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Objective:Delayed encephalopathy after acute carbon monoxide poisoning(DEACMP)is the most severe complication of carbon monoxide poisoning,which seriously endangers patients'quality of life.This study aims to investigate the efficacy of hyperbaric oxygen(HBO2)on improving dementia symptoms in patients with DEACMP. Methods:A retrospective analysis was performed on DEACMP patients,who visited Xiangya Hospital,Central South University from June 2014 to June 2020.Among them,patients who received conventional drug treatment combined with HBO2 treatment were included in an HBO2 group,while those who only received conventional drug treatment were included in a control group.HBO2 was administered once daily.Patients in the HBO2 group received 6 courses of treatment,with each course consisting of 10 sessions.The Hasegawa Dementia Scale(HDS)was used to diagnose dementia,and the Clinical Dementia Rating(CDR)was used to grade the severity of dementia for DEACMP.The Alzheimer's Disease Assessment Scale-Cognitive Section(ADAS-Cog),the Functional Activities Questionnaire(FAQ),the Neuropsychiatric Inventory(NPI),and the Clinician's Interview-Based Impression of Change-Plus Caregiver Input(CIBIC-Plus)were performed to assess cognitive function,ability to perform activities of daily living(ADL),behavioral and psychological symptoms,and overall function.The study further analyzed the results of objective examinations related to patients'dementia symptoms,including magnetic resonance imaging detection of white matter lesions and abnormal electroencephalogram(EEG).The changes of the above indicators before and after treatment,as well as the differences between the 2 groups after treatment were compared. Results:There was no significant difference in the HDS score and CDR grading between the 2 groups before treatment(both P＞0.05).After treatment,the score of ADAS-Cog,FAQ,NPI,and CIBIC Plus grading of the 2 groups were significantly improved,and the improvement of the above indicators in the HBO2 group was greater than that in the control group(all P＜0.05).The effective rate of the HBO2 group in treating DEACMP was significantly higher than that of the control group(89.47% vs 65.87%,P＜0.05).The objective examination results(white matter lesions and abnormal EEG)showed that the recovery of patients in the HBO2 group was better than that in the control group. Conclusion:Hyperbaric oxygen can significantly relieve the symptoms of dementia in patients with DEACMP.
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@#Objective To investigate the role of P2Y1 receptors and astrocytes in delayed encephalopathy after acute CO poisoning (DEACMP) and the possible pathogenesis of DEACMP.Methods Male SD rats with acceptable cognitive function were screened by water maze test and randomly divided into two groups:the control group and the CO poisoning group.The poisoning group was subjected to DEACMP model.The behavioral changes,neuronal changes and the expressions of P2Y1 receptor and astrocytes in hippocampus of the two groups were compared at 7,14,21 and 28 d after modeling,respectively.Results Compared with the control group,the escape latencies of rats in the poisoning group were significantly prolonged on the 21st and 28th days after modeling (P<0.05).HE staining showed that the hippocampal pyramidal cells and neurons in the model group exhibited obvious necrosis on days 14,21,and 28 after modeling.The water maze indicated that DEACMP occurred on day 21.Compared with the control group,Western blot analysis showed that the expression levels of P2Y1 and GFAP proteins in the hippocampus of the poisoning group were increased at each time point (P<0.05),which increased first and then decreased.Immunofluorescence showed co-expression of P2Y1 and GFAP in hippocampus.Compared with the control group,the expressions of P2Y1 and GFAP in hippocampal CA1 region were up-regulated at each time point after poisoning (P<0.05). Conclusion The activation of astrocytes by P2Y1 receptor may be one of the pathogenesis of DEACMP,and astrocytes may impair learning and memory ability of co-poisoned rats by mediating immune inflammation,leading to DEACMP.
