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

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

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、B 2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。

Objective：To investigate the influence of anxiety on delayed encephalopathy after carbon monoxide poi- soning （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 e- valuated 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 MMSI~; 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.