Abstract:

Objective　To study the risk factors associated with delayed encephalopathy in patients with acute carbon monoxide poisoning (ACOP). Methods　A retrospective analysis was performed on 365 patients with moderate to severe ACOP treated at Inner Mongolia Autonomous Region People's Hospital from October 2020 to October 2023. There were 154 females and 211 males. They were 18-80 years old. Their clinical data were collected. They were followed up for more than 60 days. According to whether delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) occurred, the patients were divided into a DEACMP group (80 cases) and a non-DEACMP group (285 cases). The univariate analysis was used to compare the general clinical data and the first emergency laboratory indicators between the two groups, and the indicators with statistical differences were selected for the multivariate logistic regression analysis to analyze the risk factors of DEACMP. According to their age, the patients were divided into a 18-45 years old group (92 cases), a >45-60 years old group (142 cases), and a >60-80 years old group (131 cases); the clinical data and the first emergency laboratory indicators were compared between the 3 groups. χ² test and Fisher's precision probability test were used to compared the data between the groups. Results　The results of univariate analysis showed that there were statistical differences between the DEACMP group and the non-DEACMP group in age, previous history (diabetes and hypertension), duration of coma, toxicity degree, myocardial injury, rhabdomyolysis, lung infection, and first hyperbaric oxygen therapy (HBOT) time (all P<0.05). The early abnormal rates of white blood cell count (WBC), C-reaction protein (CRP), D-dimer (D-D), troponin I (cTnI), and creatine kinase (CK) in the DEACMP group were higher than those in the non-DEACMP group [73.8% (59/80) vs. 42.8% (122/285), 47.5% (38/80) vs. 27.1% (77/285), 61.3% (49/80) vs. 20.7% (59/285), 67.5% (54/80) vs. 27.7% (79/285), and 78.8% (63/80) vs. 35.1% (100/285)], with statistical differences (all P<0.05). The results of multivariate logistic regression analysis showed that age increase, long duration of coma, myocardial injury, long first HBOT time, and early abnormal CRP, D-D, cTnI, and CK were independent risk factors for DEACMP (all P<0.05). The elder the patients with ACOP were, the longer the duration of coma, the easier to have rhabdomyolysis, the higher the rates of early abnormal CRP and cTnI, and the more likely they had DEACMP. Conclusion　Age increase, long duration of coma, myocardial injury, long first HBOT time, and early abnormal CRP, D-D, cTnI, and CK may be the independent risk factors for DEACMP.

Key words:

Delayed encephalopathy after acute carbon monoxide poisoning, Risk factors, Hyperbaric oxygen therapy

摘要：

目的　研究急性一氧化碳中毒（acute carbon monoxide poisoning，ACOP）患者发生迟发脑病的相关危险因素。方法　采用回顾性分析，选取2020年10月至2023年10月期间内蒙古自治区人民医院收治的365例中、重度ACOP患者，其中女154例，男211例，年龄范围18～80岁。收集临床资料，并随访60 d以上，根据是否发生急性一氧化碳中毒迟发性脑病（delayed encephalopathy after acute carbon monoxide poisoning，DEACMP）分为DEACMP组（80例）和非DEACMP组（285例），应用单因素分析比较DEACMP组和非DEACMP组患者临床资料及急诊首次实验室指标，选择有统计学意义的指标进行多因素logistic回归分析发生DEACMP的危险因素。根据年龄分为18～45岁（92例）、>45～60岁（142例）、>60～80岁（131例）3组，比较3组患者的临床资料与首次实验室指标。组间比较采用χ²检验、Fisher确切概率法。结果　单因素分析结果示：DEACMP组和非DEACMP组患者年龄、既往病史（糖尿病、高血压）、昏迷时间、中毒程度分度、心肌损伤、横纹肌溶解症、肺部感染与首次高压氧治疗（HBOT）时间比较，差异均有统计学意义（均P<0.05）；DEACMP组白细胞计数（WBC）、C反应蛋白（CRP）、D-二聚体（D-D）、肌钙蛋白I（cTnI）、肌酸激酶（CK）早期异常发生率均高于非DEACMP组［73.8%（59/80）比42.8%（122/285）、47.5%（38/80）比27.1%（77/285）、61.3%（49/80）比20.7%（59/285）、67.5%（54/80）比27.7%（79/285）、78.8%（63/80）比35.1%（100/285）］，差异均有统计学意义（均P<0.05）。多因素logistic回归分析结果示：患者年龄增加、昏迷时间长、心肌损伤、首次HBOT时间长及CRP、D-D、cTnI、CK早期异常是DEACMP发生的独立危险因素（均P<0.05）。ACOP患者年龄越大，昏迷时间越长，越容易并发横纹肌溶解症，且CRP、cTnI早期异常发生率越高，发生DEACMP的可能性越大。结论　ACOP患者年龄增加、昏迷时间长、心肌损伤、首次HBOT时间长及CRP、D-D、cTnI、CK早期异常是DEACMP发生的独立危险因素。

关键词:

急性一氧化碳中毒迟发性脑病, 危险因素, 高压氧治疗