高压氧联合糖皮质激素治疗急性CO中毒迟发性脑病的效果观察  

Effects of hyperbaric oxygen combined with glucocorticoids on patients with delayed encephalopathy after acute CO poisoning

作　　者：宋新华 陈恺 李彩虹 Song Xinhua;Chen Kai;Li Caihong(Department of Emergency,Central Hospital of Jiaozuo Coal Industry Group,Jiaozuo 454150,China)

机构地区：[1]焦作煤业(集团)有限责任公司中央医院急诊科,河南省454150

出　　处：《中国实用医刊》2020年第11期75-78,共4页Chinese Journal of Practical Medicine

摘　　要：目的探讨高压氧联合糖皮质激素治疗急性一氧化碳(CO)中毒迟发性脑病的临床效果。方法选择2016年5月至2018年10月焦作煤业(集团)有限责任公司中央医院收治的急性CO中毒迟发性脑病患者112例,按照随机数字表法分为对照组和观察组,每组56例。对照组给予高压氧和常规治疗,观察组在对照组治疗基础上给予糖皮质激素治疗,比较两组治疗效果、治疗前后氧化指标[丙二醛(MDA)、活性氧类物质(ROS)]水平、炎症因子[白细胞介素-6(IL-6)与肿瘤坏死因子(TNF-α)]水平、认知功能[神经行为认知状况测试(NCSE)和蒙特利尔量表(MoCA)]、日常生活活动能力[改良Barthel指数(MBI)]及生活质量[简明健康状况调查问卷(SF-36)]评分。结果观察组治疗总有效率(94.64%,53/56)高于对照组(80.36%,45/56),P<0.05。治疗后,观察组血清MDA为(5.81±0.96)μmol/L,ROS为(400.49±68.25)IU/ml,IL-6为(35.24±3.87)ng/L,TNF-α为(19.13±2.07)ng/L;对照组血清MDA为(7.27±1.13)μmol/L,ROS为(502.32±80.17)IU/ml,IL-6为(41.98±4.32)ng/L,TNF-α为(26.42±3.15)ng/L,观察组各指标水平均低于对照组(P均<0.05)。治疗后,观察组NCSE评分为(48.71±6.28)分,MoCA评分为(28.05±3.97)分,MBI评分为(67.24±7.73)分,SF-36评分为(70.13±9.07)分;对照组NCSE评分为(43.52±5.74)分,MoCA评分为(22.61±3.48)分,MBI评分为(56.79±6.84)分,SF-36评分为(65.43±8.35)分;观察组各指标评分均高于对照组(P均<0.05)。结论高压氧联合糖皮质激素治疗可改善急性CO中毒迟发性脑病患者认知功能及生活质量。Objective To investigate the effects of hyperbaric oxygen combined with glucocorticoids on patients with delayed encephalopathy after acute carbon monoxide(CO)poisoning.Methods A total of 112 patients with delayed encephalopathy due to acute CO poisoning treated in Central Hospital of Jiaozuo Coal Industry Group from May 2016 to October 2018 were selected.All patients were divided into the control group and observation group by random number table method,with 56 cases in each group.The control group was treated by hyperbaric oxygen and conventional therapy.Based on the treatment of control group,the observation group was additionally treated with glucocorticoids.The treatment effects,levels of oxidation index,including malondialdehyde(MDA)and reactive oxygen species(ROS),levels of inflammatory factors,such as interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α),cognitive function assessed by neurobehavioral cognitive status examination(NCSE)and Montreal Scale(MoCA),activities of daily living assessed by modified Barthel index(MBI),and quality of life assessed by 36-ItemShort-Form Health Survey(SF-36)were compared between the two groups before and after treatment.Results The total effective rate of treatment in the observation group(94.64%,53/56)was higher than that in the control group(80.36%,45/56),all P<0.05.After treatment,in the observation group,serum MDA level was(5.81±0.96)μmol/L,ROS was(400.49±68.25)IU/ml,IL-6 level was(35.24±3.87)ng/L,TNF-αlevel was(19.13±2.07)ng/L;in the control group,serum MDA level was(7.27±1.13)μmol/L,ROS was(502.32±80.17)IU/ml,IL-6 level was(41.98±4.32)ng/L,TNF-αlevel was(26.42±3.15)ng/L;the level of each index in the observation group were lower than those in the control group(all P<0.05).After treatment,NCSE score was 48.71±6.28,MoCA score was 28.05±3.97,MBI score was 67.24±7.73,SF-36 score was 70.13±9.07 in the observation group;NCSE score was 43.52±5.74,MoCA score was 22.61±3.48,MBI score was 56.79±6.84,SF-36 score was 65.43±8.35 in the control group;the s

关 键 词：糖皮质激素 高压氧 急性一氧化碳中毒 迟发性脑病 认知功能 生活质量 

分 类 号：R595.1[医药卫生—内科学]