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Objectives:To investigate the relationship between heart rate adjusted QT dispersion (QTcd) and soluble growth stimulating gene 2 protein (sST2) and the severity and prognosis of patients with acute carbon monoxide toxic heart disease.Methods:Retrospective analysis was performed on 135 patients with acute carbon monoxide toxic heart disease admitted to the Emergency Medical Department of our hospital from January 2017 to 2020. Blood sST2, creatine kinase isoenzyme (CK-MB) and troponin I(cTnI) concentrations were recorded at 3 h, 12 h, 2 d and 3 d immediately after admission.The patient was measured and calculated on the day of admission,2 d,3 d and QTcd at discharge.According to the toxicity of carbon monoxide in heart disease severity was divided into mild heart disease group (58 cases), moderate heart disease group (45 cases), severe heart disease group (32 cases), according to whether severe heart disease were divided into severe group (32 cases) and non severe group (103 cases), according to whether the patients death in patients with severe heart disease.Results:Thirty-two of the 135 patients had severe toxic heart disease, with an incidence of 23.7%.In the severe group, sST2, cTnI and CK-MB increased from 24 h and 2 d after admission, and the detected values were all higher than those of the non-severe group and the normal control group, with statistically significant differences ( P<0.05).Before treatment, there were statistically significant differences in sST2 and QTcd between the toxic group and the non-severe group and the normal control group ( P<0.05).After 2 d and 3 d poisoning, there were statistically significant differences between the two groups ( P<0.05). ROC curve analysis showed that the area under the sST2 curve was 0.726, 95% CI was 0.555-0.898, sensitivity was 56.3%, specificity was 94.1%, and truncation was 88.5 ng/mL.The area under the QTcd curve was 0.745, 95% CI was 0.602-0.889, sensitivity was 56.3%, specificity was 82.4%, and truncation value was 68.5 ms.The area under the combined detection curve was 0.939, 95% CI was 0.874-1.000, sensitivity was 81.3%, specificity was 91.2%. Conclusions:In patients with acute carbon monoxide toxic heart disease, the level of sST2 increased earlier than THAT of cTnI and CK-MB, and the combined observation of sST2 and QTcd can be used as an indicator for early prediction of acute carbon monoxide toxic heart disease and its severity.
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Objective:To investigate the predictive neutrophil/lymphocyte ratio (NLR) combined with soluble growth stimulating expression gene 2 protein (sST2) on in-hospital major adverse cardiovascular events (MACE) in patients with myocardial injury following moderate-severe acute carbon monoxide poisoning (ACOP).Methods:A single-cente prospective observational approach was conducted. Moderate-severe ACOP patients with myocardial damage from November 2016 to February 2020 in department of emergency medicine of Harrison International Peace Hospital Affiliated to Hebei Medical University were enrolled. The baseline data of the patients, NLR and sST2 (T0 sST2) on admission, sST2 at 3 days after admission (T3 d sST2), and the other myocardial injury and biochemical indicators were collected. According to whether MACE occurred, the patients were divided into MACE group and non-MACE group. The clinical data of the two groups were compared. Pearson correlation analysis was used to analyze the correlation of each index. Binary Logistic regression was used to analyze the independent risk factors of in-hospital MACE in patients with moderate-severe ACOP myocardial injury. The receiver operator characteristic curve (ROC curve) was drawn and area under ROC curve (AUC) was calculated to analyze the predictive value of NLR, sST2, and NLR combined with sST2 for the occurrence of in-hospital MACE in patients with moderate-severe ACOP myocardial injury.Results:A total of 278 patients with moderate-severe ACOP myocardial injury were included in the final analysis, and the incidence of MACE was 11.51% (32/278). Cardiac troponin I (cTnI), lactic acid (Lac), NLR, and T3 d sST2 in the MACE group were significantly higher than those in the non-MACE group [cTnI (μg/L): 0.83±0.15 vs. 0.46±0.37, Lac (mmol/L): 2.96±1.14 vs. 2.43±1.35, NLR: 13.14±4.37 vs. 9.49±4.21, T3 d sST2 (μg/L): 59.88±23.42 vs. 39.83±12.60, all P < 0.05], there was no significant difference in T0 sST2 between the MACE group and the non-MACE group (μg/L: 269.09±90.89 vs. 240.14±113.02, P > 0.05). Pearson correlation analysis showed that there were significantly positive correlations in NLR with acute physiology and chronic health evaluationⅡ(APACHEⅡ), T3 d sST2 with APACHEⅡ, and NLR with T3 d sST2 ( r values were 0.226, 0.209, 0.193, all P < 0.01). Binary Logistic regression analysis showed that T3 d sST2 and NLR were both independent risk factors for MACE in moderate-severe ACOP patients with myocardial injury [odds ratio ( OR) and 95% confidence interval (95% CI) respectively was 1.064 (1.039-1.090), 1.176 (1.066-1.298), both