急性一氧化碳中毒患者脑损伤的早期预测指标及亚低温的神经保护作用。
Early predictors of brain injury in patients with acute carbon monoxide poisoning and the neuroprotection of mild hypothermia.
机构信息
Emergency department, Shenzhen University General Hospital, Shenzhen, 518055, Guangdong, China; Department of Integration of Chinese and Western Medicine, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai 264000, Shandong, China.
Beijing Aier-Intech Eye Hospital, Beijing 100020, China.
出版信息
Am J Emerg Med. 2022 Nov;61:18-28. doi: 10.1016/j.ajem.2022.08.016. Epub 2022 Aug 18.
INTRODUCTION
Carbon monoxide (CO) poisoning can cause serious neurological sequelae. However, there is neither effective treatment strategy nor reliable indicators to determine the prognosis of patients with CO poisoning. The present study aimed to observe the changes of neurological function score, disease severity score, cerebral oxygen utilization (OUCc), bispectral (BIS) index and neuron-specific enolase (NSE) concentration, and to elucidate the clinical significance of these potential indicators and the neuroprotective effect of mild hypothermia on brain injury in patients with severe acute CO poisoning.
MATERIALS AND METHODS
A total of 277 patients with acute severe CO poisoning from 2013 to 2018 were enrolled in our hospital. Patients were divided into three groups according to their body temperature on the day of admission and their willingness to treat: a fever group (n = 78), a normal temperature group (NT group, n = 113), and a mild hypothermia group (MH group, n = 86). All patients were given hyperbaric oxygen therapy, while those in the MH group received additional mild hypothermia treatment. The severity of the disease, the neurobehavioral status, the incidence of delayed encephalopathy after acute carbon monoxide poisoning (DEACMP), and other indicators including BIS, OUCc, NSE were further evaluated in all patients at given time-points.
RESULTS
Mild hypothermia therapy improved the prognosis of patients with CO poisoning, significantly decreased the value of OUCc and NSE, and up-regulated BIS. The incidence of DEACMP at 6 months was 27% in the fever group, 23% in the NT group, and 8% in the MH group. The values of Glasgow-Pittsburgh coma scale (G-P score), BIS index and NSE were closely related to the occurrence of DEACMP, the cutoff values were 12.41, 52.17 and 35.20 ng/mL, and the sensitivity and specificity were 79.3%, 77.6%, 79.3% and 67.6%, 89.5%, 88.6% in the receiver operating characteristic curve (ROC), respectively.
CONCLUSIONS
Early mild hypothermia treatment could significantly reduce the severity of brain injury after CO poisoning, and might be further popularized in clinic. G-P scores, NSE and BIS index can be regarded as the prediction indicators in the occurrence and development of DEACMP.
CLINICAL TRIAL REGISTRATION
The study protocol was granted from Qingdao University Research Ethics Committee (Clinical trial registry and ethical approval number: QD81571283).
简介
一氧化碳（CO）中毒可导致严重的神经后遗症。然而，目前既没有有效的治疗策略，也没有可靠的指标来确定 CO 中毒患者的预后。本研究旨在观察神经功能评分、疾病严重程度评分、脑氧利用率（OUCc）、双频谱指数（BIS）和神经元特异性烯醇化酶（NSE）浓度的变化，阐明这些潜在指标的临床意义，以及亚低温对急性重度 CO 中毒患者脑损伤的神经保护作用。
材料和方法
2013 年至 2018 年期间，我院共收治 277 例急性重度 CO 中毒患者。根据入院当天的体温和治疗意愿，患者被分为三组：发热组（n=78）、正常体温组（NT 组，n=113）和亚低温组（MH 组，n=86）。所有患者均接受高压氧治疗，而 MH 组患者还接受了亚低温治疗。在特定时间点，进一步评估所有患者的疾病严重程度、神经行为状态、急性一氧化碳中毒后迟发性脑病（DEACMP）的发生率以及 BIS、OUCc、NSE 等其他指标。
结果
亚低温治疗改善了 CO 中毒患者的预后，显著降低了 OUCc 和 NSE 的值，并上调了 BIS。发热组 6 个月时 DEACMP 的发生率为 27%，NT 组为 23%，MH 组为 8%。格拉斯哥昏迷评分（G-P 评分）、BIS 指数和 NSE 与 DEACMP 的发生密切相关，其截断值分别为 12.41、52.17 和 35.20ng/ml，ROC 曲线的灵敏度和特异性分别为 79.3%、77.6%、79.3%和 67.6%、89.5%、88.6%。
结论
早期亚低温治疗可显著减轻 CO 中毒后脑损伤的严重程度，可能在临床上进一步推广。G-P 评分、NSE 和 BIS 指数可作为 DEACMP 发生发展的预测指标。
临床试验注册
本研究方案获得青岛大学伦理委员会批准（临床试验注册号和伦理审批号：QD81571283）。
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