急性一氧化碳中毒的临床表现与MRI分析

目的评价MRI对急性CO 中毒的诊断价值.方法分析59例经临床确诊的急性CO中毒患者的头颅MRI资料.结果 MRI异常表现为苍白球变性坏死,双侧大脑白质区脑水肿,以脑室周围为主的长T 1长T2信号,后期出现脑萎缩征象,海马区及脑干的改变.结论本病的诊断主要依靠病史、临床表现和影像检查,头颅MRI对本病的诊断、鉴别诊断及判断预后有价值.     

Carbon monoxide poisoning: Novel magnetic resonance imaging pattern in the acute setting

ABSTRACT: The presentation of carbon monoxide (CO) poisoning is non-specific and highly variable. The diagnosis is made when a compatible history and examination occur in a patient with elevated carboxyhemoglobin levels. The severity of intoxication is difficult to assess accurately based on laboratory markers alone. Magnetic resonance imaging has been shown to have superior sensitivity to computed tomography for the detection of abnormalities post CO poisoning. We report a novel imaging pattern on MRI undertaken in the acute setting in a patient with CO intoxication.     

白质DTI在急性一氧化碳中毒的临床应用

目的探讨磁共振扩散张量纤维束成像(DTI)参数FA和ADC值对急性一氧化碳中毒ACOP的诊断价值。方法 ACOP组56例,对照组21例。所有病例均行DTI检查,记录FA、ADC值,采用独立t检验进行统计学分析。结果 (1)ACOP患者组及对照组两侧膝部、放射冠FA、ADC值无差别(P0.05)。(2)FA值:ACOP患者组为0.7632±0.1206(胼胝体膝部)、0.3299±0.1029(放射冠额桥束),对照组为0.8329±0.0481(胼胝体膝部)、0.3800±0.1036(放射冠额桥束),P值分别为0.000、0.008(均小于0.05),差异有统计学意义。(3)ADC值:ACOP患者组为8.4594±1.5931(胼胝体膝部)、7.9261±1.1602(放射冠额桥束),对照组为7.8117±0.6160(胼胝体膝部)、7.3645±0.4879(放射冠额桥束),P值分别为0.000、0.000(均小于0.05),差异有统计学意义。结论 DTI可较准确反映ACOP患者白质区FA、ADC值变化,为早期诊断及治疗提供影像学信息。     

急性一氧化碳中毒患者核磁共振成像和质子磁共振波谱研究

目的研究急性一氧化碳中毒(COP)患者核磁共振成像(MRI)和质子磁共振波谱(H1-MRS)的改变,评价两者在COP预后的应用价值。方法研究对象(COP组30例,正常对照组20例)同时进行常规MRI和H1-MRS检查,测量H1-MRS各感兴趣区化合物的峰下面积及相对值。结果 COP患者常规MRI可表现正常,也可表现异常。COP患者的HI-MRS均有不同程度的异常,与正常对照组相比:COP组NAA/Cr比显著降低,Cho/Cr比显著升高(P<0.05);而一氧化碳中毒迟发性脑病(DNS)患者NAA/Cr比降低更明显,Cho/Cr比升高更显著,并有Lip峰出现。结论 Hl-MRS比常规MRI较早检测出COP患者脑部病灶的代谢异常,为COP的预后评估提供有益的信息。     

急性一氧化碳中毒后的迟发性脑病

目的：分析急性一氧化碳中毒导致迟发性脑病的发生机制和临床表现，探讨其综合治疗的方法和预后的影响因素。资料来源：应用计算机检索中国期刊全文数据库1983—01／2000—10和CBMdise相关文章。 检索词“急性、一氧化碳中毒、迟发性、脑病”．限定文章语言种类为中文。 资料选择：对资料进行初审．选取有关急性一氧化碳的发病机制、临床表现、治疗和预后的相关文章。纳入标准：①随机对照临床研究。②不限定盲法。排除标准、重复的同一研究。 资料提炼：共收集到240篇关手急性一氧化碳中毒导致脑病的相关文献，24篇符合纳入标准。 资料综合：急性一氧化碳中毒导致脑病的发病机制较为复杂．临床表现从症状、体征、脑电图、脑CT、磁共振方面来加深对该病的认识。治疗方法常采用：①神经细胞活化剂、血管扩张剂、抗凝剂及维生素。②高压氧。②紫外线照射充氧自血回输疗法。④针刺疗法。影响急性一氧化碳中毒后迟发性脑病预后的因素常与年龄、中毒程度、并发症及其救治的时间有关。 结论：急性一氧化碳中毒可以导致脑病的发生，是多种机制共同作用的结果。目前尚无特异性的治疗方法，应采取综合治疗．但治疗效果不理想，可遗留不同程度的智力及肢体功能障碍，长期存在睁眼昏迷。     

