急性一氧化碳中毒后焦虑对迟发性脑病的影响及综合康复治疗

目的:探讨急性一氧化碳(CO)中毒后焦虑对迟发性脑病(DEACMP)的影响及高压氧(HBO)联合康复治疗的疗效.方法:472例急性CO中毒患者经急救、HBO等治疗后均苏醒,根据汉密顿焦虑量表(HAMA)评分分为焦虑与无焦虑患者,运用简易智力状态量表(MMSE)及Barthel指数(BI)检测患者的认知状况及ADL,并观察DEACMP的发病情况.将焦虑患者中出现DEACMP并再次入院的43例患者随机分A组22例和B组21例,均给予常规药物及HBO治疗；A组同时辅以认知-运动功能训练及心理干预.于治疗前后检测2组患者ADL及认知功能,并评定疗效.结果:472例患者中并发焦虑者137例,其MMSE及BI评分明显低于无焦虑患者(P＜0.05),DEACMP发生率明显高于无焦虑患者(P＜0.01).其中43例DEACMP患者再次入院分为A、B2组,治疗50d后,2组BI及MMSE评分均较治疗前显著提高(均P＜0.01),且A组更高于B组(P＜0.05)；A组痊愈率及总有效率均高于B组(P＜0.01,0.05).结论:急性CO中毒后焦虑状态对DEACMP的发生有明显的负面影响,HBO联合康复治疗具有协同疗效,能显著改善DEACMP患者智力水平及ADL能力.

Influence of anxiety on delayed encephalopathy after acute carbon monoxide poisoning and effects of comprehensive rehabilitation training

Objective:To investigate the influence of anxiety on delayed encephalopathy after carbon monoxide poisoning (DEACMP) and the therapeutic effect of hyperbaric oxygen (HBO) combined with rehabilitation training.Methods:Four hundred and seventy-two patients diagnosed as CMP were divided into the anxiety group and non-anxiety group according to their Hamilton rating scale for anxiety (HAMA) scores.The cognitive functions were evaluated with Mini Mental State Examination (MMSE). Barthel index was used to evaluate the ADL.The incidence of DEACMP was observed.Forty-three of them diagnosed as DEACMP were randomly divided into group A(n=22) and group B(n=21).The subjects in both group were given medication and HBO treatment,and those in group A received cognitive training,functional training and psychotherapy.Results:There were 137 anxiety cases in 472 patients,and the scores of MMSE,and Barthel index of them were obviously lower than in non-anxiety group(P<0.05),and the incidence of DEACMP was obviously higher than in non-anxiety group(P<0.01).Forty-three DEACMP patients were subdivided into group A and B.After 50 days of treatment,the scores of BI and MMSE in both two groups were increased(all P<0.01),and those in group A were higher than in group B(P<0.05).The cure rate and total effective rate in group A were higher than those in group B(P<0.01,0.05).Conclusion:Anxiety status has a negative influence on the patients with DEACMP.HBO treatment combined with rehabilitation training facilitates the recovery of patients with DEACMP.