中-重度急性一氧化碳中毒患者急诊预后评估的研究  

Risk Assessment for Moderate to Severe Acute Carbon Monoxide Poisoning Prognosis under Emergence Circumstances

作　　者：杜宇[1] 牟奕[2] 刘莉[3] 刘津 

机构地区：[1]四川大学华西第四医院急诊科,四川成都610041 [2]四川大学华西医院麻醉研究室 [3]四川省卫生厅医政处 [4]四川省妇幼保健医院

出　　处：《现代预防医学》2012年第20期5452-5455,共4页Modern Preventive Medicine

摘　　要：目的寻找急诊科短期内评估中重度急性一氧化碳中毒发生死亡和迟发性脑病不良预后的危险因素。方法回顾某院2000年1月～2009年12月间收治的91例中重度急性一氧化碳中毒并接受高压氧治疗患者的急诊接诊评估参数,并随访其预后恢复情况。按病程是否进展为死亡或并发迟发性脑病分为预后良好组(A组)和预后不良组(B组),分析影响预后的危险因子。结果与预后不良高度相关的急诊评估参数中"中毒时间、昏迷时间、GCS≤5、典型脑CT改变、代谢性酸中毒、BUN、心肌酶学、cTnI、缺血性心电图改变、心肌损伤、开始HBO时间以及是否使用过机械通气"等指标均对中重度急性CO中毒患者预后有一定影响。多因素分析发现,心肌损伤和昏迷时间两项指标是短期内预测中重度急性CO中毒患者预后的危险因子,其中心肌损伤危险系数更高(OR=20.670,CI3.198～133.618,P=0.001)。结论是否存在心肌损伤和具有较长的昏迷时间是急诊接诊时评估中重度急性一氧化碳中毒患者可能发生不良预后的客观预测指标。OBJECTIVE To find immediate prognosis indicators for the delayed encephalopathy and death of moderate to severe acute carbon monoxide poisoning （ACOP） in emergency department. METHODS Retrospective analysis was conducted in 91 cases with hyperbaric oxygen-treated from Jan 2000 to Dec 2009, which were divided into good （A） or bad （B） prognosis group based on presence of death or delayed encephalopathy. We analyzed the prognostic risk factors by statistical analysis. RE SULTS Among these potential susceptible factors, poisoning time, coma time, GCS ~〈5, typical lesions on brain CT, metabolic acidosis, BUN, myocardial enzymes, troponin-I, ischemic ECG change, myocardial injury, and time from ED arrival to HBO treatment and ventilation had impact on the prognosis. By multivariate analysis, myocardial impairment and coma duration were the risk factors for ACOP, and myocaridal impairment was the high risk factor （OR = 20.670, 95%CI： 3.198 133.618, P = 0.001 ）. CONCLUSION Myocardial impairment and longer coma duration are important predictive factors for A COP in emergency department.

关 键 词：一氧化碳中毒 预后 急诊科 评估 

分 类 号：R135.1[医药卫生—劳动卫生]