Prognostic factors in unintentional mild carbon monoxide poisoning

Objectives: To identify early predictors of recovery from mild carbon monoxide poisoning, and to search for qualitative interactions between subsets of patients and treatment effects. Design and setting: Inception cohort study from a 4-year, randomised, controlled trial, which compared normobaric oxygen therapy to the combination of normobaric plus hyperbaric oxygen therapy in 307 patients. Study was conducted at a hyperbaric oxygen therapy referral centre. Patients and interventions: Victims of unintentional, non-fire-related, domestic, carbon monoxide intoxication were evaluated if the time elapsed from end of exposure to hospital admission was less than 12 h, the carboxyhaemoglobin level was greater than or equal to 10% or 5% for smoker or non-smoker, respectively, and if they did not suffer a loss of consciousness. One course of hyperbaric oxygen therapy or 6-h normobaric oxygen therapy was given. Measurements and results: The main outcome measure was status at the 1-month recovery. Of the 307 evaluated patients, 206 (67%, 95%CI: 62%-72%) had recovered at 1 month. None of the patients died or suffered severe sequelae. Apathy and headaches were the main moderate sequelae. The multivariate analysis selected dizziness before admission (OR=1.92, [1.17-3.15], p=0.010) and headaches upon hospital admission (OR=2.14, [1.09-4.17], p=0.026) as jointly associated with persistent neurological symptoms. No significant crossover interaction between each combination of these two predictors and treatment effects was observed. Conclusions: At 1 month after mild carbon monoxide intoxication, victims who presented with dizziness before hospital admission or headaches upon admission have an increased risk of minor persistent neurological symptoms, but almost all patients could resume their former occupation.     

急性一氧化碳中毒后的迟发性脑病

目的:分析急性一氧化碳中毒导致迟发性脑病的发生机制和临床表现,探讨其综合治疗的方法和预后的影响因素。资料来源:应用计算机检索中国期刊全文数据库1983-01/2000-10和CBMdise相关文章。检索词“急性、一氧化碳中毒、迟发性、脑病”,限定文章语言种类为中文。资料选择:对资料进行初审,选取有关急性一氧化碳的发病机制、临床表现、治疗和预后的相关文章。纳入标准:①随机对照临床研究。②不限定盲法。排除标准:重复的同一研究。资料提炼:共收集到240篇关于急性一氧化碳中毒导致脑病的相关文献,24篇符合纳入标准。资料综合:急性一氧化碳中毒导致脑病的发病机制较为复杂,临床表现从症状、体征、脑电图、脑CT、磁共振方面来加深对该病的认识。治疗方法常采用:①神经细胞活化剂、血管扩张剂、抗凝剂及维生素。②高压氧。③紫外线照射充氧自血回输疗法。④针刺疗法。影响急性一氧化碳中毒后迟发性脑病预后的因素常与年龄、中毒程度、并发症及其救治的时间有关。结论:急性一氧化碳中毒可以导致脑病的发生,是多种机制共同作用的结果。目前尚无特异性的治疗方法,应采取综合治疗,但治疗效果不理想,可遗留不同程度的智力及肢体功能障碍,长期存在睁眼昏迷。     

QT间期在急性一氧化碳中毒中的初步探讨

目的 探讨QT间期在急性一氧化碳中毒(ACOP)患者中的变化,观察QT间期离散度(QTd)、校正的QT间期离散度(QTcd)与碳氧血红蛋白(COHb)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、肌钙蛋白I(cTnI)及肌红蛋白(Mb)的关系. 方法选取我院住院的ACOP患者104例,另取98例本院内科患者为对照组.在入院时和出院时行心电图检查,分别测量QT间期, 计算QTd 和QTcd,并测定CK、CK-MB、LDH、cTnI及Mb.分析QTcd与CK、CK-MB、LDH、cTnI和Mb的相关性.结果 入院时两组QT值比较差异无统计意义,两组QTd和QTcd比较差异有统计学意义(P＜0.01).中毒组QT、QTd和QTcd出院时较入院时显著下降(P＜0.01).入院时QTcd与COHb(r = -0.288,P=0.019)、cTnI(r = -0.297,P=0.007)、CK-MB(r=0.262,P=0.020)和Mb(r=0.248,P=0.012)相关,而与CK和LDH无相关性.结论 ACOP可以引起患者QT间期延长,当QTcd升高时与患者的心肌损伤有相关性.     

