论文部分内容阅读
目的寻找急诊科短期内评估中重度急性一氧化碳中毒发生死亡和迟发性脑病不良预后的危险因素。方法回顾某院2000年1月～2009年12月间收治的91例中重度急性一氧化碳中毒并接受高压氧治疗患者的急诊接诊评估参数,并随访其预后恢复情况。按病程是否进展为死亡或并发迟发性脑病分为预后良好组(A组)和预后不良组(B组),分析影响预后的危险因子。结果与预后不良高度相关的急诊评估参数中“中毒时间、昏迷时间、GCS≤5、典型脑CT改变、代谢性酸中毒、BUN、心肌酶学、cTnI、缺血性心电图改变、心肌损伤、开始HBO时间以及是否使用过机械通气”等指标均对中重度急性CO中毒患者预后有一定影响。多因素分析发现,心肌损伤和昏迷时间两项指标是短期内预测中重度急性CO中毒患者预后的危险因子,其中心肌损伤危险系数更高(OR=20.670,CI3.198～133.618,P=0.001)。结论是否存在心肌损伤和具有较长的昏迷时间是急诊接诊时评估中重度急性一氧化碳中毒患者可能发生不良预后的客观预测指标。
Objective To find the short-term emergency department to assess the risk of severe acute carbon monoxide poisoning death and delayed encephalopathy adverse prognosis. Methods The emergency admissions evaluation parameters of 91 patients with moderate-to-severe acute carbon monoxide poisoning undergoing hyperbaric oxygen therapy from January 2000 to December 2009 in a hospital were retrospectively reviewed. The prognosis recovery was followed up. According to whether the course of disease progression to death or concurrent with delayed encephalopathy were divided into good prognosis group (A group) and poor prognosis group (B group), analysis of prognostic risk factors. The results were associated with poor prognosis in emergency assessment parameters such as “poisoning time, coma time, GCS ≤ 5, typical CT changes, metabolic acidosis, BUN, myocardial enzymes, cTnI, ischemic ECG changes, myocardial injury, HBO start time and whether the use of mechanical ventilation ”and other indicators have a certain impact on the prognosis of patients with moderate to severe acute CO poisoning. Multivariate analysis showed that the two indexes of myocardial injury and coma time were risk factors for short-term prognosis of patients with moderate-severe acute CO poisoning. The risk factors of myocardial injury were higher (OR = 20.670, CI = 1.98-133.618, P = 0.001) . Conclusions The existence of myocardial injury and long coma time are objective predictors of possible adverse prognosis in patients with moderate-to-severe acute carbon monoxide poisoning during emergency admissions.