P < 0.01]. ROC curve analysis showed that the predictive efficacy of NLR combined with T3 d sST2 for the occurrence of in-hospital MACE in patients with ACOP myocardial injury (AUC = 0.876) was better than that of NLR (AUC = 0.754) and T3 d sST2 (AUC = 0.813). When the optimal critical value of NLR was 10.02 and that of T3 d sST2 was 43.50 μg/L, the sensitivity of predicting the occurrence of MACE in patients with moderate-severe ACOP myocardial injury was 69.8% and 86.2% respectively, and the specificity was 74.3% and 70.4%, respectively. The specificity and sensitivity of the combined detection was 83.4% and 79.8%, respectively. Conclusions:NLR and T3 d sST2 were independent predictors of in-hospital MACE in moderate-severe ACOP patients with myocardial injury, and combined application of NLR and T3 d sST2 had good predictive value. For patients with moderate-severe ACOP myocardial injury with NLR > 10.02 and T3 d sST2 > 43.50 μg/L, the occurrence of in-hospital MACE should be alert.
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Objective@#To observe the effect of ulinastatin on myocardial injury in patients with acute severe carbon monoxide poisoning (ASCOP) .@*Methods@#By using the prospective study method, 123 cases of ASCOP patients admitted to our hospital, were randomly divided into two groups. There were no significantly different between the two groups in the abnormal rates of ECG, brain natriuretic peptide (BNP) , troponin I (cTNI) , creatine phosphokinase (CK-MB) and creatine phosphokinase (CK) . The control group according to the patients need to be treated with hyperbaric oxygen and routine medical treatment; the observation group was treated with ulinastatin 100 thousand u intravenous injection based on routine treatment measures on Q8 h, the two groups were 7 d for the 1 course of treatment. Compared two groups of patients after 3 days, 7 days of electrocardiogram, brain natriuretic peptide (BNP) , troponin I (cTNI) , creatine kinase isoenzyme (CK-MB) , creatine kinase (CK) , the case fatality rate within 14 days, and the abnormality rate of BNP, cTNI, CK-MB and Ck.@*Results@#the observation group for 3 days, 7 days, 14 days were abnormal, brain natriuretic peptide (BNP) , cardiac troponin I (cTNI) , creatine kinase isoenzyme (CK-MB) , creatine kinase (CK) the average results were significantly lower than those in the control group (P<0.05) ; The 14 d BNP in the observation group was significantly lower than the control group (P<0. 05) ; the case fatality rateof observation group was lower than the control group within 14 days (1.2% vs 3.3%) .@*Conclusion@#Ulinastatin can significantly improve the ASCOP to reduce the damage to the heart, reduce the case fatality rateand improve the prognosis.
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Objective To investigate the therapeutic effects of Xingzhi Yinao (XZYN) particles combined with hyperbaric oxygen therapy on cognitive impairment and motor dysfunction in patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP). Methods Sixty-seven patients with DEACMP were admitted to the Affiliated Yantai Yuhuangding Hospital of Qingdao University from January 2011 to December 2015, and they were randomly divided into a control group (given conventional treatment such as inhalation of oxygen, cytidine diphosphate cholin and vitamin B, 19 cases), a hyperbaric oxygen (HBO) treatment group (given conventional treatment + hyperbaric oxygen therapy once a day, 24 cases) and a XZYN particles treatment (XZYN group, given conventional treatment, hyperbaric oxygen and XZYN particles, 24 cases), the therapeutic course being 2 months in the three groups. Before and after treatment for 1 and 2 months, the cognitive function and motor function of the patients were evaluated by the use of activity of daily living (ADL) scale, Montreal cognitive assessment (MoCA) scale, and mini-mental state examination (MMSE) scale; the severity of cerebral white matter injury was assessed by age related white matter changes (ARWMC) scale; and the electromyographic evoked potential was used to detect the amplitude and latency of P300 to assess the severity of cognition impairment and prognosis. Results With the prolongation of therapeutic time, after treatment, the neurological function scores of ADL, MoCA, MMSE and amplitude of P300 were increased, while ARWMC was decreased and the latency of P300 was shortened gradually in the three groups, and the changes of above indexes after treatment for 2 months in XZYN group were more significant than those in either HBO group or control group[ADL score: 70.2±8.3 vs. 60.5±8.1, 23.0±6.1, MoCA score: 26.1±3.1 vs. 22.2±2.7, 18.2±3.6, MMSE score:25.9±4.1 vs. 22.4±3.5, 18.1±4.5, ARWMC score: 7.0±2.1 vs. 8.7±2.2, 15.2±3.3, latency of P300 (ms):332.9±20.4 vs. 352.5±23.6, 381.7±30.3, amplitude of P300 (μV): 6.5±1.6 vs. 5.6±1.3, 4.1±1.5, all P < 0.05]. Conclusion The hyperbaric oxygen therapy combined with XZYN particles for treatment of patients with DEACMP can significantly improve their cognitive and motor functions and ameliorate the severity of cerebral white matter injury.
