Efficacy and mechanism of ulinastatin in the treatment of severe acute carbon monoxide poisoning brain injury
Objective To investigate the clinical effect and mechanism of ulinastatin(UTI)in the treatment of severe acute carbon monoxide poisoning(ASCMP).Methods 210 patients with ASCMP admitted to our hospital from February 2020 to February 2023 were selected and divided into the conventional group(90 cases)and the observation group(120 cases)according to different treatment regimens.Observation group was given UTI injection 300,000 units+5％glucose injection 100 ml intravenously,once 8·h-1,for 14 days.Endothelin-1(ET-1),polyligand proteoglycan-1(SDC-1),hyaluronic acid(HA),thrombomodulin(TM),S100 calc-binding protein β(S100 β),neuron-specific enolase(NSE)and BIS were detected before treatment,5 and 14 days after treatment,respectively.National Institutes of Health Stroke Scale(NIHSS)scores and Montreal Cognitive Assessment Scale(MoCA)scores were recorded.Results After treatment,the total effective rate of observation group was higher than that of conventional group,and the difference was statistically significant(x2=4.269,P=0.033).The coma time in the observation group was shorter than that in the conventional group,and the average hospitalization days were reduced,the difference was statistically significant(P＜0.05).Before treatment,the scores of SCD-1,HA,TM,ET-1,S100 β,NSE and NIHSS were increased,while the scores of BIS and MoCA were decreased between the conventional and observation groups,and there was no statistical difference between the two groups(P＞0.05).5 days after treatment,the scores of SCD-1,HA,TM,ET-1,S100β,NSE and NIHSS were lower than before treatment,and the scores of BIS and MoCA were higher than before treatment.14 days after treatment,the scores of SCD-1,HA,TM,ET-1,S100 β,NSE and NIHSS were lower than 5 days after treatment.BIS score and MoCA score were higher than 5 d after treatment,and the improvement of each detection index in the observation group was better than that in the conventional group,with statistical significance(P＜0.01).Logistic stepwise regression showed that ASCMP patients with increased SCD-1 and HA and decreased BIS had increased risk factors for PNS.Conclusion UTI reduces blood-brainspinal fluid barrier(BCFB)permeability,reduces S100 βand NSE,increases BIS,promotes recovery of nerve function injury,and reduces PNS by improving vascular endothelial function and alleviating glycocalyces shedding.
Acute severe carbon monoxide poisoningBrain injuryUlinastatinTreatment
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