急性一氧化碳中毒后迟发性脑病早期相关危险因素分析

Early risk factors of delayed encephalopathy after acute carbon monoxide poisoning

目的探索一氧化碳中毒后迟发性脑病(DEACMP)患者在一氧化碳中毒早期相关危险因素。方法收集2018年1月至2020年8月四川省人民医院就诊的一氧化碳中毒患者183例,记录患者年龄、性别、一氧化碳中毒来源、中毒时患者意识状态、既往病史、初期脑电图、头颅MRI、胸部CT等资料,分析发生DEACMP的危险因素。结果183例一氧化碳中毒患者中,DEACMP患者26例,NDE患者157例。单因素分析提示DEACMP组患者与NDE组患者在年龄、高压氧治疗次数、中毒来源、脑电图、头颅MRI、中毒初期意识状态比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析提示急性一氧化碳中毒患者年龄大、中毒初期伴有意识障碍、头颅MRI异常、脑电图异常及患者接受高压氧治疗次数较少是DEACMP发生的危险因素(P<0.05)。结论急性一氧化碳中毒患者年龄大、在中毒初期头颅MRI信号异常、脑电图异常、发病时即伴有意识障碍均是DEACMP发生的危险因素。

Objective To explore the risk factors of delayed encephalopathy after carbon monoxide(CO)poisoning(DEACMP)in the early stage of CO poisoning.Methods One hundred and eighty-three patients with CO poisoning visiting Sichuan Provincial People's Hospital from January 2018 to August 2020 were collected.Age,gender,source of CO poisoning,conscious state at the time of poisoning,past medical history,initial EEG,brain MRI,chest CT and other data of patients were recorded.The risk factors for DEACMP were analyzed.Results Among the 183 patients,there were 26 patients with DEACMP and 157 patients with non-delayed encephalopathy(NDE).Univariate analysis showed that there were statistically significant differences in age,frequency of hyperbaric oxygen treatment,source of poisoning,EEG,brain MRI,and state of consciousness at the early stage of poisoning between DEACMP group and NDE group(P<0.05).Multivariate logistic regression analysis suggested that an older age,disturbance of consciousness at the early stage of acute CO poisoning,abnormality of cranial MRI,abnormality of EEG and less time of hyperbaric oxygen therapy were the risk factors of DEACMP(P<0.05).Conclusion An older age of patients with acute CO poisoning,abnormal brain MRI signals in the early stage of CO poisoning,abnormal EEG,and disturbance of consciousness at onset are all risk factors for the occurrence of DEACMP.