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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.
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Objective@#To explore the difference of radiological imaging features of delayed encephalopathy after carbon monoxide poisoning (DECMP) and acute carbon monoxide poisoning (ACMP) , and the correlation between the imaging findings and clinical prognosis of the disease.@*Methods@#The correlation between imaging findings and clinical manifestations and prognosis of 95 patients with moderate and severe acute carbon monoxide poisoning were retrospectively analyzed. In the above 95 cases, there were 62 cases of ACMP and 33 cases of DEACMP. All patients underwent conventional CT, MRI and magnetic resonance diffusion tensor imaging (DTI) . Circular regions of interest (ROI) measurement was used for analysis of average diffusion coefficient (ADC) value and fractional anisotropy (FA) value of the MRI and DTI imaging manifestations in different brain regions.@*Results@#The main clinical manifestation of moderate acute carbon monoxide poisoning was consciousness disorder and fatigue; Severe poisoning patients showed deep coma as the main clinical manifestations; The most prominent clinical manifestations of DEACMP were mental disorders and neurological impairment in the extrapyramidal system. A total of 95 cases with moderate or severe CO poisoning showed unilateral or bilateral cerebral cortex, bilateral basal ganglia (white ball) , cerebral white matter around bilateral ventricles or bilateral centrum semiovale, around bilateral ventricles cerebral white matter around bilateral ventricles and bilateral centrum semiovale, cerebral cortex and subcortical involvement. CT showed normal or low density shadow.MRI showed that the lesion T1WI presented slightly low or equal signal, T2WI and FLAIR sequences showed equal, a slightly higher or high signal; DWI sequence showed slightly higher or high signal. ADC value and FA value in different brain white matter regions of DEACMP group was significantly lower than those of ACMP group (P<0.05) , especially for those around semi oval center and lateral ventricles of the brain white matter (P<0.01) ; The ADC values increased significantly, FA value decreased significantly in the nerve nucleus (P<0.05) , especially for ADC values in globus pallidus (P<0.01) .@*Conclusion@#DTI can evaluate the brain tissue damage in patients with DEACMP more early and more accurately.
