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Objective:To observe the changes of blood systemic immune-inflammation index (SII) and monocyte to high-density lipoprotein cholesterol ratio (MHR) in patients with delayed encephalopathy after carbon monoxide poisoning (DEACMP) accepted transcranial direct current stimulation (tDCS) treatment, and to objectively evaluate the efficacy of tDCS in DEACMP.Methods:A total of 80 DEACMP patients admitted to our hospital from January 2020 to February 2022 were selected and randomly divided into observation group ( n=39) and routine group ( n=41). Conventional treatment was given to patients of both groups. On this basis, tDCS was given additionally to the observation group: the left dorsolateral prefrontal lobe was used as the positive stimulation site, and the right shoulder was used as the negative stimulation site; the treatment duration was 30 min/time, and the stimulation intensity was 1.5 mA, once per d; and sham stimulation was given to the routine group: the electrodes were stimulated with 1.5 mA current for 10 s and kept for 30 min, once per d. Patients of both groups were treated for 4 weeks. Before, and 4 weeks and 6 months after treatment, SII and MHR were detected; the electroencephalogram (EEG) results, and scores of Montreal Cognitive Assessment (MoCA) and activities of daily living (ADL) were observed. The total effective rate between the 2 groups after 4 weeks of treatment (total effective rate [%]=[number of cured cases+number of improved cases]/total number of cases×100%), and the correlations of SII and MHR before treatment with ADL scores and abnormal degree of EEG were analyzed. Results:The total effective rate in the observation group (92.3%, 30 were cured and 6 got improvement) was significantly higher than that in the routine group (73.2%, 22 were cured and 8 got improvement; χ2=5.070, P=0.024). Four weeks and 6 months after treatment, SII, MHR, abnormal rates of EEG and P300 latency in the observation group were significantly lower than those in the routine group, and the MoCA and ADL scores and P300 amplitude were statistically higher than those in the routine group ( P<0.05). Correlation analysis showed that SII and MHR before treatment were negatively correlated with ADL scores ( r=-0.805, P<0.001; r=-0.788, P<0.001); SII and MHR were positively correlated with abnormal degree of EEG ( r=0.803, P<0.001; r=0.719, P<0.001). Conclusion:The tDCS treatment can effectively reduce the inflammation levels and improve prognosis scores in DEACMP patients; SII and MHR can preliminarily evaluate the therapeutic effect of tDCS.
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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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AIM To investigate the effects of Shuxuening Injection (Ginkgo biloba extract) combined with ganglioside on cerebral oxygen utilization coefficient (O2UCc) and lactate clearance rate (LCR) in patients with acute severe carbon monoxide poisoning (ASCOP).METHODS Two hundred and sixty-two patients with ASCOP treated in emergency department of Harrison International Peace Hospital Affiliated to Hebei Medical University from Mar 2011 to Mar 2016 were randomly divided into control group,Shuxuening Injection group,ganglioside group and Shuxuening Injection combined with ganglioside (combined medication) group.The changes were detected in oxygen saturations of carotid blood and jugular blood,arterial blood lactic acid,O2UCc and LCR in all patients before and 6,24 hours,3 days after the treatment.The clinical symptoms,and the mortality and morbidity of delayed encephalopathy after acute carbon monoxide poisoning after two weeks were observed.RESULTS Total effective rate of the combined medication group was higher than that of the other groups.O2 Ucc at 6,24 hours after the treatment in the combined medication group were significantly lower than those in the other groups,so did the mortality and morbidity of delayed encephalopathy after acute carbon monoxide poisoning,but LCR was significantly higher than that in the other groups.All the differences had statistical significances.CONCLUSION The efficacy of combined medication of Shuxuening Injection and ganglioside in ASCOP patients is better than that of applying single administration separately.
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Objective To study the value of copeptin and APACHE Ⅱ used for assessing acute paraquat poisoning (APP). Methods One hundred and twenty six APP patients were divided into survival group (n = 58) and death group (n = 68), with clinical death as the endpoint of observation. 3 mL blood was obtained from each subject at 2 h , 24 h and 7 d after admission for detecting the levels of copeptin , and APACHE Ⅱ scores were recorded at the same time. Results There was significant difference in dosages of paraquat taken in the death group and the survival group , but the differences were significant in the rescue time , the first time for hemoperfusion and the times for hemoperfusion. 2 h after admission , the death group and survival group had significant difference in elevated copeptin but no significant difference in scores by APACHE Ⅱ. 24 h after admission copeptin decreased to normal level in the survival group but maintained at a higher level in the death group, while the scores by APACHE Ⅱ had insignificant difference between two groups. 7 d after admission, copeptin kept at a higher level and the scores by APACHE Ⅱwere significantly increased in the death group , with significant differences compared to the survival group. The oral doses of pesticides the patients took were positively correlated with copeptin level and scores by APACHE Ⅱ. Conclusion Repeated detection of copeptin and APACHE Ⅱ score are of clinical importance for the assessment of prognosis of APP patients and reasonable distribution of medical resources.
