一氧化碳中毒迟发性脑病的临床研究

目的　研究CO中毒迟发性脑病 (DEACMP)的临床与影像学特征 ,及其与病程、预后的关系。方法　对 198例DEACMP患者的假愈期、临床表现、病程、预后 ,以及头部CT、MRI、SPECT所见进行对比分析。结果　本组病例中 ,30d内病情开始好转者占 6 0 .1%,31～ 6 0d者占 2 3.7%,>6 0d者占 14.6 %,总临床治愈率为 32 .8%,有效率为 70 .1%;依据影像学所见 ,脑损害部位为双侧基底节者占 15 .2 %,皮质下白质损害者为 70 .0 %,两种损害同时存在者为 12 .6 %,无异常改变者 2 .1%;其发病至病情好转分别为 (4 4.6± 10 .1)、(38.2± 11.9)、(6 1.3± 17.0 )、(7.5± 2 .4)d。影像学所见能反映脑损害程度 ,但与临床改善不平行 ,SPECT更能反映病情改善情况。结论　DEACMP与缺血性脑损害有关 ,其病程具有显著的自限性。

A clinical study on delayed encephalopathy after carbon monoxide poisoning

OBJECTIVE: To investigate clinical and imaging characteristics of delayed encephalopathy after carbon monoxide poisoning(DEACMP). METHODS: A retrospective and comparative analysis of neurological manifestations, course, periods of false-cure, prognosis and neuroimaging findings were conducted in 198 patients with DEACMP. RESULTS: Of these patients, 60.1% obtained an initial recovery within 30 d, 23.7% within 31-60 d and 14.6% over 60 d. Total clinical rate was 32.8%, and effectiveness rate 70.1%. According to imaging findings, 15.2% patients were found to have bilateral lesions of basal ganglion, and 70.0% with lesions of subcortical white matter, 12.6% with lesions of two types above mentioned and 2.1% with no lesions. The intervals between onset of illness and initial recovery were (44.6 +/- 10.1), (38.2 +/- 11.9), (61.3 +/- 17.0) d, and (7.5 +/- 2.4) d respectively. Imaging findings can demonstrate the severity of brain injury, but not necessarily parallel to the improvement of illness, for which SPECT proves more useful. CONCLUSIONS: DEACMP is involved in ischemic brain injury and a self-limited illness.