急性CO中毒迟发性脑病临床及MRI特点探讨

目的探讨急性CO中毒迟发性脑病的临床及MRI特点。方法回顾性分析14例急性CO中毒迟发性脑病的临床资料。结果首发症状智能下降（MMSE评分〈20分）14例（100％），尿失禁11例（78％）；有6例患者HCT升高较明显，均值0．503±0．027；磁共振改变分白质弥漫性病变、皮质改变和神经核团改变3类，多合并存在；14例予改善循环治疗，9例予激素等治疗，好转率85％，未使用激素的5例皆好转。结论HCT升高可能是引起脑微循环障碍导致急性CO中毒迟发性脑病原因之一，治疗上应严密监测患者该值的变化，监测和治疗的时间应不少于3-6个月；除常规高压氧治疗外，还应实施改善脑循环和抗血小板聚集的治疗；DTI显示的FA值普遍减低，说明脑内长束纤维有脱髓鞘改变，激素的使用可能有一定作用，但治疗前最好进行DTI扫描，以便个体化治疗。     

血栓弹力图在急性一氧化碳中毒患者中的应用

目的探讨血栓弹力图(TEG)在急性一氧化碳中毒(ACOP)患者抗凝治疗中的应用价值。方法选取44例确诊为ACOP的患者作为ACOP组,以及45例健康体检者作为对照组,于治疗前后抽取静脉血,做TEG检测及常规凝血试验,并对检测结果进行统计学分析。结果 ACOP患者的TEG主要检测参数,包括反应时间(R)、血栓形成的速度(由α角度反映)、血栓最大幅度(MA),均高于对照组,差异有统计学意义(P0.01);常规凝血检测的指标,包括凝血酶原时间、活化部分凝血酶原时间、凝血酶时间、纤维蛋白原,两组差异无统计学意义(P0.01)。结论 TEG指标能更敏感地反映ACOP患者的血小板功能活性,为临床治疗提供一定的参考。     

急性一氧化碳中毒治疗体会

1．1对于症状较轻的患者，只要迅速脱离有毒环境，呼吸新鲜空气或吸氧，卧床休息、保暖，保持呼吸道通畅，恢复较快，无需其他治疗。     

血清HSP70、Caspase-3联合检测对急性一氧化碳中毒迟发性脑病的预测价值

目的探讨血清热休克蛋白70（HSP70）、半胱氨酸天冬氨酸蛋白酶-3（Caspase-3）联合检测对急性一氧化碳中毒迟发性脑病（DEACMP）的预测价值。 方法选取2019年1月至2021年1月西安交通大学医学院附属三二〇一医院191例急性一氧化碳中毒（ACMP）患者为ACMP组,根据是否发生迟发性脑病分为DEACMP组（78例）和单纯ACMP组（113例）,另选取57例体检健康者为对照组。收集ACMP患者一般资料,酶联免疫吸附试测定血清HSP70、Caspase-3水平,采用Spearman相关性分析ACMP患者血清HSP70与Caspase-3水平的相关性,多因素Logistic回归分析DEACMP影响因素,受试者工作特征（ROC）曲线分析血清HSP70、Caspase-3水平对DEACMP的预测价值。 结果ACMP组血清HSP70、Caspase-3水平分别为27.46（24.11,31.29）ng/mL、（27.35±5.72）ng/L,显著高于对照组［12.38（8.68,16.13）ng/mL、（16.47±4.03）ng/L］,差异有统计学意义（t/Z=-11.362、13.401,P均＜0.001）。ACMP患者血清HSP70与Caspase-3水平呈正相关性（r_s=0.724,P＜0.001）。年龄（OR=1.101,95%CI：1.019~1.189）,一氧化碳（CO）暴露时间（OR=1.311,95%CI：1.123~1.530）,意识障碍时间＞48 h（OR=3.531,95%CI：1.133~11.000）,HSP70（OR=1.264,95%CI：1.154~1.384）,Caspase-3（OR=1.244,95%CI：1.135~1.363）是ACMP患者发生DEACMP的独立危险因素（P＜0.05）。HSP70＋Caspase-3预测DEACMP的曲线下面积（AUC）大于HSP70、Caspase-3单独预测（P＜0.05）。 结论ACMP患者血清HSP70、Caspase-3水平升高,是DEACMP的独立危险因素,血清HSP70、Caspase-3水平联合检测能提升DEACMP预测价值。     