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Objective To investigate the clinical value of copeptin and ischemia modified albumin combined determination in the early diagnosis and clinical significance in myocardial damage of acute organic phosphorus pesticide poisoning .Methods Eighty‐six cases of AOPP patients were divided into two groups :the myocardial injury group (50 cases) and non myocardial injury group (36 cases) ;30 healthy people were selected as the control group .3 mL of venous blood were collected for all subjects involved within one hour in admission ,and their cTnI ,IMA and copeptin levels were detected .Results Compared with the control group ,the copep‐tin levels of non myocardial injury group and myocardial injury group were elevated and there was significant difference (P< 0 .05) ;the difference between myocardial injury group and non myocardial injury groups was also significantly different (P< 0 .05) .Among them ,the comparison between severe and mild to moderate group revealed that the IMA and copeptin levels reduced obviously ,there was significant difference (P< 0 .05) ;in myocardial injury group ,the IMA and copeptin levels of patients in different poisoning de‐gree were negatively correlated .Conclusion Early determination of IMA and copeptin level has important significance in the early diagnosis of myocardial injury in patients with poisoning in AOPP ,and could provide guidance for clinical medication .
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Objective To study the relationship between copeptin,ischemia modified albumin (IMA) and the degree of myocardial injury in patients with acute carbon monoxide poisoning (ACOP).Methods A total of 110 ACOP patients with different degree of poisoning were selected as poisoning group and included mild poisoning 22 cases (mild group),moderate poisoning 50 cases (moderate group),severe poisoning 38 cases (severe group),and 30 healthy subjects were selected as control group.The cardiac troponin Ⅰ (cTnⅠ),IMA,copeptin level was detected at 2 h,7 d after admission in poisoning group and at admission in control group.According to with or without complications,poisoning group was divided into complications group (26 cases) and non-complications group (84 cases).cTnⅠ,IMA,copeptin level was compared among groups.Results At 2 h after admission,IMA was decreased and copeptin was increased in mild,moderate,severe group[(62.50 ± 2.17),(59.04 ± 3.10),(56.01 ± 8.85) kU/L and (2.82 ± 0.73),(7.31 ±0.95),(13.08 ± 1.96) μg/L],there was statistical difference compared with control group [(67.23 ± 1.40) kU/L and (0.87 ±0.19) μg/L](P＜0.05),and there was significant difference between moderate group and mild group,severe group and mild group,moderate group (P ＜ 0.05);there was no statistical difference in cTnⅠ among groups.At 7 d after admission,there was no significant difference in IMA,copeptin among groups (P ＞ 0.05) ; cTnⅠ was increased in mild,moderate,severe group [(1.80 ± 0.17),(2.34 ±0.46),(2.60 ±0.54) μg/L],and there was statistical difference compared with control group [(1.27 ±0.28) μg/L] (P ＜0.05),and there was significant difference between moderate group and mild group,severe group and mild group,moderate group (P＜ 0.05).IMA,copeptin at 2 h,7 d after admission in complications group was higher than that in non-complications group [(54.62 ± 1.53) kU/L vs.(57.89 ± 4.02) kU/L,(60.65 ± 3.61) kU/L vs.(66.84 ± 1.78) kU/L and (13.88 ± 1.45) μ g/L vs.(6.99 ± 3.39) μ g/L,(6.65 ± 1.82) μ g/L vs.(2.47 ± 0.61) μ g/L](P＜ 0.05).cTnⅠ at 7 d after admission in complications group was higher than that in non-complications group [(3.10 ± 0.22) μ g/L vs.(1.87 ± 0.27) μ g/L] (P ＜ 0.05).Correlation analysis showed that copeptin was negatively correlated with IMA in patients with different degree of poisoning (r =-0.560,P ＜ 0.01).Conclusions The combined detection of IMA and copeptin has important clinical value to the early diagnosis and prognosis in evaluating the prognosis of ACOP myocardial injury.There is important guidance for early clinical drug application.