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Objective To study effect of piracetam combine with hyperbaric oxygen in treatment of acute carbon monoxide poisoning patients with electrocardiogram and its effects on Lactate clearance.Methods 60 patients of acute carbon monoxide poisoning who received therapy from February 2011 to February 2016 in our hospital were selected as research objects.All accord with the diagnostic criteria of acute carbon monoxide poisoning.According to draw method,those patients were divided into the experimental group(n=30)and the control group(n=30).The two groups were given a large number of sustained oxygen,intracranial pressure,protect brain cells,promote blood circulation and improve microcirculation and other basic symptomatic treatment.The control group on the basis,was treated with hyperbaric oxygen,one times a day,a total of ten times.while the experimental group was treated with piracetam combine with hyperbaric oxygen,hyperbaric oxygen method with the control group,intravenous drip of Piracetam and Sodium Chloride Injection,each 100ml,two times a day,a total of treatment for ten days.Then abnormal ECG,creatine kinase isoenzymes(CK-MB),troponin(cTnl),lactate clearance,incidence of delayed encephalopathy,mortality,therapeutic effect of two groups were compared.Results ECG abnormal rate there was no difference between the two groups before treatment,after treatment,the abnormal rate of the experimental group was significantly lower than the control group [6.66(2/30)vs.33.33％(10/30)](P<0.05); CK-MB、cTnl、6h and 24h after treatment,Lactate clearance rate was significantly higher than control group[(15.80±2.03)％vs.(10.26±2.01)％,(20.75±3.12)％vs.(13.07±2.56)％](P<0.05);DEACMP rate and mortality was significantly lower than the control group[6.66％(2/30)vs.33.33％(10/30),3.33％(1/30)vs.30.00％(9/30)](P<0.05); The total effective rate was significantly higher than the control group[95.56％(28/30)vs.75.56％(22/30)](P<0.05).Conclusion Piracetam combine with hyperbaric oxygen is well for acute carbon monoxide poisoning,which can improve the clearance rate of lactic acid,improve hypoxia and myocardial injury,and reduce the abnormal ecg.
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Objective To explore the home nursing care experience of caregivers of patients withdelayed encephalophathy after acute carbon monoxide poisoning. Methods Using qualitative analysis method proposed by Miles and Hurberman, authors analyzednursing experience of the caregivers, by semi-structured interview with 14 caregivers to understand the trajectory of their nursing care at home. Results Semi-structured interviews found that patients with delayed encephalophathy after acute carbon monoxide poisoning have experienced four main themes, including role conflicts, care load, lack of support and social isolation. Discussions Clinical professionals know home nursing care experience of caregivers, and their physical and mental reactions, and care requirements, etc., so that establishing one personalized care program at the time of its admission, reasonable arranging for their daily life after discharge, and straining their psychological adjustment skills.
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Objective To investigate the therapeutic effect of oxiracetam combined with dexamethasone for treatment of patients with severe acute carbon monoxide poisoning (ACOP).Methods Eighty-seven patients with severe ACOP admitted to Affiliated Hospital of Xuzhou Medical University from January 2013 to July 2016 were enrolled, and they were divided into observation group (47 cases) and control group (30 cases) according to random number table method. The two groups were given conventional nerve nutrition, hyperbaric oxygen and symptomatic treatment, while in the observationgroup, on the basis of conventional treatment the patients received intravenous drip of dexamethasone 5 mg (with addition of normal saline 100 mL), once a day for consecutive 3 days, and intravenous drip of oxiracetam 3.0 g plus 100 mL normal saline, once a day for consecutive 7 days. The changes of mini-mental state examination (MMSE), Barthel index and Glasgow coma scale (GCS) were observed after discharge for 30 days, and the differences of the incidence of delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) and hospitalization time between the two groups were compared.Results After treatment the MMSE and GCS scores of the two groups were higher than those before treatment, and the Barthel score was lower than that before onset. After discharge for 30 days, MMSE score (26.93±2.92 vs. 24.20±6.82), GCS (14.41±1.32 vs. 13.98±2.13), Barthel (94.78±12.62 vs. 85.25±19.57) of the observation group were significantly higher than those of control group, and the incidence of DEACMP was obviously lower than that in the control group [8.5% (4/47) to 17.5% (7/40)], the differences between the two groups being statistically significant (allP 0.05).Conclusion Early combined application of oxiracetam and dexamethasone can significantly improve the cognition and self-care abilities and reduce the incidence of DEACMP in patients with severe ACOP after discharge for 30 days.
