量化评价急性一氧化碳中毒病人神经精神损伤

Assessment of carbon monoxide poisoned patients by the neuropsychological screening battery

目的 建立一氧化碳中毒病人神经精神测试方法 ,为急诊医师提供快速、简便、可靠的评价急性一氧化碳中毒病人神经精神损伤的工具。方法 本文参考国外资料 ,建立急诊一氧化碳中毒病人神经精神测试 (carbonmonoxideneuropsychologicbattery ,CONSB)。并采用前瞻、对照的方法对 1998年 11月至2 0 0 0年 3月到中国医大急诊就诊的 66名一氧化碳中毒病人和 66名健康对照进行了测试。结果 一氧化碳中毒病人完成CONSB的能力明显低于健康人。病人组与正常对照组首次COSB得分差异非常显著 (P <0 0 1) ;1次治疗后仍有显著差异。来诊时完成CONSB能力较差的病人氧治疗后恢复的也较慢 ;来诊时CO Hb小于 2 0 %与COHb大于 2 0 %的病人及来诊前有昏迷史和无昏迷史的病人CONSB得分均无显著差异 (P >0 0 5 ) ;高压氧与常压氧治疗均可改善病人状况 ,提高其CONSB操作能力 ,但高压氧治疗组病人治疗前后得分差值明显高于常压氧治疗组治疗前后得分差值 (P <0 0 1)。结论 CONSB是适用于急诊进行判断CO中毒脑功能损害程度及协助诊断CO中毒的工具 ,敏感性及准确性均较高。COHb结果和来诊前有无昏迷不能全面反映脑功能损害程度。

Objective The carbon monoxide neuropsychological screening battery(CONSB)was develped to improve the neurological assessment of CO-poisoned patients in an emergency setting.Methods A prospective and control study was conducted in ED,the First Affiliated Hospital of China Medical University.CONSB was taken by 66 CO poisoned patients and 66 control from December 1998 to March 2000.All patients received oxygen therapy either hyperbaric oxygen(HBO)or normobaric oxygen(NBO).CONSB was performed by patients pretreatmet and posttreatment.Results There were significant differences in performing the CONSB between patients and controls (P<0 01)either taken immediately after their entering ED or after their first treatment.Scores of CONSB between patients whose COHb level either less than 20% or more than 20% have no significant difference.For the patients who received HBO,their abilities to perform CONSB improved more rapidly than abilities of patients with NBO.Conclusion CONSB is a useful screening procedure to assist neuropsychological assessment of CO-poisoned patients for the purpose of making treatment decisions.The abilities of CONSB performing were improved more significantly in HBO therapy group than NBO therapy group.