急性一氧化碳中毒患者视功能障碍临床特点分析

Analysis of clinical characteristics of visual dysfunction in patients with acute carbon monoxide poisoning

目的分析急性一氧化碳(CO)中毒患者视功能障碍的临床特点。方法收集2012年10月至2020年12月在青岛大学附属烟台毓璜顶医院就诊的急性CO中毒患者490例,其中轻度中毒者132例、中度中毒者193例、重度中毒者165例,通过询问病史、常规体格检查、颅脑磁共振、眼科专项检查及视功能相关生存质量问卷调查(NEI-VFQ)等方法,分析急性CO中毒患者视功能障碍的临床特点及其影响因素。结果急性CO中毒临床症状的严重程度与CO接触时间、院外滞留时间、给氧开始时间及高压氧治疗开始时间相关(P<0.05)。3组患者中均发现少量CO中毒相关眼科病变的病例,其中轻度中毒组14例(10.6%)、中度中毒组18例(9.3%)、重度中毒组17例(10.3%),3组在发病率方面比较,差异无统计学意义(P>0.05)。3组患者中视功能障碍损伤程度略有不同:轻度中毒组眼科检查Ⅰ级损伤的病例略多(9例),重度中毒组Ⅲ级损伤的病例明显增多(10例),与其他2组比较,差异有统计学意义(P<0.05)。尽管3组患者中均有少数患者出现临床症状和/或眼科专科检查异常,但患者的临床症状与其眼科专科检查结果并不完全符合(P<0.01),有些患者即便出现比较严重的专科检查异常,但缺乏典型的临床症状。经正规治疗后,重度中毒组患者视功能障碍持续时间为(10.4±3.4)个月,明显超过轻度中毒组[(5.2±5.3)个月]及中度中毒组[(6.1±5.5)个月],3组比较,差异有统计学意义(P<0.05)。在疗效方面,轻度中毒组和中度中毒组患者的治愈率、好转率明显优于重度中毒组(P<0.05)。在预后方面,经过正规治疗,尽管重度中毒组患者临床表现有不同程度改善,但其眼科后遗症发生率(58.8%)明显高于其他2组(0%和16.7%,P<0.05)。结论急性CO中毒患者可出现视功能障碍,其临床症状丰富多样、持续时间长、预后差,应及早完善眼科相关检查,尽早干预治疗。

Objective To analyze the clinical characteristics of visual dysfunction in patients with acute carbon monoxide(CO)poisoning.Methods A total of 490 patients with CO poisoning were enrolled in Yantai Yuhuangding Hospital affiliated to Qingdao University from October 2012 to December 2020,and they were divided into mild poisoning group(132 cases),moderate poisoning group(193 cases),and severe poisoning group(165 cases).The clinical characteristics of visual dysfunction and its influencing factors in the patients with acute CO poisoning were analyzed by inquiring their medical history,carrying out regular physical examination,brain magnetic resonance imaging(MRI),ophthalmic examination,and the National Eye Institute Visual Function Questionnaire(NEI-VFQ)survey.Results The severity of clinical symptoms in patients with acute CO poisoning were correlated with their CO exposure time,delay time before being hospitalized,and the start time of oxygen administration and hyperbaric oxygen therapy(P<0.05).A small number of cases with ophthalmic diseases related to CO poisoning were found in all three groups,and there were 14 cases(10.6%)in the mild poisoning group,18 cases(9.3%)in the moderate poisoning group,and 17 cases(10.3%)in the severe poisoning group.There was no statistical difference in the incidences of ophthalmic diseases among the three groups(P>0.05).The severity of visual impairment differed from group to group.There were slightly more cases of grade I visual impairment in the mild poisoning group(9 cases),while there was a significant increase in the cases of grade III visual impairment in the severe poisoning group(10 cases),which was higher than those of the other two groups,with statistically significant differences(P<0.05).Although a few patients in the three groups had clinical symptoms and/or abnormalities in ophthalmic examination,those two were not completely relevant.Some patients lacked typical clinical symptoms even if they had the examination results of severe ophthalmic abnormalities(P<0.01).After standard treatment,the duration of visual dysfunction in the severe poisoning group was(10.4±3.4)months,which was obviously longer than those in the mild and the moderate poisoning groups[(5.2±5.3)and(6.1±5.5)months,respectively],with statistically significant differences(P<0.05).In terms of therapeutic effect,the cure rates and improvement rates in the mild and the moderate poisoning groups were both better than those in the severe poisoning group(P<0.05).As for prognosis,although the clinical manifestations of many sever patients were more or less improved after standard treatment,the incidence of ophthalmic sequelae(58.8%)in the severe poisoning group was notably higher than those in the other two groups(0%and 16.7%,P<0.05).Conclusion Patients with acute CO poisoning may develop visual function impairment,which can have diverse clinical symptoms,long duration,and poor prognosis.Therefore,early and comprehensive ophthalmic examinations and timely intervention and treatment are necessary.