To explore the effect of butylphthalide on delayed encephalopathy after carbon monoxide poisoning (DEACMP) and its effect on white matter lesions by magnetic resonance imaging (MRI).

Thirty-six DEACMP patients who met the criteria for admission were included and 21 patients were randomly enrolled into the trial group and the other 15 into the control group in multiple research centers from April 2018 to December 2019. The patients in the control group were received hyperbaric oxygen and routine treatment, and the trial group was treated with the same therapy as the control group plus the buphthalin treatment (injection and capsule) up to 90 days. Clinical data of the two groups of patients before treatment, 1 month and 3 months after the treatment were collected, including the mini-mental state examinination (MMSE), Barthel index rating scale (BI), the modified Ashworthscores, and head magnetic resonance imaging. The t-test was used forcomparing differences in MMSE scores, BI scores, and brain white matter demyelination volumes between 2 groups, rank-sum test for Ashworth scores between 2 groups, χ² test for treatment efficiency, and linear trend tests for MMSE scores, BI scores, and modified Ashworth scores at different times.

After 3 months of treatment, The MMSE and BI scores were higher in the trial group than in the control group [(24.61±5.59) score vs (15.64±10.95) score; (91.66±15.83) points vs (62.85±38.11) points], However, the modified Ashworth scores were lower than that in the control group [0.0 (0.0, 0.0) vs 1.0(0.0, 1.0)], the differences were all statistically significant (t=2.830, P=0.011; t=2.686, P=0.016; Z=3.618, P=0.004). The MMSE and BI scores increased in the trial group, while the modified Ashworth scores decreased with trend test-specific statistical significance (both P＜0.05). The volume of brain white matter demyelination in the trial group at 3 months after treatment was smaller than that at 1 month after treatment [33 518±14 273) mm³ vs (57 394±18 973) mm³], and the difference was statistically significant (P＜0.05). More Patients in the trial group were treated after 3 months than the number in the control group (95.0% vs 60.0%), and the difference was statistically significant (χ²=6.937, P=0.013).

Butylphthalide is more effective than the routine treatment in promoting the recovery of neurological function in patients with DEACMP, improving the cognitive function, self-care ability in daily life, and muscle tone. And buphthalein may promote the recovery of cerebral white matter demyelination in patients with DEACMP.