急性一氧化碳中毒迟发脑病危险因素分析及高压氧疗效评价  

Analysis of risk factors for delayed encephalopathy with acute carbon monoxide poisoning and evaluation of the efficacy of hyperbaric oxygen therapy

作　　者：张丽娜[1,2] 姚斐 张璐 萧欣 赵云 吴镝 Zhang Lina;Yao Fei;Zhang Lu;Xiao Xin;Zhao Yun;Wu Di(Department of Special Medicine,School of Basic Medicine,Qingdao University,Qingdao 266071,China;Department of Clinical Laboratory and Pathology,Laoshan Medical District,No.971 Hospital of Navuy,Qingdao 266102,China;Department of Military and Special Medicine,No.971 Hospital of Navy,Qingdao 266071,China)

机构地区：[1]青岛大学基础医学院特种医学系,青岛266071 [2]海军第九七一医院崂山医疗区检验病理科,青岛266102 [3]海军第九七一医院军事医学与特种学科,青岛266071

出　　处：《中华航海医学与高气压医学杂志》2025年第2期185-189,共5页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的:分析急性一氧化碳(CO)中毒患者发生迟发脑病(DE)的危险因素,评估不同假愈期及治疗时间窗对HBO治疗效果的影响。方法:回顾性分析2016年11月至2020年11月海军第九七一医院军事医学与特种学科(高压氧科)收治的203例急性CO中毒患者资料,其中DE组109例、非DE组94例,分析2组患者CO暴露后发生昏迷、昏迷时间>4 h、MRI异常的比例以及首诊时格拉斯哥昏迷评分(GCS)和HBO治疗时间窗。根据假愈期时间(21 d)和是否CO暴露24 h内接受HBO治疗对47例DE随访组患者进行分组,比较不同组别患者的治疗效果、简易智力精神状态检查量表(MMSE)和巴瑟尔指数(BI)得分。结果:DE组患者CO暴露后发生昏迷(99.08%)、昏迷时间>4 h(77.98%)、MRI异常(99.08%)的比例高于非DE组(53.19%、21.28%、37.23%),GCS[(5.98±2.61)分]低于非DE组[(7.56±1.62)分]、HBO治疗时间窗[14.0(6.5,24.0)h]长于非DE组[5.0(3.0,8.0)h],差异均有统计学意义(均P<0.01);与假愈期天数≤21 d的DE患者相比,假愈期天数>21 d的DE患者确诊前[60(20,65)分]、确诊后1、2、3个月时BI评分[(64.50±22.35)、(75.50±20.96)、(87.00±22.50)分]明显升高,确诊后1、2、3个月时MMSE评分[(13.25±5.46)、(17.45±6.96)、(21.95±7.23)分]明显升高,差异均具有统计学意义(P<0.01或P<0.05);CO暴露24 h内与24 h后接受HBO治疗的DE患者治疗效果及BI、MMSE评分差异均无统计学意义(均P>0.05)。结论:急性CO中毒患者在CO暴露后发生昏迷、昏迷时间>4 h、MRI异常、GCS较低及HBO治疗时间窗较长是DE发病的危险因素,且假愈期越长的患者HBO治疗的预后越好,而将24 h作为治疗时间窗观察HBO疗效的意义不大。Objective:To analyze the risk factors for delayed encephalopathy(DE)in patients with acute carbon monoxide(CO)poisoning,and to evaluate influence of different latent periods and treatment time-windows on the therapeutic effect of hyperbaric oxygen(HBO)therapy.Methods:A retrospective statistical analysis was conducted on the medical records of the 203 patients with acute CO poisoning admitted and treated at the Department of Military and Special Medicine(Department of HBO)of No.971 Hospital of Navy from November 2016 to November 2020.Among them,there were 109 cases in the DE group and 94 cases in the non-DE group.The following data were collected and analyzed:the proportions of coma after CO exposure,coma time>4 hours,abnormal MRI results ratios,the Glasgow coma scale(GCS)score at the first diagnosis,and the HBO treatment time-window.According to the latent period time(21 days)and whether receiving HBO therapy within 24 hours of CO exposure,47 patients in the DE group were further included into the DE follow-up group.The treatment effects,mini-mental state examination(MMSE)scores and Barthel index(BI)scores of patients in different groups were compared.Results:In the DE group,the proportions of patients with coma(99.08%),coma time>4 hours(77.98%),and abnormal MRI(99.08%)after CO exposure were higher than those in the non-DE group(53.19%,21.28%,and 37.23%);the GCS score[(5.98±2.61)points]was lower than that in the non-DE group[(7.56±1.62)points];and the HBO treatment time-window[14.0(6.5,24.0)hours]was longer than that in the non-DE group[5.0(3.0,8.0)hours].The differences were all statistically significant(all P<0.01).Compared with the DE patients with a latent period within 21 days,the DE patients with a latent period over 21 days had significantly higher BI scores before diagnosis[60(20,65)points]and at different periods after diagnosis[(64.50±22.35),(75.50±20.96),(87.00±22.50)points],and had significantly higher MMSE scores at 1,2,and 3 months after diagnosis[(13.25±5.46),(17.45±6.96)and(21.95±7.23)poin

关 键 词：急性一氧化碳中毒 迟发脑病 危险因素 高压氧 

分 类 号：R74[医药卫生—神经病学与精神病学]