Clinical value of ganglioside combined with nalmefene on delayed encephalopathy after carbon monoxide poisoning

Abstract

Objective To observe the effects of ganglioside combined with nalmefene on patients with delayed encephalopathy after carbon monoxide poisoning (DEACMP). Methods A total of 128 patients with DEACMP treated in Emergency Department from January 2012 to March 2016 were randomly divided into control group and therapy group. The control group were treated with routine treatments of ganglioside 0.1 g intramuscular injection, hyperbaric oxygen, prevention and treatment of cerebral edema and enhancement of brain cell metabolism, and the therapy group were treated with nalmefene 0.3 mg intravenous injection in addition to routine treatment. After observation for two weeks, 10 mL of venous blood were collected to detect malonyldialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-PX), nitric oxide (NO) and nitric oxide synthase (NOS), as well as the changes of mini-mental state examination (MMSE) were observed. T test was used to compare MMSE score, MDA, NO levels and the changes in SOD, GSH-PX and NOS activity between two groups and, the clinical efficacy of treatment was compared between prior and after treatment of two groups with chi square test. Results The total effective rate of therapy group was 84.4%, and the total effective rate of control group was 68.8%. (χ2=4.354, P=0.037). Before treatment, there were no difference in the MMSE score and plasma levels of MDA, NO, SOD, GSH-PX and NOS between two groups (P>0.05). The plasma levels of MDA, NO and NOS after treatment in control group were (4.39±1.01)μmol/L, (60.28±9.68)μmol/L, (21.46±5.53)U/mL, respectively, and those in therapy group were (3.37±0.83)μmol/L, (55.29±9.57)μmol/L, and (18.71±4.40)U/mL, respectively, which were significantly lower than those before treatment [control group(5.54±0.96)μmol/L, (68.42±12.71)μmol/L, (29.75±6.79)U/mL; therapy group: (5.48±1.16)μmol/L, (69.46±16.37)μmol/L, (30.42±7.39)U/mL] (P<0.05), and those in the treatment group was lower than those in control group (P<0.05). The MMSE and plasma levels of SOD and GSH-PX after treatment in control group were (18.30±5.91), (81.66±10.75)U/mL, (60.58±9.69)U/L, respectively, and those in therapy group were (23.85±7.21), (96.41±9.64)U/mL, (73.22±9.95)U/L, respectively which were significantly increased compared with those before treatment [control group: (8.93±2.49), (69.58±8.05)U/mL, (49.35±6.71)U/L; therapy group: (9.14±2.85), (70.41±7.30)U/mL, (48.40±7.89)U/L] (P<0.05), and the changes in therapy group were higher than those in control group (P<0.05). Conclusion Ganglioside combined with nalmefene used for the treatment of DEACMP patients in addition to the conventional treatment could effectively reduce the levels of MDA, NO and NOS, enhance the expression of SOD and GSH-PX, and improve the recovery of neurological function. The clinically therapeutic efficacy of this treatment is noticeable thus providing important evidence for clinical practice. Key words: Acute carbon monoxide poisoning; Delayed encephalopathy; Ganglioside; Nalmefene; Oxidative stress; Nitric oxide synthase