张婧婧,康冀云,程永梅,等.早期体温控制对重度急性一氧化碳中毒脑损伤患者预后的影响[J].中华物理医学与康复杂志,2021,43(10):904-909
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| 早期体温控制对重度急性一氧化碳中毒脑损伤患者预后的影响 |
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| DOI：10.3760/cma.j.issn.0254-1424.2021.10.009 |
| 中文关键词: 急性重症一氧化碳中毒 体温控制 格拉斯哥昏迷评分 脑电双频指数 神经元特异性烯醇化酶 |
| 英文关键词: Carbon monoxide poisoning Temperature control Bispectral index Neuron-specific enolase |
| 基金项目:国家自然科学基金项目（82071465、81571283）；山东省自然科学基金项目（ZR2020MH154、ZR2016HL2）；深圳市医疗卫生三名工程项目（SZSM201911007）；山东省重点研发项目（2018GSF118215） |
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| 中文摘要: |
| 目的 探讨早期体温控制对重度急性一氧化碳中毒脑损伤患者预后的影响。 方法 选取2013年1月至2019年12月在我院住院的重度急性一氧化碳中毒患者277例，根据患者入院时及入院后3 d的体温情况、患者及家属的治疗意愿，分为发热组（78例）、正常体温组（113例）、亚低温组（86例）。所有患者入院后均给予高压氧及常规药物治疗，亚低温组在此基础上给予亚低温治疗（体温控制在34 ℃~35 ℃）。治疗前后记录3组患者的格拉斯哥昏迷评分（GCS）、急性生理学及慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、长谷川痴呆量表（HDS）和简易智能精神量表（MMSE）评分，比较3组患者迟发型脑病的发生率及病死率，分析脑电双频指数（BIS）、神经元特异性烯醇化酶（NSE）与迟发型脑病发生的相关性。 结果 治疗后，3组患者的多项指标均较组内治疗前有不同程度的改善。与发热组同时间点比较，正常体温组除治疗1 d外、亚低温组治疗1 d［（15.67±3.34）分］、3 d［（24.56±3.97）分］、7 d［（29.35±4.85）分］、1个月［（31.13±4.61）分］的GCS评分较高，且亚低温组GCS评分较正常体温组优异（P＜0.05）。正常体温组和亚低温组的APACHE Ⅱ评分均较发热组低（P＜0.05），且亚低温组APACHE Ⅱ评分较正常体温组低（P＜0.05）。正常体温组和亚低温组的HDS评分均较发热组高（P＜0.05），且亚低温组HDS评分较正常体温组高（P＜0.05）。与发热组同时间点比较，正常体温组除治疗7 d外、亚低温组治疗7 d［（23.33±3.41）分］、1个月［（27.12±3.57）分］、6个月［（28.82±3.56）分］的MMSE评分较高，且亚低温组MMSE评分较正常体温组优异（P＜0.05）。与发热组同时间点比较，正常体温组除治疗1 d外、亚低温组治疗1 d（60.64±6.43）、3 d（67.67±8.76）、7 d（81.92±7.89）、1个月（92.33±8.28）的BIS值均较高（P＜0.05）。正常体温组治疗7 d［（34.67±8.10）ng/ml］、1个月［（23.40±7.18）ng/ml］及亚低温组治疗3 d［（20.25±6.58）ng/ml］、7 d［（14.30±5.18）ng/ml］、1个月［（9.27±3.62）ng/ml］的NSE浓度均较低（P＜0.05）。与正常体温组同时间点比较，亚低温组治疗1 d、3 d、7 d、1个月的BIS值均较高（P＜0.05），治疗3 d、7 d、1个月的NSE浓度较低（P＜0.05）。与其他两组相比，亚低温组的平均昏迷时间较短，迟发型脑病发生率及神经系统损伤发生率较低。GCS、BIS、NSE值与迟发型脑病的发生密切相关。 结论 早期体温控制能明显减轻一氧化碳中毒脑损伤的程度，减少神经系统后遗症的发生。早期动态检测GCS评分、NSE浓度及BIS，对预测迟发型脑病的发生具有重要意义。 |
| 英文摘要: |
| Objective To observe the effect of early temperature control on the prognosis of brain injury patients after severe carbon monoxide poisoning (COP). Methods A total of 277 patients hospitalized with severe COP were randomly divided into a fever group (n=78), a normal temperature group (n=113) and a mild hypothermia group (n=86). All were given hyperbaric oxygen therapy and any necessary supportive treatment. The mild hypothermia group were kept in a room at 34 to 35℃. Evaluation was with the Glasgow Coma Scale (GCS), version II of the Acute Physiology and Chronic Health Evaluation (APACHE), the Hasegawa dementia scale (HDS) and the mini mental state examination (MMSE). The incidence of delayed encephalopathy (DEACMP) and mortality were compared among the three groups. The bispectral index (BIS) and neuron-specific enolase (NSE) levels were correlated with DEACMP. Results After the treatments, improvement was observed in multiple indexes of all three groups compared with before the treatment. Compared with the fever group, the average GCS of the mild hypothermia group was significantly higher on the 2nd, 4th, 8th and 31st day after the intervention. It was significantly higher than the normal temperature group′s averages on the 4th, 8th and 31st day. The average APACHE scores of the normal temperature and the mild hypothermia groups were significantly lower than the fever group′s average, with that of the mild hypothermia group significantly lower than that of the normal group. The average HDS scores of the normal temperature and mild hypothermia groups were significantly higher than the fever group′s average, with that of the mild hypothermia group significantly higher than that of the normal group. The average MMSE score of the mild hypothermia group was significantly improved after 7 days, one month and three months of treatment. That of the normal group showed significant improvement after one and three months, but the mild hypothermia group′s averages were superior. Compared with the fever group, the average BIS score of the mild hypothermia group was significantly better after one, three and seven days, and one month. This was true for the normal group beyond three days after the intervention. The average NSE concentration of the normal group after 7 days and one month was significantly lower than that of the fever group. For the mild hypothermia group this was true after only 3 days. Compared with the other two groups, the average coma time, incidence of DEACMP and nervous system injury were significantly lower in the hypothermia group. The average GCS, BIS and NSE values were closely related to the occurrence of DEACMP. Conclusions Early temperature control can significantly reduce the severity of brain injury after COP and reduce the incidence of neurological sequelae. Early dynamic detection of GCS, NSE concentration and BIS is of great significance for predicting the incidence of DEACMP. |
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