金纳多对一氧化碳中毒迟发性脑病的临床价值

目的 探讨金纳多对急性一氧化碳中毒迟发性脑病(DEACMP)早期诊断指标的影响.方法 2010年10月至2015年3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598例急性一氧化碳中毒(ACOP)患者,以发病6h乳酸清除率的高低分为高乳酸清除率组(＞10％)和低乳酸清除率组(≤10％).所有入选者分别于治疗前及治疗后6h、24h不吸氧条件下抽取动脉血,检测动脉血乳酸,同时计算乳酸清除率.同时采静脉血3 mL检测Copeptin、BNP、cTnI.随机数字表法将186例DEACMP患者随机(随机数字法)分为3组.A组:高压氧治疗、甘露醇、胞磷胆碱、脑细胞营养剂治疗;B组:大剂量胞磷胆碱3.0g治疗;C组:大剂量胞磷胆碱3.0g联合金纳多70 mg静滴综合治疗;治疗后7d复查BNP、MDA、LPA、AP,比较两组患者DEACMP临床疗效.结果 低乳酸清除率组和高乳酸清除率组比较,昏迷时间、接触CO时间、初始血乳酸、6h的乳酸清除率和Copeptin水平差异具有统计学意义.高乳酸清除率组24 h Copeptin水平(2.52±0.58)与6 h Copeptin水平(7.31±0.95)差值比较低乳酸清除率组24 h Copeptin水平(13.08±1.96)与6 h Copeptin水平(2.65±0.57)差值逐渐下降,差异具有统计学意义.低乳酸清除率组24 h BNP (2 576.20±84.84)、cTnI(2.74±0.53)水平与6 h(2 085.34±56.20)、(1.22±0.41)差值比较高乳酸清除率组24hBNP(2 323.18 ±94.73)、cTnI(1.86±0.19)水平与6 h(2 114.30±60.93)、(1.24±0.23)差值明显升高,差异具有统计学意义.低乳酸清除率组患者DEACMP发生率41.16％较高乳酸清除率组11.39％增高,差异具有统计学意义.治疗前A、B、C三组间BNP、MDA、LPA、AP水平比较差异无统计学意义(P＞0.05).治疗后7d与治疗前比较,BNP、MDA、LPA、AP水平明显下降,差异具有统计学意义.治疗后7d,C组BNP (409.48±25.84)、MDA (3.05 ±0.37)、LPA (2.05 ±0.18)、AP(3.23±0.18)水平较A组(519.83 ±28.25)、(6.28±0.79)、(3.14±0.11)、(3.67±0.16)、B组(454.51±24.80)、(5.41±0.42)、(2.66±0.14)、(3.46±0.21)下降明显,B组较A组下降,差异具有统计学意义(P＜0.05).结论 金纳多对DEACMP早期诊断指标有影响价值,明显降低BNP、MDA、LPA、AP水平,指导临床治疗提供重要依据.

Clinical value of Kinnado on delayed encephalopathy after carbon monoxide poisoning

Objective To investigate the effects of Ginaton (a Chinese herbal preparation from the folium of Ginkgo biloba L.extracted) on delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) as well as on the early diagnosis criteria.Methods A total of 598 patients with acute carbon monoxide poisoning (ACOP) were selected,and lactate clearance test was carried out at 6 hours after ACOP.Patients were divided into two groups as per the results of lactate clearance test,namely high rate group (＞ 10％) and low rate group (less than or equal to 10 percent).Arterial blood samples were taken in all patients without oxygen inhalation therapy for determination of lactate levels before and 6 h,24 hours after treatment.Thus the lactate clearance rate could be calculated.At the same time,3 mL of venous blood was taken for detecting cTnI,Copeptin and BNP.Of them,186 DEACMP patients were randomly divided into 3 groups by the random number table method.The patients of group A were treated with hyperbaric oxygen,mannitol,citicoline,and neurocyte nutrition.The patients of group B were treated with large dosage of citicoline 3.0 g.The patients of group C were treated with large dose of citicoline 3.0 g combined with Ginaton 70 mg by intravenous drip.After treatment for 7 days,and the blood levels of BNP (brain natriuretic peptide),MDA (malondialdehyde),LPA (lysophosphatidic acid) and AP (acid phosphatase) were detected and compared between two groups of patients with DEACMP for estimating the therapeutic efficacy.Results There were significant differences in the rate of lactate clearance at 6 hours after treatment,length of CO exposure time,length of coma time,initial blood lactate,and Copeptin levels between low lactate clearance rate (LR) group and high lactate clearance rate (HR) group.There was difference in Copeptin between 24 h (2.52 ± 0.58) and 6 h (7.31 ±0.95) in HR group.In the LR group,the Copeptin level at 24 hours was (13.08 ± 1.96) and at 6 hours was (2.65 ± 0.57) which was significantly lower than that in HR group (P ＜ 0.05).The difference in BNP and cTnI between 24 h BNP (2 576.20 ± 84.84),cTnI (2.74 ± 0.53) and 6h BNP (2 085.34 ± 56.20),cTnI (1.22 ± 0.41) in LR group.In the HR group,24 h BNP (2 323.18 ± 94.73) and 24 h cTnI (1.86 ± 0.19) were higher than 6 h BNP (2 114.30 ± 60.93) and 6 h cTnI I (1.24 ± 0.23) (P ＜ 0.05).The incidence of DEACMP in LR group was 41.16％ which was higher than 11.39％ in HR group (P ＜0.05).The levels of BNP,MDA,LPA,and AP in A,B and C groups before treatment were not significant difference (＞ 0.05).After treatment,the levels of AP,LPA,MDA and BNP were significantly decreased,and the differences were statistically significant.After treatment for 7days,the levels of BNP (409.48 ± 25.84),MDA (3.05 ±0.37),LPA (2.05 ±0.18),AP (3.23 ±0.18) in C group were significantly lower than those in A group(519.83±28.25),(6.28±0.79),(3.14±0.11),(3.67±0.16) respectively,andBgroup (454.51 ± 24.80),(5.41 ± 0.42),(2.66 ± 0.14),(3.46 ± 0.21) respectively,and those in B group were significantly lower than those in A group (P ＜ 0.05).Conclusions Ginaton has significant effects on early diagnosis criteria of DEACMP and on BNP,MDA,LPA,AP levels after treatment,providing important basis for clinical treatment.