摘要
目的分析重度急性一氧化碳中毒迟发性脑病(s-DEACMP)的临床特点,探讨其发生的危险因素。方法回顾性分析2017年1月1日至2020年12月31日首都医科大学附属北京朝阳医院高压氧(HBO)科收治的急性一氧化碳中毒(ACMP)患者170例,根据是否并发迟发性脑病分为DEACMP组与非DEACMP(n-DEACMP)组;并采用DEACMP疾病过程中最重时的日常生活能力评分对DEACMP患者进行分级,总分≤60分为s-DEACMP组,总分>60分为轻中度急性一氧化碳中毒迟发性脑病(m-DEACMP)组。比较患者的临床特点,分析s-DEACMP发生的危险因素。结果s-DEACMP患者70例,m-DEACMP患者49例,n-DEACMP患者51例。与n-DEACMP组患者相比,s-DEACMP组患者年龄大(平均年龄59.0岁vs.49.0岁,P=0.005),年龄>40岁的比例高(97.1%vs.66.7%,P<0.001);ACMP入院时格拉斯哥昏迷评分(GCS)较低[(4.0±3.0)分vs.(6.0±5.0)分,P=0.024];ACMP意识障碍时间长[(32.0±31.8)h vs.(20.5±26.4)h,P=0.017],意识障碍>48 h的患者比例高(24.3%vs.9.8%,P=0.041);ACMP接受高压氧治疗的患者比例低(70.0%vs.86.3%,P=0.036);高血压患者比例高(38.6%vs.17.6%,P=0.013),高同型半胱氨酸血症患者比例高(40.0%vs.19.6%,P=0.017),吸烟指数>400的患者比例高(24.3%vs.9.8%,P=0.041)。与m-DEACMP组患者相比,s-DEACMP组患者中高同型半胱氨酸血症的比例高(40.0%vs.20.4%,P=0.024)。多因素Logistic回归显示年龄>40岁、意识障碍>48 h、高血压和高同型半胱氨酸血症是s-DEACMP发生的独立危险因素(P<0.05)。结论s-DEACMP患者具有年龄大、意识障碍程度深且时间长、早期接受HBO治疗比例低、高血压、高同型半胱氨酸血症、吸烟指数>400的临床特点,其中年龄>40岁、意识障碍>48 h、高血压是独立危险因素,值得注意的是,高同型半胱氨酸血症也是s-DEACMP的独立危险因素。
Objective To explore the clinical characteristics and risk factors of the severe delayed encephalopathy after acute carbon monoxide poisoning(s-DEACMP).Methods A retrospective analysis of 170 acute carbon monoxide poisoning(ACMP)patients treated in the Hyperbaric Oxygen(HBO)Department of Beijing Chao-yang Hospital,Capital Medical University from January 1st,2017 to December 31st,2020 was conducted.According to the occurrence of delayed encephalopathy,the ACMP patients were divided into DEACMP group and non-DEACMP(n-DEACMP)group.The DEACMP patients were stratified by the activities of daily living scale when they were most severely ill.The patients with total score≤60 were classified as s-DEACMP and the patients with total score>60 were classified as mild to moderate DEACMP(m-DEACMP).Their clinical characteristics were compared and the risk factors of s-DEACMP were analyzed.Results There were 70 s-DEACMP patients,49 m-DEACMP patients,and 51 n-DEACMP patients.Compared with the n-DEACMP group,the s-DEACMP group was older(average age:59.0 vs.49.0,P=0.005),had a higher proportion of patients over 40 years old(97.1%vs.66.7%,P<0.001),lower Glasgow coma scale scores[(4.0±3.0)vs.(6.0±5.0),P=0.024]on admission to the hospital,longer consciousness disturbance[(32.0±31.8)h vs.(20.5±26.4)h,P=0.017],a higher proportion of patients with consciousness disturbance over 48 hours(24.3%vs.9.8%,P=0.041),a lower proportion of patients receiving HBO therapy(70.0%vs.86.3%,P=0.036),a higher proportion of patients with hypertension(38.6%vs.17.6%,P=0.013),a higher proportion of patients with hyperhomocysteinemia(40.0%vs.19.6%,P=0.017),and a higher proportion of patients with smoking index over 400(24.3%vs.9.8%,P=0.041).Compared with the m-DEACMP group,the s-DEACMP group had a higher proportion of patients with hyperhomocysteinemia(40.0%vs.20.4%,P=0.024).Multivariate Logistic regression showed that age over 40 years old,consciousness disturbance over 48 hours,hypertension,and hyperhomocysteinemia were independent risk factors of s-DEACMP(P<0.05).Conclusion The clinical characteristics of s-DEACMP patients are that the patients are older,have a deeper and longer consciousness disturbance,a lower proportion of early HBO intervention,a higher proportion of hypertension,hyperhomocysteinemia,and smoking index over 400.Among them,the age over 40 years old,disturbance consciousness over 48 hours,and hypertension were the independent risk factors of the occurrence of s-DEACMP.In additon hyperhomocysteinemia was also an idependent risk factor for s-DEAMP,which special worth attention.
作者
朱婉秋
张奕
高宇
刘雪华
梁芳
李茁
杨琳
侯晓敏
马琳琳
张静
杨璐
南丁
杨晶
Zhu Wanqiu;Zhang Yi;Gao Yu;Liu Xuehua;Liang Fang;Li Zhuo;Yang Lin;Hou Xiaomin;Ma Linlin;Zhang Jing;Yang Lu;Nan Ding;Yang Jing(Department of Hyperbaric oxygen,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中华航海医学与高气压医学杂志》
CAS
CSCD
2021年第3期309-314,共6页
Chinese Journal of Nautical Medicine and Hyperbaric Medicine
关键词
急性一氧化碳中毒
迟发性脑病
高压氧
临床特点
危险因素
Acute carbon monoxide poisoning
Delayed encephalopathy
Hyperbaric oxygen therapy
Clinical characteristics
Risk factors
