重度急性一氧化碳中毒迟发性脑病的临床特点及危险因素  

Clinical characteristics and risk factors of severe delayed encephalopathy after acute carbon monoxide poisoning

作　　者：朱婉秋[1] 张奕[1] 高宇[1] 刘雪华[1] 梁芳[1] 李茁[1] 杨琳[1] 侯晓敏[1] 马琳琳[1] 张静 杨璐 南丁 杨晶[1] Zhu Wanqiu;Zhang Yi;Gao Yu;Liu Xuehua;Liang Fang;Li Zhuo;Yang Lin;Hou Xiaomin;Ma Linlin;Zhang Jing;Yang Lu;Nan Ding;Yang Jing(Department of Hyperbaric oxygen,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院高压氧科,北京100020

出　　处：《中华航海医学与高气压医学杂志》2021年第3期309-314,共6页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的分析重度急性一氧化碳中毒迟发性脑病(s-DEACMP)的临床特点,探讨其发生的危险因素。方法回顾性分析2017年1月1日至2020年12月31日首都医科大学附属北京朝阳医院高压氧(HBO)科收治的急性一氧化碳中毒(ACMP)患者170例,根据是否并发迟发性脑病分为DEACMP组与非DEACMP(n-DEACMP)组;并采用DEACMP疾病过程中最重时的日常生活能力评分对DEACMP患者进行分级,总分≤60分为s-DEACMP组,总分>60分为轻中度急性一氧化碳中毒迟发性脑病(m-DEACMP)组。比较患者的临床特点,分析s-DEACMP发生的危险因素。结果s-DEACMP患者70例,m-DEACMP患者49例,n-DEACMP患者51例。与n-DEACMP组患者相比,s-DEACMP组患者年龄大(平均年龄59.0岁vs.49.0岁,P=0.005),年龄>40岁的比例高(97.1%vs.66.7%,P<0.001);ACMP入院时格拉斯哥昏迷评分(GCS)较低[(4.0±3.0)分vs.(6.0±5.0)分,P=0.024];ACMP意识障碍时间长[(32.0±31.8)h vs.(20.5±26.4)h,P=0.017],意识障碍>48 h的患者比例高(24.3%vs.9.8%,P=0.041);ACMP接受高压氧治疗的患者比例低(70.0%vs.86.3%,P=0.036);高血压患者比例高(38.6%vs.17.6%,P=0.013),高同型半胱氨酸血症患者比例高(40.0%vs.19.6%,P=0.017),吸烟指数>400的患者比例高(24.3%vs.9.8%,P=0.041)。与m-DEACMP组患者相比,s-DEACMP组患者中高同型半胱氨酸血症的比例高(40.0%vs.20.4%,P=0.024)。多因素Logistic回归显示年龄>40岁、意识障碍>48 h、高血压和高同型半胱氨酸血症是s-DEACMP发生的独立危险因素(P<0.05)。结论s-DEACMP患者具有年龄大、意识障碍程度深且时间长、早期接受HBO治疗比例低、高血压、高同型半胱氨酸血症、吸烟指数>400的临床特点,其中年龄>40岁、意识障碍>48 h、高血压是独立危险因素,值得注意的是,高同型半胱氨酸血症也是s-DEACMP的独立危险因素。Objective To explore the clinical characteristics and risk factors of the severe delayed encephalopathy after acute carbon monoxide poisoning(s-DEACMP).Methods A retrospective analysis of 170 acute carbon monoxide poisoning(ACMP)patients treated in the Hyperbaric Oxygen(HBO)Department of Beijing Chao-yang Hospital,Capital Medical University from January 1st,2017 to December 31st,2020 was conducted.According to the occurrence of delayed encephalopathy,the ACMP patients were divided into DEACMP group and non-DEACMP(n-DEACMP)group.The DEACMP patients were stratified by the activities of daily living scale when they were most severely ill.The patients with total score≤60 were classified as s-DEACMP and the patients with total score>60 were classified as mild to moderate DEACMP(m-DEACMP).Their clinical characteristics were compared and the risk factors of s-DEACMP were analyzed.Results There were 70 s-DEACMP patients,49 m-DEACMP patients,and 51 n-DEACMP patients.Compared with the n-DEACMP group,the s-DEACMP group was older(average age:59.0 vs.49.0,P=0.005),had a higher proportion of patients over 40 years old(97.1%vs.66.7%,P<0.001),lower Glasgow coma scale scores[(4.0±3.0)vs.(6.0±5.0),P=0.024]on admission to the hospital,longer consciousness disturbance[(32.0±31.8)h vs.(20.5±26.4)h,P=0.017],a higher proportion of patients with consciousness disturbance over 48 hours(24.3%vs.9.8%,P=0.041),a lower proportion of patients receiving HBO therapy(70.0%vs.86.3%,P=0.036),a higher proportion of patients with hypertension(38.6%vs.17.6%,P=0.013),a higher proportion of patients with hyperhomocysteinemia(40.0%vs.19.6%,P=0.017),and a higher proportion of patients with smoking index over 400(24.3%vs.9.8%,P=0.041).Compared with the m-DEACMP group,the s-DEACMP group had a higher proportion of patients with hyperhomocysteinemia(40.0%vs.20.4%,P=0.024).Multivariate Logistic regression showed that age over 40 years old,consciousness disturbance over 48 hours,hypertension,and hyperhomocysteinemia were independent risk factors of s-DEA

关 键 词：急性一氧化碳中毒 迟发性脑病 高压氧 临床特点 危险因素 

分 类 号：R595.1[医药卫生—内科学] R747.9[医药卫生—临床医学]