一氧化碳中毒继发脑梗死患者的临床相关因素分析及预后评估研究

发布时间：2019-03-08 14:21

【摘要】：[目的]探讨一氧化碳中毒(Carbon monoxide,CO)继发脑梗死患者的临床相关因素及预后,为临床一氧化碳中毒继发脑梗死患者的治疗及预后的评估提供参考。[方法]采用回顾性研究方法,收集、分析2011年1月至2016年09月期间到延边大学附属医院就诊的151例急性一氧化碳中毒患者的相关人口统计学及临床基本信息资料。根据患者头部影像学、一氧化碳中毒继发脑梗死组患者第90天改良Rankin评分(ModifiedRankinScale,mRS)、假愈期天数,采用多因素Logistic回归分析并明确一氧化碳中毒相关临床因素及预后危险因素。[结果]1.一氧化碳中毒继发脑梗死组与未继发脑梗死组中,多因素Logistic回归分析示:校正单因素分析中与新发脑梗死相关的危险因素(糖尿病、高血压、吸烟、饮酒、体重指数、纤维蛋白原测定)后,糖尿病(OR 12.673,95%C/4.100-39.175,P0.001)、高血压(OR3.315,95%CI1.247-8.811,P=0.016)、饮酒(OR 3.272,95%C/1.083-9.885,P=0.036)是一氧化碳中毒继发脑梗死的独立危险因素。2.一氧化碳中毒继发脑梗死患者预后良好组与预后不良组中多因素Logistic回归分析示:校正单因素分析中与预后不良组的危险因素(饮酒、总胆固醇浓度、使用依达拉奉治疗、辅助通气、纤维蛋白原测定)后,饮酒(OR45.454,95%CI 1.190-9.434,P=0.022)是一氧化碳中毒继发脑梗死预后不良的独立危险因素,使用依达拉奉(OR 0.274,95%CI0.107-0.701,P=0.007)是一氧化碳中毒继发脑梗死预后不良的保护因素。辅助通气组与未辅助通气组就入院NIHSS评分、第90天NIHSS评分、NIHSS评分下降数值方差分析示:第90天NIHSS评分(F=4.589,P=0.034),NIHSS下降数值(F=8.009,P=0.006)差异有统计学意义。3.一氧化碳中毒迟发性脑病2-30天组与30-60天组中多因素Logistic回归分析模型示:校正单因素分析中与延长假愈期的危险因素[糖尿病、高血压、吸烟、饮酒、低密度脂蛋白胆固醇浓度(Low density lipoprotein cholesterol,LDL)、高密度脂蛋白胆固醇浓度(High density lipoprotein cholesterol,HDL)]后,糖尿病(OR 59.087,95%CI 5.826-7.054,P=0.001)、高血压(OR 19.040,95%CI 2.714-133.576,P=0.003)、吸烟(OR 10.640,95%CI1.748-64.760,P=0.010)、饮酒(OR 29.429,95%CI3.666-236.231,P=0.001)是延长假愈期时间的独立危险因素。[结论]影响一氧化碳中毒继发脑梗死患者预后及迟发性脑病假愈期的危险因素较多,如糖尿病、高血压、饮酒等,应早期评估一氧化碳中毒的患者,治疗上使用依达拉奉、辅助通气等积极干预措施可能改善其预后。
[Abstract]:[objective] to explore the clinical related factors and prognosis of patients with secondary cerebral infarction of carbon monoxide poisoning (Carbon monoxide,CO), and to provide reference for the treatment and prognosis evaluation of patients with secondary cerebral infarction of carbon monoxide poisoning. [methods] A retrospective study was conducted to collect and analyze the demographic and clinical data of 151 patients with acute carbon monoxide poisoning from January 2011 to September 2016 in Yanbian University affiliated Hospital. According to the head imaging of the patients, the modified Rankin score (ModifiedRankinScale,mRS) on the 90th day and the days of false recovery in the patients with secondary cerebral infarction caused by carbon monoxide poisoning were analyzed by multivariate Logistic regression analysis and the related clinical factors and prognostic risk factors were identified in the patients with carbon monoxide poisoning secondary cerebral infarction. [result] 1. Multivariate Logistic regression analysis showed that the risk factors associated with new cerebral infarction (diabetes mellitus, hypertension, smoking, drinking, body mass index) in univariate analysis were corrected in patients with secondary cerebral infarction due to carbon monoxide poisoning and non-secondary cerebral infarction group, and that the risk factors associated with new cerebral infarction (diabetes mellitus, hypertension, smoking, drinking, body mass index) in univariate analysis. After fibrinogen test), diabetes mellitus (OR 12.673, 95% C = 4.100 / 39.175, P0.001), hypertension (OR3.315,95%CI1.247-8.811,P=0.016), drinking (OR 3.272, 95% C = 1.083 / 9.885, P 0.001), P0. 036) is an independent risk factor for cerebral infarction secondary to carbon monoxide poisoning. Multivariate Logistic regression analysis showed that the risk factors (alcohol drinking, total cholesterol concentration, Edaravone treatment) in univariate analysis and poor prognosis group were corrected in patients with secondary cerebral infarction caused by carbon monoxide poisoning, and the patients with good prognosis and poor prognosis were treated with Edaravone. After assisted ventilation and fibrinogen test, drinking (OR45.454,95%CI 1.190, 9.434, P0. 022) was an independent risk factor for poor prognosis of cerebral infarction secondary to carbon monoxide poisoning. The use of Edaravone (OR 0.274, 95% CI 0.107 / 0.701, P < 0.007) was a protective factor for the poor prognosis of cerebral infarction secondary to carbon monoxide poisoning. In the assisted ventilation group and the non-assisted ventilation group, the admission NIHSS score, NIHSS score on the 90th day, the decrease in the NIHSS score on the 90th day were analyzed by ANOVA: on the 90th day, the NIHSS score (F = 4.589, P = 0.034), NIHSS) decreased (F = 8.009, P = 0.034, P < 0.01, P < 0.01). The difference was statistically significant. 3. The multivariate Logistic regression model of delayed encephalopathy induced by carbon monoxide poisoning for 2 days and 60 days showed that univariate analysis was used to correct the risk factors associated with prolongation of the period of false recovery [diabetes mellitus, hypertension, smoking, alcohol drinking, diabetes mellitus, hypertension, smoking, alcohol consumption, diabetes mellitus (DM), hypertension, smoking, and alcohol consumption. " Low density lipoprotein cholesterol (Low density lipoprotein cholesterol,LDL), high density lipoprotein cholesterol (High density lipoprotein cholesterol,HDL)] diabetes mellitus (OR 59.087, 95% CI 5.826, 7.054, P0. 001), High blood pressure (OR 19.040, 95% CI 2.714 / 133.576, P < 0.003), smoking (OR 10.640, 95% CI 1.748 / 64.760, P = 0.010), alcohol drinking (OR 29.429, 95% CI 3.666 / 236.231, OR 10.640,95% CI 1.748 / 64.760, P = 0.010), P < 0. 001) is an independent risk factor for the duration of extended vacation. [conclusion] there are many risk factors, such as diabetes, hypertension, drinking and so on, which affect the prognosis of patients with secondary cerebral infarction of carbon monoxide poisoning and delayed brain sick leave. The patients with carbon monoxide poisoning should be evaluated early, and Edaravone should be used in the treatment of the patients with carbon monoxide poisoning. Positive intervention such as auxiliary ventilation may improve the prognosis.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R595.1;R743.3

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