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AIM To investigate the therapeutic effects of Xingnaojing Injection (Moschus,Gardeniae Fructus,Curcumae Radix,Borneolum Syntheticum) combined with hyperbaric oxygen on patients with acute carbon monoxide (CO) poisoning.METHODS Seventy-four cases of patients with acute CO poisoning treated from Jan 2013 to Jan 2016 in emergency department of our hospital were selected and randomly assigned into two groups.Control group was treated with hyperbaric oxygen,and observation group was treated with hyperbaric oxygen combined with Xingnaojing Injection.Clinical curative effects and the effects on levels of serum C-reactive protein (CRP),alanine aminotransferase (ALT),serum creatinine (Scr) between the two groups were compared.RESULTS Recovery time and hospitalization time in the observation group were significantly shorter,delayed encephalopathy rate was significantly lower,and efficacy rate was significantly higher than those in the control group,all the differences were statistically significant (P ＜ 0.05).After the treatment,serum MDA,CRP,ALT and Scr in the two groups were significantly decreased,and SOD was significantly increased as compared with those before the treatment.These indices in the observation group were significantly better than those in the control group,all the differences were statistically significant (P ＜ 0.05).CONCLUSION Xingnaojing Injection combined with hyperbaric oxygen can scavenge oxygen free radicals,inhibit inflammatory reaction,improve clinical symptoms,reduce delayed encephalopathy occurance,protect liver and kidney function and then improve clinical efficacy in the treatment of acute CO poisoning.
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Objective To explore the association of increased cerebrospinal fluid pressure with delayed encepha?lopathy after acute carbonmonoxide poisoning. Methods One hundred twenty cases of severe acute carbon monoxide poi?soning patients were included in the present study. All patients underwent lumbar puncture for measurement of cerebro?spinal fluid pressure (mmH2O) within seven days following acute carbon monoxide poisoning. Results Thirty-eight pa?tients of total 120 patients had a delayed encephalopathy and the incident rate of delayed encephalopathy was 31.67%. In?creased cerebrospinal fluid pressure was detected in 34 cases of delayed encephalopathy patients and the abnormal rate was 89.47%. Thirty-two of 38 patients with delayed encephalopathy demonstrated improvement to varying degrees af?ter treatment:6 cases had complete recovery, 26 regained or partially regained the ability to live independently, four died and two were in coma. Cerebrospinal fluid pressure was less than 150 mmH2O in six patients who achieved full recovery, while cerebrospinal fluid pressure was great than 200 mmH2O in six patients who died or were in coma. Cerebrospinal flu?id pressure was around 150~180 mmH2O in patients who regained or partially regained the ability to live independently. Conclusion Elevated cerebrospinal fluid pressure at the early phase of carbon monoxide poisoning may have a predictive value in diagnosis and prognosis of delayed encephalopathy.
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OBJECTIVE: To observe the mouse nerve growth factor on early intervention in rats with acute carbon monoxide intoxication delayed encephalopathy control effects, and preliminarily discuss the pathogenesis of delayed encephalopathy. METHODS: Ninety-two weight only 180-230 g, male Wistar rats were randomly divided into two experimental groups (n=40), and a healthy control group (n=12), namely the CO poisoning group (COP) of the group; mouse nerve growth factor (NGF plays group); healthy controls (NC group). Experimental group was according to 150 mL·kg-1 intraperitoneal injections of CO in the preparation of animal model of acute carbon monoxide poisoning, in the control group rats were injected with equal volume of air. NGF group rats were injected within 30 min after poisoning muscle injection of mouse nerve growth factor, once a day, every time 18 μg·kg-1, total 7 days; Control group and the COP were given intramuscular isodose physiological saline. NGF group rats were treated with 18 μg·kg-1·d-1 NGF (total 7 times); NC group and COP group treated with the same dose saline. 90 min, 7 day, 14 day and 21 day groups of rats serum myelin basic protein (MBP) levels were monitored. The routine preparation of brain tissue frozen pathology slice, line HE and MBP immunohistochemical staining. Animal intelligence is assessed by Morris water maze experiment, in the 120 s in rats to determine correctly through the platform number less than 3 times DEACMP. RESULTS: All rats showed typical toxic after CO poisoning. Experimental group rats died 29, including COP death cases in the group, the model NGF group of 15, 14, mortality rates were 37.50%, 35.00% respectively. Morris water maze experiment results showed that the COP in the group 8 rats were judged to be delayed encephalopathy; model NGF group has 5 only be judged to be delayed encephalopathy; COP group rats serum MBP content increased significantly, model NGF group close to normal.Differences were obvious in poisoning after 7 days, 14 days.Pathological examination showed the COP group delayed encephalopathy rats in poisoning 90 min-21 d in hippocampus, subcortical neurons damage, such as myelin basic protein depigmentation pathological changes.The above pathological changes can be observed in each group, the COP group rats lesion severity is heavy, model NGF group was lighter. CONCLUSION: Mouse nerve growth factor can significantly reduce the incidence of delayed encephalopathy in rats, but can't reduce the mortality. Myelin basic protein (MBP) in the pathogenesis of delayed encephalopathy may play an important role.
