急性一氧化碳中毒244例临床分析

A clinical analysis of 244 patients with acute cabon monoxide poisoning

目的分析急性一氧化碳中毒(ACOP)的临床特点、诊断、治疗及发生一氧化碳中毒迟发脑病的影响因素。方法回顾性分析我科1995年1月至2003年2月收治的244例ACOP患者的临床特点,并对迟发脑病组与无迟发脑病组病例进行统计学分析。结果生活性ACOP仍为主要病因;迟发脑病组与无迟发脑病组在高压氧(HBO)治疗次数、年龄、昏迷时间、是否伴有其他疾病方面差异有非常显著性(P<0.01);两组患者血低密度脂蛋白差异有显著性(P<0.05);两组患者血清酶、白细胞、血小板、嗜中性粒细胞差异无显著性;而在性别、有无并发症、吸烟史方面两组患者差异亦无显著性(P>0.05)。结论对于重度ACOP患者而言,年龄大、高血脂、昏迷时间长、有高血压、脑梗死等其他伴随疾病、HBO治疗次数不足是其出现迟发脑病的易患因素。采用HBO治疗结合激素、抗血小板聚集剂、改善脑循环及代谢药物等综合治疗措施治疗ACOP具有科学性和可行性。

Objective To study the clinical characteristics, diognosis and treatment of ACOP, and to discuss the pathogenesis of delayed encephalopathy following ACOP(DEACMP). Methods A review and statistical analysis of 244 ACOP patients in the time period from January 1995 to February 2003 were made, including age, occupation, poisoning degree, poisoning reason, accompanying disease, smoking history and other factors.Results Living reason was still the chief factor leading to ACOP. Comparing DEACMP group with non-DEACMP group,there were very significant differences in accompanying disease, time for coming round,times of HBOT(P<0.01); age,LDL-C in the DEACMP group were significantly higher than those in the non-DEACMP group(P<0.05); while it showed no remarkable differences in other respects.Conclusions For severe ACOP patients,advanced age, accompanied with hypertension, hypercholesterolemia, cerebral infarction or other disease, longer time for coming round and insufficient HBO treatment might be important risk factors related to DEACMP. It is scientific and effective for us to use mannitol reasonably and to give ACOP patients sufficient HBO treatment together with glucocorticoid, medicine of promoting blood circulation and removing blood stasis, antiplatelet aggregation agent and medicine of improving cerebral metabolism.