一氧化碳中毒迟发性脑病临床特征及危险因素分析  

Analysis of clinical features and risk factors for delayed encephalopathy after carbon monoxide poisoning

作　　者：潘锐[1] 唐亚梅[1] 容小明[1] 沈庆煜[2] 谢海琴[3] 李鹏亮[4] 游春林[1] 彭英[1] 

机构地区：[1]中山大学孙逸仙纪念医院神经内科1区,广州510120 [2]中山大学附属博济医院神经内科,广东增城511300 [3]中山大学附属第三医院超声科,广州510630 [4]中山大学附属第一医院显微外科,广州510080

出　　处：《中国实用内科杂志》2012年第10期787-790,共4页Chinese Journal of Practical Internal Medicine

基　　金：广东省自然科学基金(10151130001000001;S2011010004708);国家自然科学基金资助项目(30600164;81072242)

摘　　要：目的总结急性一氧化碳中毒迟发性脑病(DEACMP)的临床特点并探讨可能的危险因素。方法对中山大学附属第一、第二、第三医院自1998—2011年收治的所有一氧化碳中毒性脑病患者进行调查,共收集中毒性脑病患者58例,按是否发生迟发性脑病分为DEACMP组(17例)和非DEACMP组(41例),对两组患者的性别、年龄、既往烟酒史、高血压、糖尿病、卒中病史、急性中毒期昏迷时间、急性期COHb饱和度、急性期有否高压氧治疗进行单因素检验,对有统计学差异或有临床意义者作多因素Logistic回归分析,并采用Logistic曲线拟合急性期昏迷时间与DEACMP发病率的关系。结果 DEACMP的临床表现以痴呆最为多见,常合并震颤麻痹,其次为精神症状,舞蹈症及局灶性损害少见。脑电图以广泛慢波改变为主,头部影像学常见双侧脑白质及基底节区异常改变。急性期治愈好转后观察时间大于30 d后,DEACMP发病率明显降低。危险因素分析表明,仅急性期昏迷时间长短(OR=1.197,95%CI 1.067～1.343)及有否高压氧治疗(OR=0.160,95%C.0.033～0.776)是DEACMP发生的独立危险因素。当昏迷时间大于11 h者,迟发性脑病的发病率明显升高。结论对于一氧化碳中毒急性期昏迷时间在11 h以上者,应高度警惕DEACMP的发生,早期进行并延长高压氧治疗时间,可能减少迟发性脑病的发病率。Objective To summarize the clinical features and potential risk factors of delayed encephalopathy after acute carbon monoxide poisoning （DEACMP）. Methods We surveyed the profiles of 58 patients with carbon monoxide-poisoning encephalopathy admitted to three affiliated hospitals of Sun Yat-sen University between 1998 and 2011 and divided pa- tients to DEACMP group （n = 17） and non-DEACMP group （n = 41 ）, based on the presence of DEACMP. This was followed by univariate analysis on the age, gender, past history of smoking or alcohol drinking, history of hypertension or diabetes or stroke, duration of coma, COHb saturation and acute-phase hyperbaric oxygenation therapy. Further processing an the correlation between duration of coma and incidence rate of DEACMP was conducted via Logistic regression analysis regarding the indices with statistical difference or clinical value. Results The most common symptom of DEACMP was dementia, followed by agitans paralysis and psychiatric symptom, while chorea and focal neurological dysfunction was less clinically manifested. Electroencephalogram （EEG） was featured by extensive slow waves, and abnormal signals could be observed bi- laterally in white matter and basal ganglia region. Lower incidence rate of DEACMP was associated with prolonged observation period more than 30 days after acute poisoning. Both prolonged duration of coma（ OR = 1. 197,95% CI 1. 067 - 1. 343 ） and failure of initiating hyperbaric oxygen therapy at acute phase（ OR = 0. 160,95% CI 0. 033 -0. 776 ） were regarded as risk factors of DEACMP. Prolonged duration of coma for 〉 11 hours may result in markedly increased incidence rate of DEACMP. Conclusion Physicians should be alert to the incidence of DEACMP in patients with acute carbon monoxide poisoning who had prolonged duration of coma for 〉 11 hours, suggesting that early initiation of hyperbaric oxygen therapy may effectively reduce the incidence rate of DEACMP.

关 键 词：一氧化碳中毒 迟发性脑病 

分 类 号：R747.9[医药卫生—神经病学与精神病学]