早期激素干预对一氧化碳中毒迟发性脑病的影响

The effect of early hormone intervention on delayed encephalopathy after acute carbon monoxide poisoning

目的:探讨早期激素干预对一氧化碳(CO)中毒迟发性脑病的预防作用。方法:收集2011-01-2013-12我院急诊科收治的70例CO中毒患者的临床资料进行统计分析,按照随机分组原则分为高压氧组和联合治疗组,每组各35例,高压氧组采用高压氧等传统综合措施进行治疗,联合治疗组则在高压氧组治疗的基础上早期加用地塞米松治疗,治疗结束后比较2组患者的治疗效果及迟发性脑病的发生率。结果:2组患者的症状均有不同程度的缓解,联合治疗组的总有效率为91.42%,显效率为85.71%;高压氧组的总有效率为71.43%,显效率为62.86%;联合治疗组的显效率和总有效率明显高于高压氧组,差异有统计学意义(P<0.05)。联合治疗组发生迟发性脑病者3例,占8.57%;高压氧组发生迟发性脑病者10例,占28.57%;联合治疗组的发生率明显低于高压氧组,差异有统计学意义(P<0.05)。联合治疗组1例患者死亡,占2.86%;高压氧组4例患者死亡,占11.43%,差异无统计学意义。2组患者中均无激素相关并发症的发生。结论:高压氧与激素早期联合应用可有效治疗CO中毒,效果满意;早期使用激素可有效降低CO中毒迟发性脑病(DEACMP)的发生,且不增加发生激素相关并发症的风险,但目前尚不能证实早期使用激素可降低患者病死率。

Objective：To analyze the prevention effect of early hormone intervention on delayed encephalopathy after acute carbon monoxide poisoning.Method：Clinical data of 70 patients with carbon monoxide poisoning admitted in the emergency department of affiliated hospital of jining medical university were analyzed form January 2011 to December 2013,in accordance with the principle of randomized hyperbaric oxygen group and combination group were divided with 35 cases in each group,traditional comprehensive measures such as hyperbaric oxygen treatment were used in hyperbaric oxygen group,in addition to hyperbaric oxygen treatment early examethasone were used in combination group.Compare the curative effect of two groups and the incidence of delayed encephalopathy after treatment.Result：The symptom of all patients alleviate at different degree after treatment.In the combination treatment group,the total effective rate was 91.42%,the significant efficiency rate was 85.71%.In the hyperbaric oxygen group,the total effective rate was 91.43%,the significant efficiency rate was 62.86%.The total effective rate and significant efficiency rate in the combination treatment group was obviously higher than that in hyperbaric oxygen group（P〈0.05）.There were 3patients occurred delayed encephalopathy in the combination group,accounted for 8.57%.There were 10 patients occurred delayed encephalopathy in the hyperbaric oxygen group,accounted for 28.57%.The incidence of delayed encephalopathy in the combination group was lower than that in hyperbaric oxygen group（P〈0.05）.One patient in the combination treatment group died,accounting for 2.86%.Four patients in hyperbaric oxygen group died,accounting for 11.43%,there was no statistically significant difference.There were no hormones related complications occurred in all patients.Conclusion：Hyperbaric oxygen with early hormone intervention is a effective way in the treatment of carbon monoxide poisoning,Early use of hormone can effectively reduce the incidence risk of encephalopathy after acute carbon monoxide poisoning and does not increase the risk of hormone related complications,but it is not confirmed that early use of hormones can decrease the mortality of patients after acute carbon monoxide poisoning.