Clinical value of Kinnado on delayed encephalopathy after carbon monoxide poisoning

Objective To investigate the effects of Ginaton ( a Chinese herbal preparation from the folium of Ginkgo biloba L. extracted) on delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) as well as on the early diagnosis criteria. Methods A total of 598 patients with acute carbon monoxide poisoning (ACOP) were selected, and lactate clearance test was carried out at 6 hours after ACOP. Patients were divided into two groups as per the results of lactate clearance test, namely high rate group (> 10%) and low rate group (less than or equal to 10 percent). Arterial blood samples were taken in all patients without oxygen inhalation therapy for determination of lactate levels before and 6 h, 24 hours after treatment. Thus the lactate clearance rate could be calculated. At the same time, 3 mL of venous blood was taken for detecting cTnI, Copeptin and BNP. Of them, 186 DEACMP patients were randomly divided into 3 groups by the random number table method. The patients of group A were treated with hyperbaric oxygen, mannitol, citicoline, and neurocyte nutrition. The patients of group B were treated with large dosage of citicoline 3.0 g. The patients of group C were treated with large dose of citicoline 3.0 g combined with Ginaton 70 mg by intravenous drip. After treatment for 7 days, and the blood levels of BNP (brain natriuretic peptide), MDA (malondialdehyde), LPA (lysophosphatidic acid) and AP (acid phosphatase) were detected and compared between two groups of patients with DEACMP for estimating the therapeutic efficacy. Results There were significant differences in the rate of lactate clearance at 6 hours after treatment, length of CO exposure time, length of coma time, initial blood lactate, and Copeptin levels between low lactate clearance rate (LR) group and high lactate clearance rate (HR) group. There was difference in Copeptin between 24 h (2.52±0.58) and 6 h (7.31±0.95) in HR group.In the LR group, the Copeptin level at 24 hours was (13.08±1.96) and at 6 hours was (2.65±0.57) which was significantly lower than that in HR group (P 0.05). After treatment, the levels of AP, LPA, MDA and BNP were significantly decreased, and the differences were statistically significant. After treatment for 7days, the levels of BNP (409.48±25.84), MDA (3.05±0.37), LPA (2.05±0.18), AP (3.23±0.18) in C group were significantly lower than those in A group (519.83±28.25), (6.28±0.79), (3.14±0.11), (3.67±0.16) respectively, and B group(454.51±24.80), (5.41±0.42), (2.66±0.14), (3.46±0.21) respectively , and those in B group were significantly lower than those in A group (P<0.05). Conclusions Ginaton has significant effects on early diagnosis criteria of DEACMP and on BNP, MDA, LPA, AP levels after treatment, providing important basis for clinical treatment. Key words: Acute carbon monoxide poisoning; Delayed encephalopathy; Lactate clearance rate; Peptide hormone; Brain natriuretic peptide; Kinnado