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目的 探讨丹参川芎嗪注射液联合神经节苷脂对急性重度一氧化碳中毒(ASCOP)患者的疗效.方法 选取2011年1月-2015年3月该院ASCOP患者329例,随机分成对照组(A组)、丹参川芎嗪注射液组(B组)、神经节苷脂组(C组)和丹参川芎嗪注射液联合神经节苷脂治疗组(D组),A组给予高压氧、防治脑水肿及促进脑细胞代谢等治疗;B组在常规治疗基础上加用丹参川芎嗪注射液;C组在常规治疗基础上加用神经节苷脂;D组在常规治疗基础上加用丹参川芎嗪注射液和神经节苷脂联合治疗.4组均2周为1个疗程.所有患者均于治疗前及治疗后6、24和72 h在不吸氧条件下取1 ml动脉血,检测动脉血乳酸,同时计算LCR.比较4组患者的初始血乳酸水平及6、24和72 h LCR.观察4组患者急性生理学和慢性健康状况Ⅱ(APACHE Ⅱ)评分、治疗2周后的临床症状改善情况、急性一氧化碳中毒迟发性脑病的发生率及病死率.结果 D组的总有效率高于A、B、C组,差异有统计学意义;4组患者入院时乳酸水平和APACHE Ⅱ评分比较差异无统计学意义;治疗后D组患者6和24h LCR明显高于A、B、C组;B组与A组、C组与A组比较,差异有统计学意义(P＜0.05),B组与C组比较差异无统计学意义(P＞0.05);治疗后D组患者6、24和72 h急性生理学和APACHE状况Ⅱ评分低于A、B、C组,B组与A组、C组与A组比较,差异有统计学意义(P＜0.05),B组与C组比较差异无统计学意义(P＞0.05);治疗72h后4组的LCR比较差异无统计学意义(P＞0.05);治疗后D组患者急性一氧化碳中毒迟发性脑病的发生率和患者病死率低于A、B、C组,B组与A组、C组与A组、B组与C组比较差异无统计学意义(P＞0.05).结论 丹参川芎嗪联合神经节苷脂治疗ASCOP患者能有效地提高LCR,降低急性生理学和APACHE Ⅱ评分,减少急性一氧化碳中毒迟发性脑病的发生率和病死率,改善患者预后,临床疗效显著,值得推广应用.“,”Objective To observe effects of Danshen Chuanxiongqin injection combined with Ganglioside on lactate clearance rate (LCR) and prognosis in patients with acute severe carbon monoxide poisoning (ASCOP).Methods A total of 329 patients with ASCOP treated in our hospital from Jan.2011 to Mar.2015 were randomly divided into control group (group A),Danshen Chuanxiongqin injection group (group B),Ganglioside group (group C) and Danshen Chuanxiongqin injection combined with Ganglioside group (group D).The group A received routine treatment of hyperbaric oxygen,prevention and treatment of cerebral edema and promoting the metabolism of brain cells;the group B was given Danshen Chuanxiongqin injection based on the routine treatment;the group C was given Ganglioside based on the routine treatment;the group D was given Danshen Chuanxiongqin injection combined with Ganglioside based on the routine treatment;2 weeks for one therapeutic course.Arterial blood (1 ml) was collected from all the patients at ambient air before and 6,24 and 72 hours after treatment,arterial blood lactic acid (Lac) was determined,and LCR was calculated.The initial level of blood lactic acid and LCR at 6,24 and 72 hours after treatment were compared among the 4 groups.The changes of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores,the incidence of delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) and the mortality rate were observed in all the groups.Results Total effective rate of the group D was significantly higher than that of the groups A,B and C (P＜ 0.05).In admission,there were no differences in the level of arterial blood Lac or APACHE Ⅱ scores among the four groups (P＞ 0.05).The LCR at 6 and 24 hours after treatment in the group D were significantly higher than that of the groups A,B and C (P ＜ 0.05),and there was significant difference between the group B and the group A,the group C and the group A (P＜ 0.05),but there was no statistical difference between the group B and the group C (P＞ 0.05).The APACHE Ⅱ scores at 6,24 and 72 hours after treatment in the group D were lower than those of the groups A,B and C (P＜ 0.05),and there was significant difference between the group B and the group A,the group C and the group A (P＜ 0.05),and there was no statistical difference between the group B and the group C (P＞ 0.05).There were no statistical differences in LCR at 72 hours after treatment among the 4 groups (P ＞ 0.05).The occurrence of DEACMP and the mortality rate after treatment in the group D were lower than those of the groups A,B and C (P ＜ 0.05),but there were no statistical differences among the groups A,B and C (P＞ 0.05).Conclusions Early treatment of Danshen Chuanxiongqin injection combined with Ganglioside in ASCOP patients could effectively elevate LCR,reduce the APACHE Ⅱ scores,decrease the occurrence of DEACMP and the mortality rate,thus improve the prognosis.The clinical curative effect is distinct,and it is worthy of clinical popularizing and application.