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Objective Study of Shuxuening combined with sodium phosphocreatine on acute severe carbon monoxide poisoning with ischemia modified albumin level and its curative effect in patients. Methods 66 cases of ASCOP patients were randomly divided into routine group and treatment group, all patients were detected for myocardial enzymes, cTnI, IMA before treatment, after treatment 6 h and 3 d. Results IMA was significantly decreased before treatment, while no significant changes occurred in myocardial enzymes and cTnIn levels. After treatment for 6 h, IMA in treatment group was higher than conventional group (P 0.05). After treatment for 3d, cTnI level of normal group increased obviously compare with the treatment group (P>0.05). Myocardial enzymes, IMA restored to the normal level (P>0.05). The level of cTnI after treatment for 3 d improved compare with 6 h. Conclusion Treatment of early ASCOP patients by Shuxuening combined with sodium phosphocreatine significantly improve the recovery of myocardial injury poisoning. The level of IMA can be used as evaluation index of myocardial ischemia and drug treatment.
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Objective To investigate the circulating levels of platelet-leukocyte aggregates (PLA) in patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP).Methods The circulating levels of platelet-neutrophil aggregates (PNA) and platelet-monocyte aggregates (PMA) were quantified in 30 patients with DEACMP (DEACMP group) and 30 patients with acute carbon monoxide poisoning (ACOP group) by using flow cytometry assay,whose results were compared with those of 20 healthy subjects (controls).Results Circulating PNA and PMA levels in DEACMP group and ACOP group at acute stage were significantly higher than those in controls,respectively (P＜0.05),while no significant difference was noted between ACOP group and DEACMP group at acute stage (P＞0.05),indicating that platelets were in activation status and PLA levels raised significantly in patients with DEACMP and ACOP at acute stage.Circulating PNA and PMA levels were significantly higher in DEACMP group at acute stage than those in DEACMP group at stable stage (P＜ 0.05),suggesting that platelet activation were controlled after the illness state were stabilized in patients with DEACMP.Conclusion Platelet is involved in the pathogenesis of DEACMP and the change trend of circulating PLA levels is basically consistent with illness state.
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Objective To investigate the value of electroencephalogram (EEG) nonlinear parameters in assessing the therapeutic efficacy in patients with acute carbon monoxide poisoning (ACMP). Methods Twenty-one patients diagnosed with ACMP in our department from November 2010 to March 2011 and 21 healthy volunteers were enrolled in this study.The EEG nonlinear parameters were obtained fi om the patients for analysis on the day of admission, at 2 and 4 weeks post-treatment,respectively,including approximate entropy (ApEn),cross-approximate entropy (C-ApEn),correlation dimension (D2),point wise correlation dimension (PD2),mutual dimension (Dm),Lyapunov exponent (LE),Kolmogorov entropy (KE) and Complexity (Cx).The EEG nonlinear parameters of the patients were compared with those of the healthy volunteers. Results The mean values of D2, Cx,ApEn,C-ApEn and Dm were found to gradually increase with the duration of therapy, whereas the values of PD2,LE and KE had no association with the therapy.On the day of admission,the mean values of D2,Cx,ApEn, C-ApEn and Dm for ACMP patients were significantly different from those of the healthy volunteers (P＜0.05),but at 2 and 4 weeks post-therapy,the mean values ofLE,PD2,D2,Dm,Cx,ApEn and C-ApEn of the ACMP patients were not significantly different from those of the healthy volunteers (P＞0.05). Conclusion Since EEG nonlinear parameters (D2,DM,Cx,ApEn,C-ApEn) can objectively reflect the status of brain functional recovery in ACMP patients at an early treatment stage,they can serve as practical measures in the treatment of ACMP.
