一氧化碳中毒迟发性脑病危险因素分析

目的探讨急性一氧化碳中毒迟发性脑病（DEACMP）的危险因素，为其预防提供参考。方法DEACMP患者198例为DEACMP组，经历急性一氧化碳中毒（ACMP）但未出现DEACMP患者130例为ACMP组。对2组患者的一般情况[包括年龄、性别、BMI、职业、居住情况（独居／群居）等]、中毒程度、伴发基础病情况、昏迷时间、接受高压氧治疗时间、中毒后并发症及脑CT／MRI表现进行单因素和多因素回归分析。结果DEACMP组年龄〉60岁、从事脑力劳动者、独居者所占比例[65．2％（129／198）、24．7％（49／198）、48．5％（96／198）]均高于ACMP组[50．O％（65／130）、13．8％（18／130）、19．2％（25／130）]（P〈0．05或P〈0．01）；重度中毒者所占比例明显高于ACMP组[58．1％（115／198）比9．2％（12／130），P〈0．01]；伴发心脑血管疾病（包括脑供血不足、脑萎缩、冠心病、高血压）和糖尿病者所占比例明显高于ACMP组（P〈0．05或P〈0．01）；昏迷时问〉24h者所占比例均明显高于ACMP组（P〈0．05或P〈0．01）；接受高压氧治疗时间超过4h者所占比例明显高于ACMP组[77．3％（153／198）比30．8％（40／130），P〈0．01]。DEACMP组并发症发生率及脑实质损伤所占比例明显高于ACMP组（P〈0．05或P〈0．01）。多因素回归分析发现中毒程度、昏迷时间、脑实质性损伤、独居、肺部感染、接受高压氧治疗时间、多脏器功能受损、脑力劳动等8个因素为DEACMP的独立危险因素。结论DEACMP具有多方面的危险因素，意识到这些危险因素对于临床上DEACMP的预防具有重要的指导意义。

Analysis of risk factors of delayed encephalopathy after acute carbon monoxide poisoning

Objective To explore the risk factors for delayed encephalopathy after acute carbon monoxide poisoning （DEACMP）. Methods All 198 patients with DEACMP were enrolled as DEACMP group, and 130 patients without DEACMP after acute carbon monoxide poisoning （ACMP） were as ACMP group. The general conditions（including age, gender, body mass index, occupation） , poisoning degree, coma duration, the time of treatment of hyperbaric oxygen, complications after ACMP and brain image of CT/MRI were analyzed. Results The rates of age 〉 60 years, brainworkers, living alone in DEACMP group[ 65.2% （129/198） , 24.7% （49/198） , 48.5% （96/198） ] were higher than those in ACMP group[50.0% （65/130）, 13.8% （ 18/130）, 19.2% （25/ 130） ]. The severe poisoning patients were more in DEACMP group than in ACMP group [ 58.1% （115/198） vs 9.2% （ 12/130 ） , P 〈 0. 01 ]. The patients accompanied with cardiovascular and eerebrovaseular diseases （including insufficiency of brain blood supply, eneephalatrophy, coronay heart disease and hypertension ） or diabetes in DEACMP group were more than those in ACMP group （ P 〈 O. 05 or P 〈 O. 01 ）. The rates of coma duration more than 24 h and the time of treatment of hyperbaric oxygen treatment for more than 4 h in DEACMP group were higher than those in ACMP group（ P 〈 0.05 or P 〈 O. Ol ）. The patients accompanied with complications and brain injury in DEACMP group were more than those in ACMP group（ P 〈 0.05 or P 〈 0.01 ）. The muhiple factor regression analysis explored 8 risk factors of DEACMP, including poisoning degree, coma time, brain materially injury, living alone, pulmonary infection, the time aeeepted treatment of hyperbaric oxygen, multiple organ dysfunctions and brainworkers. Conclusion There are versatile risk factors of DEACMP.