急性一氧化碳中毒后迟发性脑病60例临床剖析.docVIP

急性一氧化碳中毒后迟发性脑病60例临床剖析 　　[摘要] 目的：研究急性一氧化碳中毒后迟发性脑病的发病机制及治疗。方法：本文回顾性分析了60例急性一氧化碳中毒后迟发性脑病患者的临床资料。结果：急性一氧化碳中毒后迟发性脑病临床表现复杂多样，以痴呆、精神症状、二便失禁为主，CT提示额、顶、枕叶皮质下白质密度降低。治疗主要为高压氧疗、激素、改善局部血液循环，有效率为89.1%，26.7%的患者可痊愈。结论：神经系统损害程度及预后与急性期吸入一氧化碳的浓度、昏迷时间长短、患者年龄、急性期是否及时行高压氧治疗、既往身体状况有关。 　　[关键词] 一氧化碳中毒；迟发性脑病 　　[中图分类号] R749.6+3 [文献标识码]C[文章编号]1673-7211（2008）11（b）-161-02 　　 　　Clinical analysis on 60 patients with delayed encephalopathy after acute carbon monoxide poisoning 　　WU Qiang1, MA Hui-juan1, LU Fa-zhi1, ZHANG Jiao-jiao2 　　(1.Department of Nerves, Xinxiang Central Hospital, Xinxiang453000,China; 2.Infirmary of Xinxiang 22nd Middle School, Xinxiang453000,China) 　　[Abstract] Objective: To research the pathogenesis and treatments of delayed encephalopathy after acute carbon monoxide poisoning (DEACMP). Methods: Data were retrospectively analyzed on the 60 patients with DEACMP admitted to the hospital. Results: The main manifestation of DEACMP consisted of dementia, psychiatric symptoms and urinary and fecal incontinence. In computerized tomography(CT), it can be hinted that the density of white matter under the cerebral cortex of frontal lobe, parietal lobe and occipital lobe were decreased. The main treatments were hyperbaric oxygen therapy, hormone and improving the localblood circulation. The effective power was 89.1% and the cure rate was 26.7%. Conclusion: The damage of nervous system and prognosis are related to concentration of carbon monoxide breathed in by patients , the comatose time, a patients age, whether or not having hyperbaric oxygen treatment promptly andprevious physical status. 　　[Key words] Carbon monoxide poisoning; Delayed encephalopathy 　　 　　急性一氧化碳中毒后迟发性脑病(carbon monoxide intoxication delayed encephalopathy,COIDE)，是指部分急性一氧化碳中毒患者在急性期意识障碍恢复正常后，经过一段时间的假愈期，突然出现以痴呆、精神和锥体外系症状为主的脑功能障碍[1]。为了加深对这一疾病的认识，现将2002～2007年我科收治的60例的临床情况分析如下： 　　1 临床资料 　　1.1一般资料 　　60例本病患者中，男性36例，女性24例，年龄最大者75岁，最小者18岁，平均56.4岁，其中18～59岁12例，60～69岁36例，70～75岁12例。病因均为冬季煤炉或土暖气取暖不慎，烟囱抽烟不良所致。昏迷时间3～7