亚低温联合高压氧对重度急性一氧化碳中毒患者神经功能、炎性因子及预后的影响

Effect of subhypothemia combined with hyperbaric oxygen therapy on nerve function,expression levels of inflammatory factors and prognosis of severe acute carbon monoxide poisoning

目的探讨亚低温联合高压氧对重度急性一氧化碳中毒患者神经功能、炎性因子及预后的影响。方法选取2018年10月至2020年12月急诊科收治的重度急性一氧化碳中毒患者64例,根据不同治疗方案分为对照组和研究组,每组32例。2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,对照组给予高压氧治疗,研究组给予亚低温联合高压氧治疗。均治疗2个月,评估2组患者临床疗效;观察2组患者治疗前、治疗后1周血清神经元特异性烯醇化酶(neuron specific enolase,NSE)、S100β蛋白、肿瘤坏死因子α(tumor necrosis factor alpha,TNF-α)、白介素-6(interleukin-6,IL-6)水平变化;观察2组患者治疗前后脑电图(electroencephalogram,EEG)异常情况;记录2组患者发生不良反应情况;统计2组患者急性一氧化碳中毒迟发型脑病(delayed encephalopathy after acute carbon monoxide poisoning,DEACMP)发生率及死亡率情况。结果研究组疗效优于对照组(P<0.05);治疗后1周,2组NSE、S100β蛋白、TNF-α、IL-6水平较治疗前均减低,且研究组明显低于对照组,差异均有统计学意义(P<0.05);2组EEG异常情况改善较治疗前有显著差异,且研究组明显显著于对照组(P<0.05);2组不良反应发生率差异无统计学意义(P>0.05);研究组DEACMP发生率及死亡率均明显低于对照组(P<0.05)。结论亚低温联合高压氧治疗重度急性一氧化碳中毒患者安全且疗效显著,可明显减轻患者脑损伤,有效减轻炎性反应,改善EEG异常情况,从而提高患者的治疗效果,改善预后,显示了良好的临床前景。

Objective To explore the effect of subhypothemia combined with hyperbaric oxygen therapy on nerve function,expression levels of inflammatory factors and prognosis of severe acute carbon monoxide poisoning.Methods A total of 64 patients with severe acute carbon monoxide poisoning admitted to the Department of Emergency from October 2018 to December 2020 were enrolled.They were assigned to study group and control group,with 32 cases in each group.Patients in both groups were given to 2-months of routine treatment,including nourishing nerves,dehydration to reduce intracranial pressure,and scavenging free radicals.Patients in the control group and study group were additionally treated with hyperbaric oxygen therapy,and that combined with subhypothemia therapy,respectively.The curative effect was evaluated.The changes of serum neuron specific enolase(NSE),S100β,tumor necrosis factor alpha(TNF-α)and interleukin-6(IL-6)levels were observed before and one week after treatment in the two groups.Electroencephalogram(EEG)findings were observed before and after treatment.The incidence of adverse events was recorded.The incidence and mortality of delayed acute carbon monoxide poisoning(DEACMP)were counted.Results The curative effect in the study group was significantly better than that in the control group(P<0.05).One week after treatment,serum levels of NSE,S100β,TNF-α,and IL-6 were reduced in both groups than those before treatment,which were significantly lower in study group(all P<0.05).EEG abnormalities in the two groups were significantly improved after treatment,which were more pronounced in study group than those in control group(P<0.05).There was no significant difference in the incidence of adverse events between the two groups(P>0.05).The incidence and mortality of DEACMP were significantly lower in the study group than those in the control group(both P<0.05).Conclusion Subhypothemia combined with hyperbaric oxygen therapy has a pronounced therapeutic efficacy on severe acute carbon monoxide poisoning with a high safety,which can significantly reduce the degree of brain damage,and inflammatory response,and improve abnormal EEG,and the prognosis,showing good clinical prospects.