丹参川芎嗪注射液联合神经节苷脂治疗一氧化碳中毒后患者脑氧利用率的变化及意义

摘要

Objective To investigate the changes and significance of cerebral oxygen utilization coefficients (O2UCc) in patients with acute carbon monoxide poisoning (ACOP) after treatment with Danshen Chuanxiongqin injection combined with ganglioside.Methods A prospective study was conducted.Two hundreds and six patients with ACOP admitted to the Department of Emergency in Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2011 to January 2016 were enrolled,and they were divided into Danshen Chuanxiongqin group,ganglioside group and Danshen Chuanxiongqin injection combined with ganglioside group (combined treatment group) by random number table.The changes in oxygen saturation of internal carotid artery blood (SaO2) and oxygen saturation of internal jugular vein blood (SjO2) were detected by blood gas analysis for all the patients before and 6 hours,1 day,3 days after treatment,and then according to the rate of oxygen utilization formula [O2UCc=S(a-j)O2/SaO2],O2UCc wascalculated.Before and after treatment,the changes of O2UCc in three groups were compared;after treatment for 14 days,the improvement of clinical symptoms,the incidence of delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) and the 28-day mortality were observed.Results The total therapeutic effective rate of combined treatment group was significantly higher than that in either Danshen Chuanxiongqin injection group or ganglioside group [91.67％ (66/72) vs.77.27％ (51/66),77.94％ (53/68),both P ＜ 0.05].Before treatment,there were no differences in levels of O2UCc among three groups (P ＞ 0.05);after treatment for 6 hours and 1 day,the level of O2UCc in combined treatment group was obviously lower than either that of Danshen Chuanxiongqin injection group or of ganglioside group [6 hours:(38.13±7.95)％ vs.(42.96±7.58)％,(42.30±9.87)％,1 day:(28.42±5.41)％ vs.(33.27±7.53)％,(32.64 ± 6.76)％,all P ＜ 0.05],and the levels of O2UCc at 6 hours and 1 day after treatment had no statistical significant differences between those in Danshen Chuanxiongqin injection group and ganglioside group (P ＞ 0.05);after treatment for 3 days,the percentages of O2UCc levels were very close in Danshen Chuanxiongqin injection group,ganglioside group and combined treatment group [(23.87 ± 6.06)％,(22.38±6.09)％,(23.68 ±4.34)％,respectively,all P ＞ 0.05];The incidence of DEACMP and the 28-day mortality after treatment in combined treatment group were lower than those in Danshen Chuanxiongqin injection group or ganglioside group [the incidence of DEACMP:2.78％ (2/72) vs.12.12％ (8/66),14.71％ (10/68),the 28-day mortality:2.78％ (2/72) vs.13.64％ (9/66),16.18％ (11/68),both P ＜ 0.05];while the incidence of DEACMP and the 28-day mortality after treatment had no statistical significant differences between Danshen Chuanxiongqin injection group and ganglioside group (all P ＞ 0.05).No adverse reactions occurred in the three groups.Conclusion The treatment of Danshen Chuanxiongqin injection combined with ganglioside in treatment of ACOP patients can effectively reduce the O2UCc,decrease the occurrence of DEACMP and 28-day mortality,thus it may improve the prognosis,and the clinical curative effect is distinct.%目的 观察急性一氧化碳中毒(ACOP)患者应用丹参川芎嗪注射液联合神经节苷脂治疗后脑氧利用率(O2UCc)的变化及意义.方法 采用前瞻性研究方法,选择2011年1月至2016年1月入住河北医科大学附属哈励逊国际和平医院急救医学部的206例ACOP患者,按随机数字表法分为丹参川芎嗪组、神经节苷脂组和丹参川芎嗪注射液联合神经节苷脂治疗组(联合治疗组).所有患者均于治疗前及治疗后6h、1d、3d经颈内动脉和颈内静脉采血,检测颈内动脉血氧饱和度(SaO2)和颈内静脉血氧饱和度(SjO2),根据公式推导O2UCc[O2UCc=S (a-j) OJSaO2].比较3组患者治疗前后O2UCc的变化;观察治疗14 d后患者临床症状改善情况、ACOP迟发性脑病(DEACMP)的发生率及28 d病死率.结果 联合治疗组总有效率明显高于丹参川芎嗪组和神经节苷脂组[91.67％ (66/72)比77.27％ (51/66)、77.94％ (53/68),均P＜ 0.05].3组患者治疗前O2UCc水平比较差异无统计学意义;治疗后6h和1d联合治疗组O2UCc均明显低于丹参川芎嗪注射液组和神经节苷脂组[6 h:(38.13±7.95)％比(42.96±7.58)％、(42.30±9.87)％,1 d:(28.42±5.41)％比(33.27±7.53)％、(32.64±6.76)％,均P＜O.05],而丹参川芎嗪组、神经节苷脂组患者治疗6h和1d后O2UCc比较差异无统计学意义;治疗3d后丹参川芎嗪组、神经节苷脂组、联合治疗组O2UCc水平数值已接近[分别为(23.87±6.06)％、(22.38±6.09)％、(23.68±4.34)％,均P＞0.05].联合治疗组DEACMP发生率和28 d病死率均低于丹参川芎嗪组和神经节苷脂组[发生率:2.78％ (2/72)比12.12％(8/66)、14.71％ (10/68),28 d病死率:2.78％ (2/72)比13.64％(9/66)、16.18％(11/68),均P＜O.05],而丹参川芎嗪组与神经节苷脂组DEACMP发生率和28 d病死率比较差异均无统计学意义(均P＞0.05).3组均无不良反应发生.结论 丹参川芎嗪联合神经节苷脂治疗ACOP患者能有效降低O2UCc水平和DEACMP的发生率以及28 d病死率,改善患者预后,临床疗效良好.