Wen Tuoying, Liang Jinghong, Wei Yulan, Lin Weijun, Pan Liya
Department of hyperbaric oxygen and Neurology, the Fourth Affiliated Hospital of Guangxi Medical University, 156 Heping Road, Liuzhou City, 545007, China.
Department of hyperbaric oxygen, the Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou City, China.
Sci Rep. 2024 Dec 2;14(1):29972. doi: 10.1038/s41598-024-81634-1.
This study retrospectively analyzed children admitted to the Fourth Affiliated Hospital of Guangxi Medical University for CO (carbon monoxide) poisoning from January 2018 to December 2022 and followed up on their neurological sequelae for a long time. The study was approved by the Ethics Committees of the Fourth Affiliated Hospital of Guangxi Medical University (the identification code was KY2023131) and informed consent was obtained from all participants and/or their legal guardians. The study complied with the Declaration of Helsinki. Through Global Deterioration Scale [GDS], we further compared the differences between children with and without cognitive impairment, and identified some risk factors for long-term cognitive impairment in children after CO poisoning. The GDS score of the patient was based on the follow-up score, and we only conducted one follow-up and recorded the GDS score throughout the entire study period. The follow-up time interval is defined as the time from the first discharge of the patient to our follow-up. A total of 113 children were encompassed in the study, with an average follow-up of 3.6 years (3.6 ± 1.5 years). Among them, 13 children (11.5%, 13/113) had cognitive abnormalities. The utilization of gas water heaters in enclosed bathrooms (101 cases, 89.4%) constituted the most frequent cause of CO poisoning among children in this study, followed by heating with fire (11 cases, 9.7%). Furthermore, one child was left by his father in a running car, thereby resulting in poisoning. The clinical manifestations of CO poisoning in children were mainly consciousness disorders (67 cases, 59.3%), dizziness or headache (37 cases, 32.7%), and other manifestations including irritability, crying, vomiting, limb weakness, and limb twitching, a total of 9 cases. The duration of consciousness disorders in children with cognitive abnormalities was mostly more than one day, with a median of 5 days, and the hospitalization time was longer. Children with cognitive abnormalities had higher C-reactive protein (CRP) levels, higher D-dimer levels, and higher liver enzyme levels. The most common imaging change after CO poisoning in children was cerebral edema, with two cases of subarachnoid hemorrhage observed and one case of demyelinating changes observed. For children with coma time less than one hour, there were few abnormal changes in cranial imaging. Children with cognitive abnormalities were more likely to develop epilepsy (38.5%, 5/13) and other system damage (53.8%, 7/13) during hospitalization, including pulmonary infection (3 cases), stressful gastrointestinal bleeding (2 cases), electrolyte imbalance (2 cases), dysfunction of liver, kidney or myocardial (3 cases), and some children had multiple system damage at the same time. There were statistical differences in the admission CO hemoglobin level, fibrinogen, D-dimer, high-sensitivity CRP, neuron enolase, alanine aminotransferase or aspartate aminotransferase (ALT or AST), lactate dehydrogenase, length of hospital stay, discharge and admission Glasgow Coma Scale (GCS), seizure frequency, duration of consciousness disorders more than one day, cranial imaging changes, use of ventilators, presence of other system damage, the number of hyperbaric oxygen (HBO) treatments, and whether the patients were transferred to another hospital between the two groups of children. Multivariate logistic regression analysis showed that head imaging changes and consciousness disorders lasting for more than a day were statistical differences. For children with unconsciousness lasting for more than one hour, it is advisable to contemplate conducting a head imaging examination as soon as possible within 3 days after CO exposure to guide the treatment during the acute phase.Characteristic alterations in cranial imaging and a longer duration of consciousness disorders (exceeding one day) might be correlated with subsequent neurological sequelae. For children with CO poisoning presenting these characteristics, active treatment can be implemented, encompassing but not restricted to HBO treatments, to minimize subsequent damage to the greater extent possible. So, for children who were unconscious for more than one day or presented characteristic changes in cranial imaging, long-term follow-up should be carried out to determine whether delayed encephalopathy or subsequent cognitive impairment occurs.
本研究回顾性分析了2018年1月至2022年12月在广西医科大学第四附属医院收治的一氧化碳（CO）中毒儿童，并对其神经后遗症进行了长期随访。本研究经广西医科大学第四附属医院伦理委员会批准（识别代码为KY2023131），并获得了所有参与者和/或其法定监护人的知情同意。本研究遵循赫尔辛基宣言。通过全球衰退量表[GDS]，我们进一步比较了有认知障碍和无认知障碍儿童之间的差异，并确定了CO中毒后儿童长期认知障碍的一些危险因素。患者的GDS评分基于随访评分，在整个研究期间我们仅进行了一次随访并记录了GDS评分。随访时间间隔定义为患者首次出院至我们随访的时间。本研究共纳入113名儿童，平均随访3.6年（3.6±1.5年）。其中，13名儿童（11.5%，13/113）有认知异常。在封闭浴室中使用燃气热水器（101例，89.4%）是本研究中儿童CO中毒最常见的原因，其次是用火取暖（11例，9.7%）。此外，有一名儿童被父亲留在发动着的汽车里，从而导致中毒。儿童CO中毒的临床表现主要为意识障碍（67例，59.3%）、头晕或头痛（37例，32.7%），其他表现包括烦躁、哭闹、呕吐、肢体无力和肢体抽搐，共9例。有认知异常的儿童意识障碍持续时间大多超过1天，中位数为5天，住院时间更长。有认知异常的儿童C反应蛋白（CRP）水平更高、D-二聚体水平更高、肝酶水平更高。儿童CO中毒后最常见的影像学改变是脑水肿，观察到两例蛛网膜下腔出血和一例脱髓鞘改变。对于昏迷时间少于1小时的儿童，头颅影像学很少有异常改变。有认知异常的儿童在住院期间更易发生癫痫（38.5%，5/13）和其他系统损害（53.8%，7/13），包括肺部感染（3例）、应激性胃肠出血（2例）、电解质紊乱（2例）、肝、肾或心肌功能障碍（3例），部分儿童同时存在多系统损害。两组儿童在入院时的CO血红蛋白水平、纤维蛋白原、D-二聚体、高敏CRP、神经元烯醇化酶、丙氨酸氨基转移酶或天门冬氨酸氨基转移酶（ALT或AST）、乳酸脱氢酶、住院时间、出院和入院时的格拉斯哥昏迷量表（GCS）、癫痫发作频率、意识障碍超过1天的持续时间、头颅影像学改变、呼吸机使用情况、其他系统损害的存在、高压氧（HBO）治疗次数以及患者是否转院等方面存在统计学差异。多因素logistic回归分析显示头颅影像学改变和意识障碍持续超过1天有统计学差异。对于昏迷持续超过1小时的儿童，建议在CO暴露后3天内尽快考虑进行头颅影像学检查，以指导急性期治疗。头颅影像学的特征性改变和意识障碍持续时间较长（超过1天）可能与随后的神经后遗症相关。对于具有这些特征的CO中毒儿童，可实施积极治疗，包括但不限于HBO治疗，以尽可能最大程度减少后续损害。因此，对于昏迷超过1天或头颅影像学有特征性改变的儿童，应进行长期随访，以确定是否发生迟发性脑病或随后的认知障碍。
