、血清S100钙结合蛋白(S100B)表达水平。随访60 d,比较两组患者急性一氧化碳中毒迟发性脑病(DEACMP)发生率及发病时间。结果与对照组比较,观察组患者入院时NSE、S100B差异无统计学意义(P=0.711、0.326),入院后3、7 d时NSE、S100B升高,观察组较对照组升高缓慢,差异有统计学意义(P3 d=0.045、0.032,P7 d=0.021、0.000);14 d逐渐下降,但观察组较对照组下降迅速,差异有统计学意义(P=0.009、0.025)。60 d随访结果,与对照组DEACMP发生率[38.00%(19/50)]比较,观察组发生率[18.87%(10/53)]明显降低(P=0.048);与对照组发生DEACMP时间[(22.30±5.42)d]比较,观察组患者发生DEACMP时间[(16.79±5.28)d]更晚,差异有统计学意义(P=0.013)。结论ASCOP患者早期给予tDCS可阻止神经损伤标志物NSE、S100B产生,并可改善DEACMP发生率及发病时间。

Objective To observe the effects of transcranial direct current stimulation(tDCS)on nerve injury markers and prognosis in patients with acute severe carbon monoxide poisoning(ASCOP).Methods In May 2021,103 ASCOP patients were treated in the emergency department of Harrison International Peace Hospital of Hebei Medical University from November 2020 to January 2021.The patients were divided into two groups according to whether they received tDCS treatment.The control group(50 cases)were given oxygen therapy(hyperbaric oxygen and oxygen inhalation),reducing cranial pressure,improving brain circulation and cell metabolism,removing oxygen free radicals and symptomatic support,and the observation group(53 cases)was treated with 2 weeks of tDCS intensive treatment on the basis of conventional treatment.All patients underwent at least 24 h bispectral index(BIS)monitoring,BIS value was recorded at the hour and the 24 h mean value was calculated.Neuron-specific enolase(NSE)and serum S100B calcium-binding protein(S100B)were detected after admission,3 d,7 d and discharge.Follow-up for 60 days,the incidence and time of onset of delayed encephalopathy(DEACMP)with acute carbon monoxide poisoning in the two groups were recorded.Results The NSE and S100B proteins of ASCOP patients were significantly increased at admission,but there was no significant difference between the two groups(P=0.711,0.326).The NSE and S100B proteins were further increased at 3 and 7 days after admission.The increase in the observation group was slower than that in the control group,and the difference was statistically significant(P3 d=0.045,0.032,P7 d=0.021,0.000);After 14 days,it gradually decreased,but the observation group decreased rapidly compared with the control group,with a statistically significant difference(P=0.009,0.025).The 60 day follow-up results showed that the incidence of DEACMP in the observation group was 18.87%(10/53),compared with 38.00%(19/50)in the control group(P=0.048);The time of DEACMP in the observation group[(16.79±5.28)d]was later than that in the control group[(22.30±5.42)d],and the difference was statistically significant(P=0.013).Conclusion The early administration of tDCS in ASCOP patients can prevent the production of NSE and S100B proteins,which are markers of nerve damage.and can improve the incidence and time of DEACMP.