49例急性一氧化碳中毒患者的护理观察

目的探讨对急性一氧化碳中毒患者实施有效的观察与护理措施。方法回顾性分析49例急性一氧化碳中毒患者的临床资料及护理措施。结果 47例轻度患者全部治愈出院,未出现后遗症;好转1例(患者年龄偏大,营养状况差以致恢复欠佳);1例因本院医疗设备所限,转至90医院继续治疗。结论及时有效地实施护理观察是抢救急性一氧化碳中毒患者成功的关键。     

Normal brain anatomy on magnetic resonance imaging

The exquisite detail provided by brain magnetic resonance imaging scans can make interpretation simultaneously straightforward and complicated, particularly to the novice. For this reason, it is essential to become familiar with normal structures before describing the pathologic condition. This article serves as a practical reference point to further enhance knowledge of the intracranial anatomy.     

Multicenter retrospective analysis of the risk factors for delayed neurological sequelae after acute carbon monoxide poisoning

ObjectiveDelayed neurological sequelae (DNS) is a devastating consequence following acute carbon monoxide (CO) poisoning. This study aims at exploring the independent predictors of DNS in patients with CO exposure.MethodsData of patients with diagnosis of CO poisoning was retrospectively collected and reviewed in 5 regional medical facilities. Patients were classified into the DNS group and non-DNS group according to clinical findings during a follow-up period of 6 months. Demographic characteristics, co-morbidities, clinical manifestations, and treatment strategies were compared to identify possible correlative factors. Multivariate analysis was performed to determine the independent predictors of DNS.ResultsWe screened 1129 patients and enrolled 326 cases (158 males, average age 44.56 ± 16.08 years) in the analysis. Thirty-seven (11.35%) developed DNS at a median interval of 33 days. Uni-variable analysis identified older age, higher body mass index, hypertension, loss of consciousness, longer CO exposure, lower Glasgow Coma Scale (GCS) on-site/at emergency room, and elevation of lactate as relevant factors for DNS; while multivariable logistic regression revealed that older age (OR = 1.11; p < 0.001), longer duration of CO exposure (OR = 1.54; p = 0.023), GCS on-site (OR = 2.06; p < 0.001), and GCS at emergency room (OR = 1.33; p = 0.048) were independent predictors for DNS.ConclusionsOur multicenter study demonstrated older age, longer duration of CO exposure, and GCS score were independent predictors of DNS in COP patients. GCS scored on-site might be a more sensitive and specific parameter compared with GCS evaluated at the emergency room. Further prospective studies in a larger patient cohort are warranted to draw a comprehensive conclusion.     

Characteristics of headache associated with acute carbon monoxide poisoning

OBJECTIVE: To evaluate systematically the characteristics of headache due to acute exposure to carbon monoxide. BACKGROUND: Headache is the most commonly reported symptom in acute carbon monoxide poisoning. While it is often described as throbbing and diffuse, a systematic characterization of carbon monoxide-associated headache has never been published. METHODS: Patients referred for hyperbaric oxygen treatment of acute carbon monoxide poisoning were asked whether headache was part of their symptom complex. When present, specific details about the nature of the headache were collected from 100 consecutive patients through use of a standardized questionnaire. RESULTS: Information on carbon monoxide-associated headache was collected from 34 female and 66 male patients with a mean carboxyhemoglobin level of 21.3%+/- 9.3%. The most common location for pain was frontal (66%), although more than one location was involved in 58% of patients. Nature of the pain at any time during its course was dull in 72% of patients and sharp in 36%. Headache was throbbing in 41%, continuous in 74%, and intermittent in 16% of those evaluated. Peak intensity of pain did not correlate with the carboxyhemoglobin level. Headache improved prior to hyperbaric oxygen treatment in 72%, resolving entirely in 21%. Of those with residual headache, pain improved with hyperbaric oxygen in 97%, resolving entirely in 44%. CONCLUSION: The headache accompanying acute carbon monoxide poisoning is extremely variable in nature. "Classic" throbbing, diffuse headaches were rarely described by patients. There are no patterns which can be considered characteristic to aid in the diagnosis of carbon monoxide-induced headache. Similarly, no trait was identified which might allow elimination of carbon monoxide poisoning from the differential diagnosis of headache.