亚低温联合高压氧对急性一氧化碳中毒患者心肌损伤标志物、氧化应激反应及神经因子水平的影响  

Effects of Mild Hypothermia Combined with Hyperbaric Oxygen on Myocardial Injury Markers,Oxidative Stress Response and Neurofactors Levels in Patients with Acute Carbon Monoxide Poisoning

作　　者：钱晓林[1] 耿文丽[1] 马莉莉[1] 乔妍 李焕 QIAN Xiao-lin;GENG Wen-li;MA Li-li;QIAO Yan;LI Huan(Department of Hyperbaric Oxygen Medicine,Affiliated Hospital of Jining Medical University,Jining,Shandong,272000,China)

机构地区：[1]济宁医学院附属医院高压氧医学科,山东济宁272000

出　　处：《现代生物医学进展》2024年第17期3376-3380,3385,共6页Progress in Modern Biomedicine

基　　金：山东省中医药科技发展计划项目(2019-0492)。

摘　　要：目的:探讨亚低温联合高压氧对急性一氧化碳中毒(ACMP)患者心肌损伤标志物、氧化应激反应、神经因子水平的影响,以为ACMP的治疗提供临床指导。方法:选取2022年1月至2023年5月我院收治的共计96例ACMP患者,以随机数字表法分成研究组(n=48)与对照组(n=48),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,比较两组心肌损伤标志物、氧化应激反应、神经因子、神经功能、昏迷程度、日常生活能力、病死率、急性一氧化碳中毒迟发型脑病(DEACMP)发生率及不良反应。结果:治疗后两组脑钠肽(BNP)、肌酸激酶同工酶(CK-MB)、肌酸激酶同工酶(cTnI)水平下降(P<0.05),研究组较对照组更低(P<0.05);治疗后两组谷胱甘肽过氧化酶(GSH-Px)、超氧化物歧化酶(SOD)水平升高(P<0.05),丙二醛(MDA)、一氧化氮(NO)水平下降(P<0.05),研究组GSH-Px、SOD水平较对照组更高(P<0.05),MDA、NO水平更低(P<0.05);治疗后两组血清神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)、脑脊液中枢神经特异蛋白(S100β)下降(P<0.05),研究组较对照组更低(P<0.05);治疗后两组美国国立卫生研究院卒中量表(NIHSS)评分下降(P<0.05),格拉斯哥昏迷量表(GCS)、标准日常生活能力Barthel(BI)评分升高(P<0.05),研究组NIHSS评分较对照组更低(P<0.05),GCS、BI评分更高(P<0.05);研究组病死率、DEACMP发生率为2.08%(1/48)、16.67%(8/48),较对照组的10.42%(5/48)、27.08%(13/48)更低(P<0.05);研究组不良反应发生率为12.50%(6/48),与对照组的18.75%(9/48)比较差异无统计学意义(P>0.05)。结论:亚低温联合高压氧应用于ACMP患者治疗中,能够减轻心肌、神经损伤及昏迷程度,缓解氧化应激反应,促进神经功能恢复,提高日常生活能力,降低病死率与DEACMP发生率,安全性较高。Objective:To investigate the effects of mild hypothermia combined with hyperbaric oxygen on myocardial injury markers,oxidative stress response and neurofactors levels in patients with acute carbon monoxide poisoning(ACMP),so as to provide clinical guidance for the treatment of ACMP.Methods:A total of 96 ACMP patients admitted to our hospital from January 2022 to May 2023 were selected and divided into study group(n=48)and control group(n=48)by random number table method.The control group was given hyperbaric oxygen therapy,and the study group was given mild hypothermia combined hyperbaric oxygen therapy.Myocardial injury markers,oxidative stress,neurofactors,neurological function,coma degree,ability of daily living,mortality,incidence of acute carbon monoxide poisoning delayed encephalopathy(DEACMP)and adverse reactions were compared between the two groups.Results:After treatment,the levels of brain natriuretic peptide(BNP),creatine kinase isoenzyme(CK-MB)and creatine kinase isoenzyme(cTnI)in two groups were decreased(P<0.05),and the levels in the study group were lower than those in the control group(P<0.05).After treatment,the levels of glutathione peroxidase enzyme(GSH-Px)and superoxide dismutase(SOD)in the two groups were increased(P<0.05),while the levels of malondialdehyde(MDA)and nitric oxide(NO)were decreased(P<0.05).The levels of GSH-Px and SOD in the study group were higher than those in the control group(P<0.05),and the levels of MDA and NO were lower(P<0.05).After treatment,serum neuron specific enolase(NSE),myelin basic protein(MBP)and cerebrospinal fluid central nerve specific protein(S100β)were decreased in both groups(P<0.05),and those in the study group were lower than those in the control group(P<0.05).After treatment,the score of National Institutes of Health Stroke Scale(NIHSS)decreased(P<0.05),while the score of Glasgow Coma Scale(GCS)and Barthel(BI)of standard daily living ability increased(P<0.05).The NIHSS score of the study group was lower than that of the control group(P<0.05),and the

关 键 词：急性一氧化碳中毒 亚低温 高压氧 心肌损伤标志物 氧化应激 神经因子 

分 类 号：R595.1[医药卫生—内科学]