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Objective To observe the changes of brainstem auditory evoked potential (BAEP) and lower limb short latency somatosensory evoked potential ( SLSEP) in acute carbon monoxide poisoning patients and explore the predictive value of BAEP and SLSEP for delayed encephalopathy after acute carbon monoxide poisoning (DEACMP). Methods Sixty-six acute CO poisoning patients was divided into a DEACMP group and a non-DEACMP group according to their symptoms. At the same time, 60 healthy subjects were included in the control group. BAEP and lower limb SLSEP dynamic testing were conducted at different time points. Results The abnormal rates in the first test of BAEP and lower limb SLSEP in the acute CO poisoning patients were 31.8% and 68.2% respectively.The BAEP results in the acute stage and later in the DEACMP group were comparable to those of the non-DEACMP group and the normal control group. Interpeak latency of Ⅰ-Ⅲ was not significantly different, but the remaining indices were significantly longer. Compared to the control group, the lower limb SLSEP readings in the acute DEACMP group and the non-DEACMP group were significantly longer. Compared to the non-DEACMP group and the control group, the SLSEP results of the DEACMP group were significantly extended. The specificity index of the BAEP predicted DEACMP up to 85.7% , significantly more than SLSEP testing. Conclusions Early detection of BAEP can help predict DEACMP. This finding should be promulgated and applied.
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Objective To study the efficacy of hyperbaric oxygen(HO)for the delayed encephalopathy after acute carbon monoxide poisoning(DEACMP)Method One hundred and eleven patients who were diagnozed as the DEACMP from November 2000 to March 2007 in Tangdu Hospital the Fourth Military Medical University were randomly divided into two groups.Thirty-six cases were treated by onventional approach(group A),and 76 cases by HO besides conventional treatment(group B).The efficacy of HO was evaluated after 4courses of treatment. The curative effects were evaluated as(1)cured:clinical symptoms and signs fully disappeared,abnormal electroencephalogram recovered,patients were completely self-help and competent enough for routine work.(2)improved:chnical symptoms and signs partly disappeared,abnormal electroencephalogram partly recovered,patients were partial self-help and incompetent enough for routine work.(3)inefficacy:patient's condition didn't changed.Data were expressed as((x)±s)and analyzed with the chi-quare test and t-test.The statistical significance was established as P＜0.05.Results In group B,62(81.58%)were in good recover,9(11.84%)improved and 5(6.94%)were inefficacy;while in group A:21(58.33%)were in good recover,5(13.89%)were improved and 10(27.78%)were inefficacy.The effciency rate in group B was significantly higher(93.42%)than that(72.22%)in group A(P＜0.05),and the required time for the therapeutic effect noticed time in group B were significantly shorter(P＜0.05)Conclusions HO Can improve the therapeutic effects on DEACMP
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Objective To investigate the effect of xenon intervention on delayed neuropsychologic sequelae (DNS)in acute carbon monoxide(CO)poisoning.Method Adult Wistar rats were randomly divided into sustained group,early intervention group,and control group.CO(150 ml/kg)was infused by intraperitoneal injection to produce DNS model.In sustained intervention group(S-group),xenon(150 ml/kg/d)was infilsed by intraperitoneal injection for 2 weeks;in control group(C-group),xenon was replaced by equal volume air;and in early intervention group(E-tvoup),xenon(150 ml/kg/d)was,employed in the first 3 days and air(150 ml/kg/d)was substituted for xenon in the following days until 2 weeks after CO poisoning.Morris maze test was used to evaluate the intelligence of rats.The long-term potentiation(LTP)of hippocampus Was detected by neuroelectricity recording.The apoptosis rates in brain was detected by TUNEL staining.The data were expressed as(x±s)and analyzed with student's test and analysis of variance.A P value less than 0.05 indicated statisfical significance.Results After exposure to CO,poisoned rats showed intelligence decline,demyeliation ofwater matler and cell apoptosis increased,which were consistent with DNS.In S-group and E-group,the rates of DNS and apoptosis were significantly lower than those in C-group,whereas the rote of LTP in S-group and E-group Was significantly higher than those in C-group.Conclusions Early xenon intervention can effectively decrease the rates of DNS occurred after acute CO poisoning.