摘要：
目的 探究不同高压氧治疗方案对一氧化碳中毒迟发脑病(delayed neuropsychiatric sequelae followed carbon monoxide poisoning,DNS)的干预作用.方法 回顾性收集2015年10月至2016年10月河南科技大学第一附属医院住院诊断为急性一氧化碳中毒(acute carbon monoxide poisoning,ACOP)及DNS患者的个人资料、临床症状、高压氧治疗方案等,排除急性期死亡和持续昏迷的患者,根据是否发生DNS把患者分成DNS组和治愈组,先单因素分析不同患者个人资料、临床特征、高压氧治疗方案等与DNS的关系;再采用二元Logistic回归模型校正混杂因素,分析高压氧治疗时间、频率及次数与DNS的关系.结果 共纳入169例患者,其中治愈组130例,DNS组39例.单因素分析发现,与治愈组相比,DNS组年龄≥55岁、吸烟的比率明显增高,差异有统计学意义(P＜0.05);ACOP伴昏迷,治疗后意识恢复,但遗留认知障碍的患者更易出现DNS(P=0.017).24 h内接受高压氧治疗使DNS的风险明显降低(OR =0.14,P＜0.01);24h内增加高压氧治疗次数(2次/d)也可显著降低DNS风险(OR=0.29,P=0.011);即使给予2次/d的高压氧治疗,但未在24 h内进行,并不能降低DNS的风险(OR=0.06,P＞0.05);急性期连续高压氧治疗＞6d也可降低DNS风险,差异有统计学意义(OR=0.44,P=0.024).校正混杂因素后发现:24 h内给予高压氧治疗(OR=0.22,95％CI:0.09～0.52);24 h内给予2次/d的高压氧治疗(OR=0.30,95％CI:0.10～0.87);早期连续治疗＞6 d(OR=0.30,95％CI:0.10-0.87),可降低DNS的风险.结论 ACOP后24 h内及时给予1次/d,或2次/d的高压氧治疗;急性期连续高压氧治疗＞6 d可降低DNS发生的风险.%Objective To explore the effect of different hyperbaric oxygen treatment (HBOT) on delayed neuropsychiatric sequelae followed carbon monoxide (CO) poisoning (DNS).Methods Patients diagnosed acute carbon monoxide poisoning (ACOP) or DNS due to CO poisoning in the hospital from October 2015 to October 2016 were included.Patients who died of ACOP or in persisting unconsciousness condition were excluded.Information of the patients were retrospectively collected including personal data,clinical features and treatment course of hyperbaric oxygen (HBO).All subjects were divided into two groups,consisting of cases who developed into DNS and who fully recovered,according toclinical symptoms.The differences of personal data,clinical features and treatment course of HBO were compared between the two groups.After adjusting the confounding factors,hyperbaric oxygen treatment program of the two groups were analyzed.Results DNS occurred in 39 patients with acute CO poisoning,while 130 patients were fully recovery.The ratio of patients over 55 years old or with smoking history in the DNS group were higher than that in the good outcome group (82.1％ vs.60.8％,23.1％ vs.10.8％).Patients who awoke from unconsciousness but left cognitive impairment were more likely to develop into DNS (P=0.017).Patients who treated with HBO within the first 24 hours,risk of developing into DNS were decreased(OR=0.14,P＜0.01).At the same time,2 times per day and within the first 24 hours worked also as well.(OR=0.29,P=0.011).Even if patients who were given 2 times a day of HBO but not in the first 24 hours after poisoning,could not reduce the risk of evolving to DNS(OR=0.06,P＞0.05);The proportion of patients in the good outcome group accepted HBO for more than six days after poisoning was higher than that in the DNS group (68.5％ vs.48.7％).After adjusting confounding factors,patients who treated with HBO within the first 24 hours (OR=0.22,95％CI:0.09-0.52),2 times per day(OR=0.30,95％CI:0.10-0.87)and lasted for more than 6 days(OR=0.30,95％CI:0.10-0.87)were in a lower risk of involving to DNS.Conclusions For patients diagnosed ACOP,HBOT began in the first 24 hours,1 or 2 times per day or early sustaining to give HBO for more than 6 days could reduce the risk of DNS.
