Du Y R, Du Y X, Wang P, Wang W Z
Department of Rehabilitation Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui 053000, China.
Emergency Department, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui 053000, China.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2023 Jan 20;41(1):39-43. doi: 10.3760/cma.j.cn121094-20211027-00522.
To observe the effects of transcranial direct current stimulation (tDCS) on nerve injury markers and prognosis in patients with acute severe carbon monoxide poisoning (ASCOP) . In May 2021, 103 ASCOP patients were treated in the emergency department of Harrison International Peace Hospital of Hebei Medical University from November 2020 to January 2021. The patients were divided into two groups according to whether they received tDCS treatment. The control group (50 cases) were given oxygen therapy (hyperbaric oxygen and oxygen inhalation) , reducing cranial pressure, improving brain circulation and cell metabolism, removing oxygen free radicals and symptomatic support, and the observation group (53 cases) was treated with 2 weeks of tDCS intensive treatment on the basis of conventional treatment. All patients underwent at least 24 h bispectral index (BIS) monitoring, BIS value was recorded at the hour and the 24 h mean value was calculated. Neuron-specific enolase (NSE) and serum S100B calcium-binding protein (S100B) were detected after admission, 3 d, 7 d and discharge. Follow-up for 60 days, the incidence and time of onset of delayed encephalopathy (DEACMP) with acute carbon monoxide poisoning in the two groups were recorded. The NSE and S100B proteins of ASCOP patients were significantly increased at admission, but there was no significant difference between the two groups (=0.711, 0.326) . The NSE and S100B proteins were further increased at 3 and 7 days after admission. The increase in the observation group was slower than that in the control group, and the difference was statistically significant ((3 d)=0.045, 0.032, (7 d)=0.021, 0.000) ; After 14 days, it gradually decreased, but the observation group decreased rapidly compared with the control group, with a statistically significant difference (=0.009, 0.025) . The 60 day follow-up results showed that the incidence of DEACMP in the observation group was 18.87% (10/53) , compared with 38.00% (19/50) in the control group (=0.048) ; The time of DEACMP in the observation group[ (16.79±5.28) d] was later than that in the control group[ (22.30±5.42) d], and the difference was statistically significant (=0.013) . The early administration of tDCS in ASCOP patients can prevent the production of NSE and S100B proteins, which are markers of nerve damage. and can improve the incidence and time of DEACMP.
观察经颅直流电刺激（tDCS）对急性重度一氧化碳中毒（ASCOP）患者神经损伤标志物及预后的影响。2020年11月至2021年1月，河北医科大学附属哈励逊国际和平医院急诊科收治103例ASCOP患者。根据是否接受tDCS治疗将患者分为两组。对照组（50例）给予氧疗（高压氧及吸氧）、降低颅内压、改善脑循环及细胞代谢、清除氧自由基及对症支持治疗，观察组（53例）在常规治疗基础上给予2周的tDCS强化治疗。所有患者均接受至少24小时的脑电双频指数（BIS）监测，记录每小时的BIS值并计算24小时平均值。入院时、入院后3天、7天及出院时检测神经元特异性烯醇化酶（NSE）和血清S100B钙结合蛋白（S100B）。随访60天，记录两组急性一氧化碳中毒后迟发性脑病（DEACMP）的发生率及发病时间。ASCOP患者入院时NSE和S100B蛋白显著升高，但两组间差异无统计学意义（P = 0.711，0.326）。入院后3天和7天NSE和S100B蛋白进一步升高。观察组升高幅度低于对照组，差异有统计学意义（（3天）P = 0.045，0.032，（7天）P = 0.021，0.000）；14天后逐渐下降，但观察组下降速度较对照组快，差异有统计学意义（P = 0.009，0.025）。60天随访结果显示，观察组DEACMP发生率为18.87%（10/53），对照组为38.00%（19/50），差异有统计学意义（P = 0.048）；观察组DEACMP发病时间[（16.79±5.28）天]晚于对照组[（22.30±5.42）天]，差异有统计学意义（P = 0.013）。ASCOP患者早期给予tDCS可预防神经损伤标志物NSE和S100B蛋白的产生，并可改善DEACMP的发生率及发病时间。
