急性一氧化碳中毒后迟发性脑病发病的危险因素分析

目的探讨急性一氧化碳中毒后迟发性脑病(DEACMP)发病的相关危险因素。方法以2001—2014年在豫北地区10家医院符合入组标准和排除标准的急性一氧化碳中毒(ACMP)752例住院患者为研究对象,收集临床资料,并随访90d以上,根据以后是否发生DEACMP分为ACMP组和DEACMP组,对所有患者的年龄、昏迷时间、昏迷程度、吸烟饮酒史等26个指标进行统计归纳,分析ACMP后患者发生DEACMP的可能危险因素。结果 752例ACMP患者中127例发生DEACMP,发生率16.9%。单因素分析结果显示,ACMP患者男性较女性更易患DEACMP,差异有统计学意义(P0.05);昏迷时间12h者DEACMP发生率明显升高,48h者58.3%发生DEACMP;中度以上昏迷、病理征阳性、丧偶、吸烟史、饮酒史、重大精神刺激等患者发生DEACMP风险大于无此类病史者,差异均有统计学意义(P0.05);ACMP急性期颅脑CT异常、并存其他疾病其DEACMP发生率较高,差异有统计学意义(P0.05)。多因素回归分析显示,性别、丧偶、头颅CT异常、昏迷程度、昏迷时间是发生DEACMP的独立危险因素。结论发生DEACMP的危险因素较多,尤其对40岁以上、男性、有丧偶史、头颅CT异常、中度昏迷以上、昏迷时间12h的ACMP患者应特别注意加强临床监测,提前采取干预措施给予病前预防性治疗。

Risk factor analysis of the delayed encephalopathy after acute carbon monoxide poisoning

Objective To investigate the associated risk factors of the delayed encephalopathy after acute carbon mon-oxide poisoning (DEACMP) .Methods Seven hundred and fifty-two cases of acute carbon monoxide poisoning (ACMP) in-patients admitted to 10 hospitals in northern Henan during 2001 -2014 who met the inclusive and exclusive criteria were re-cruited .The clinical information of each ACMP patient was collected ,and following-up for each patient was more than 90 days .Based on the occurrence of DEACMP ,the patients were divided into ACMP group and DEACMP group .The statistical induction of 26 indicators in each patient ,such as age ,coma duration ,severity of coma ,smoking & drinking ,etc .was con-ducted to analyze the possible risk factors of DEACMP in ACMP patients .Results One hundred and twenty-seven out of 752 patients demonstrated DEACMP ,the univariate analysis showed that male ACMP patients were more susceptible to DEACMP than female patients ,and the difference was statistically significant (P<0 .05) .When the coma duration was >12 h ,the inci-dence of DEACMP significantly increased ,and up to 58 .3% once the coma last for >48 h .The patients who had moderate-a-bove coma ,positive pathology ,being widowed ,history of smoking and drinking ,major mental stimulation was more suscepti-ble to DEACMP than those without above issues ,and the differences were all statistically significant (All P<0.05) .The pa-tients whose brain CT showed abnormalities at the acute stage of ACMP ,or who exhibited coexistence of other diseases were more likely to suffer from DEACMP ,the difference was statistically significant (P<0 .05) .Multivariate regression analysis showed that the gender ,history of being widowed ,abnormal brain CT ,the severity of coma ,coma duration were the inde-pendent risk factors of DEACMP .Conclusion There are multiple risk factors for DEACMP ,especially for the ACMP pa-tients who are over 40 years old ,male with a history of being widowed ,abnormal brain CT ,moderate-above coma ,coma du-ration >12 h .Additional care has to be taken for their clinical monitoring to take premorbid preventive treatment as early in-tervention to the disease .