一氧化碳中毒迟发性脑病的临床和影像学特征及其与病程和预后的关系分析

Clinical and Imaging Features of Delayed Encephalopathy after CO Poisonning and Its Relationship with the Course of Disease and Prognosis

目的研究一氧化碳中毒迟发性脑病(DEACMP)的临床和影像学特征及其与病程和预后的关系。方法选择随州市曾都医院2010年2月至2013年7月收治的86例DEACMP患者为研究对象。对所有患者假愈期、脑部CT、磁共振成像、单光子发射计算机断层成像术以及临床特征、病程和预后进行分析。结果假愈期≤14 d组治疗有效率为80.4%,治愈率为19.6%(10/51),而假愈期≥15 d组治愈率高达45.7%(16/35);假愈期≤14 d组中病程<30 d占47.1%(24/51),≥30 d占52.9%(27/51);假愈期≥15 d组病程<30 d占65.7%(23/35),≥30 d占34.3%(12/35)。根据影像学检查结果,脑受损部位为双侧基底节病患占14.8%(13/85),皮质下白质损害病患为70.4%(61/85),两种损害同时存在者为12.4%(11/85)。其所受损部位双侧基底节、皮质下白质损害、两种损害同时存在发病至病情好转时间分别为(45±10)、(38±12)、(61±17)、(7.5±2.6)d,差异有统计学意义(P<0.05)。结论影像学特征检查对DEACMP患者进行临床早期诊断以及预后具有重要意义,临床上应对患者及时进行影像学特征检查。

Objective To study the clinical and imaging features ofdelayed encephalopathy after CO poisoning（ DEACMP）,and its relationship with the course of disease and prognosis. Methods A total of 86 DEACMP patients admitted in Zengdu Hospital of Suizhou City from Feb. 2010 to Jul. 2013 were selected as research objects. For all the patients,latent phase,brain CT,magnetic resonance imaging,single-photon emission computed tomography and clinical features,course of disease and prognosis were analyzed. Results For patients with latent period of less than or equal to 14 d,the effective rate was 80. 4%,the cure rate was19. 6%; while for patients with latent period of equal to or greater than 15 d,the cure rate was as high as45. 7%（ 16 /35）. Patients with course of disease less than 30 d in patients with latent period equal to or less than 14 d accounted for 47. 1%（ 24 /51）,and patients with course of disease equal to or greater than 30 d accounted for 52. 9%（ 27 /51）; patients with course of disease less than 30 d in patients with latent period greater than or equal to 15 d accounted for 65. 7%（ 23 /35）,and patients with course of disease equal to or greater than 30 d accounted for 34. 3%（ 12 /35）. According to the imaging findings,patients with brain damage in bilateral basal ganglia accounted for 14. 8%（ 13 /85）,patients with subcortical white matter damage accounted for 70. 4%（ 61 /85）,patients with both damages at the same time accounted for 12. 4%（ 11 /85）,time from onset to recovery in above three kinds of damageswas（ 45 ± 10） d,（ 38 ± 12） d,（ 61 ± 17） d,the difference was statistically significant（ P〈0. 05）. Conclusion The characteristic imaging examination plays an important role in early diagnosis and prognosis of DEACMP patients,it is important to apply timely imaging examination to DEACMP patients in clinic.