急性一氧化碳中毒危险分层与常压氧或高压氧综合治疗预后研究

目的 分析急性一氧化碳中毒(ACOP)患者的治疗方法与一氧化碳中毒迟发脑病(DEACMP)发病特点.方法 对我院高压氧科2007年1月至2009年2月经急诊首诊的201例有昏迷史的ACOP患者进行回顾性分析,根据ACOP中毒时间分组,A组患者昏迷时间<2 h,B组患者昏迷时间>2 h,B组根据昏迷时间及年龄再次分组.A组予高压氧(HBO)或常压氧(NBO)治疗,B组予HBO综合治疗,统计各组DEACMP的发病率.结果 有意识障碍的ACOP患者总的DEACMP发生率为3.5%,A组无DEACMP发生,B组DEACMP的发病率为10.3%.B组中昏迷时间>6 h的患者DEACMP发生率27.3%,与昏迷时间在2～6 h的患者DEACMP比较差异有统计学意义(P<0.01).B组不同年龄患者的DEACMP发生率差异无统计学意义(P>0.05).结论 ACOP患者中毒昏迷程度及时间为DEACMP的发病高危因素,根据发生DEACMP的危险程度分层后进行HBO综合治疗可使DEACMP发生率明显降低.

Hazard stratification of acute carbon monoxide poisoning and study on the prognosis of related patients

Objective To analyze treatment methods for patients with acute carbon monoxide poisoning and features of delayed encephalopathy following acute carbon monoxide poisoning (DEACMP). Methods A retrospective analysis was made by using 201 cases of patients, who were admitted for emergency treatment upon first clinical visit from January 2007 to February 2009 due to coma induced by acute carbon monoxide poisoning (ACOP). The patients were stratified into 2 groups according to coma time. Group A consisted of patients with a coma time less than 2 h and Group B consisted of patients with a coma time over 2 h. The latter group was subdivided according to coma time and age. Patients of Group A were given hyperbaric oxygen (HBO) treatment, and/ or normobarie oxygen (NBO)and patients of Group B given integrated hyperbaric oxygen treatment. Incidence rate of delayed encephalopathy following acute carbon monoxide poisoning was analyzed statistically. Results Total incidence rate of DEACMP in ACOP patients with conscious disorder was 3.5%. In Group A, there were no patients with DEACMP; and rate of DEACMP for patients in Group B was 10.3%. And in Group B, incidence rate of DEACMP for patients with a coma time over 2 h was 27.3%, indicating a significant statistical difference, when compared with that of those patients with a coma time for 2～6 h (P <0.01). No statistical differences were noted in rate of DEACMP for the patients of group B with difference ages (P >0.05). Conclusions The degree of unconsciousness and coma time were high risk factors of DEACMP for patients with acute carbon monoxide poisoning. Integrated HBO treatment based on risk stratification of DEACMP might result in a relatively low incidence rate of DEACMP.