高压氧对一氧化碳中毒迟发性脑病的疗效及对脑电图的影响

Effect of hyperbaric oxygen on delayed encephalopathy after carbon monoxide poisoning and its influence on electroencephalogram

  • 摘要:
    目的  探讨高压氧治疗对一氧化碳中毒迟发性脑病(DEACMP)的疗效及对患者脑电图的影响。
    方法  选取98例DEACMP患者作为研究对象,随机分为观察组与对照组,每组49例。对照组采用常规治疗,观察组在对照组基础上加用高压氧治疗,持续治疗2个月。比较2组患者的临床疗效和治疗前后的认知功能简易精神状态量表(MMSE)评分、日常生活能力日常生活能力量表(ADL)评分、脑白质病变情况、脑电图异常情况、脑血流速度,并比较2组患者治疗前后外周血单个核细胞核因子-κB(NF-κB)、基质金属蛋白酶-9(MMP-9)、Th1型细胞因子干扰素-γ(IFN-γ)、白细胞介素(IL)-2和Th2型细胞因子(IL-4、IL-10)表达水平。
    结果  观察组治疗有效率为81.63%, 高于对照组的61.22%, 差异有统计学意义(P < 0.05); 治疗后, 2组MMSE评分高于治疗前, ADL评分低于治疗前,且观察组MMSE评分高于对照组, ADL评分低于对照组,差异有统计学意义(P < 0.05); 治疗后, 2组脑白质病变、脑电图异常均较治疗前减轻,且观察组轻于对照组,差异有统计学意义(P < 0.05); 治疗前后, 2组患者脑血流速度比较,差异无统计学意义(P > 0.05); 治疗后, 2组外周血单个核细胞NF-κB、MMP-9、IL-2、IFN-γ水平低于治疗前,且观察组低于对照组,差异有统计学意义(P < 0.05); 治疗后, 2组IL-4、IL-10水平高于治疗前,且观察组高于对照组,差异有统计学意义(P < 0.05)。
    结论  高压氧治疗对DEACMP具有较好的疗效,可有效改善患者认知功能和日常生活能力,减轻脑白质损害和脑电图异常,调控NF-κB信号通路,抑制过度激活的免疫炎性反应。

     

    Abstract:
    Objective  To investigate the therapeutic effect of hyperbaric oxygen on delayed encephalopathy after carbon monoxide poisoning (DEACMP) and its influence on electroencephalogram.
    Methods  A total of 98 with DEACMP patients were selected as study objects, and were randomly divided into observation group and control group, with 49 patients in each group. The control group was given routine treatment, and the observation group was given hyperbaric oxygen therapy on the basis of the control group, the treatment was continuously lasted for 2 months. Clinical efficacy, cognitive function mini-mental State Examination(MMSE) and daily living abilityActivities of Daily Living (ADL), pathological condition of white matter, electroencephalogram abnormalities, cerebral blood flow velocity pretherapy and post-treatment were compared. The expression levels of peripheral blood mononuclear nuclear fack-κB (NF-κB), matrix metalloproteinase-9 (MMP-9), Th1 cytokines interferon-γ (IFN-γ), interleukin (IL)-2 and Th2 cytokines (IL-4, IL-10) were compared between the two groups.
    Results  The effective rate of treatment in the observation group was 81.63%, which was higher than 61.22% in the control group, and the difference was statistically significant (P < 0.05). After treatment, the MMSE score of the two groups was higher than that before treatment, the ADL score was lower than that before treatment, and the MMSE score of the observation group was higher than that of the control group, the ADL score was lower than that of the control group, the differences were statistically significant (P < 0.05). The white matter lesions and EEG abnormalities in the two groups were alleviated when compared with those before treatment, and the above indexes in the observation group were lighter than those in the control group, differences were statistically significant (P < 0.05). There were no significant difference in blood flow velocity of the brain between the two groups after treatment (P > 0.05). The levels of NF-κB in peripheral blood mononuclear cell, MMP-9, IL-2 and IFN-γ after treatment in the observation group were significantly lower than before treatment, and were lower in the observation group than those in the control group (P < 0.05). After treatment, the levels of IL-4 and IL-10 were significantly higher than before treatment, and were higher in the observation group than those in the control group (P < 0.05).
    Conclusion  Hyperbaric oxygen therapy in DEACMP patients has better efficacy. It can effectively improve the cognitive function and the ability of daily living, reduce the white matter damage and electroencephalogram abnormalities, regulate NF-κB pathway, and inhibit the over-activated immune inflammatory response.

     

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