| Objectives In the first, for providing the evidence-based proof,we systematically review the efficacy and safety of Glucocorticoids combined conventional high pressure oxygen for delayed encephalopathy after acute carbon monoxide poisoning. Secondly, through the clinical cases of acute carbon monoxide poisoning and delayed encephalopathy after acute carbon monoxide poisoning from chongqing municipal center for prevention and treatment of occupational diseases were retrospectively analyzed to contrast the treatment effect is consistent with meta-analysis and to explore the treatment of glucocorticoids combined high pressure oxygen for acute carbon monoxide poisoning. Finally, on the base of the resulte of the Meta-analysis and retrospective study, and according to the unreasonable situation of clinical use of glucocorticoid in treating delayed encephalopathy after acute carbon monoxide poisoning, this is the first time to adopt the delphi expert investigation method to explore for the use advice for glucocorticoid in treating delayed encephalopathy after acute carbon monoxide poisoning, and evaluate the advantages and disadvantages of this method. All in all, we hope this study could provide some suggestions for glucocorticoid in treating delayed encephalopathy after acute carbon monoxide poisoning.Methods First, Database including Pub Med, EMbase, Web of Science, the Cochrane Library, CBM, CNKI, VIP and Wan Fang Data were searched to retireve the relevant references from the start to September 30, 2015. Meta-analyse, sensitivity analysis(Rev Man 5.3),publication bias measuring were all done(Stata 14.0). Secondly, we made a retrospective analysis for the clinical 240 cases of acute carbon monoxide poisoning and delayed encephalopathy after acute carbon monoxide poisoning from chongqing municipal center for prevention and treatment of occupational diseases from January 1, 2008 to December 1,2015.Then,we compares the curative effect of test group which using glucocorticoids combined hyperbaric oxygen and control group which just using hyperbaric oxygen.We apply Epidata4.1 and SPSS14.1 software to logging and analysze the data, chi-square test and Fisher’s exact probability method was used to compare the difference of curative effect index. Finally,after we getting the research result of Meta-analysis and retrospective study,the delphi method was used to collect the expert’s opinions about the treatment advice for glucocorticoid in treating delayed encephalopathy after acute carbon monoxide poisoning and the Epidata4.1 and SAS9.2 software were used to anallyzed the experts’ opinions.Results First, A total of 12studies were included for final meta-analysis, involving 1415 participants. Meta-analysis showed that:(1) Compared with the control group of using hyperbaric oxygen therapy, the test group of corticosteroids and hyperbaric oxygen therapy had better outcomes in reducing DEACMP incidence [RR = 0.23,95% CI(0.14,0.38), P <0.001],improving the cure rate [RR = 1.52,95% CI(1.17,1.98), P = 0.002],improving the overall efficiency [RR = 1.36,95% CI(1.22,1.51), P <0.001], reducing the inefficiency [RR = 0.24,95% CI(0.15,0.40), P <0.001],all with significant differences.(2)There is no significant difference between two group in mortality of DEACMP(P = 0.38).(3)Compared with the control group, the glucocorticoids group had presented a small amount of adverse reactions(1.6%). Secondly, retrospective survey study shows that:(1)The test group in which was used by glucocorticoid combined hyperbaric oxygen has a higher cure rate(P = 0.025), higher overall efficiency(P = 0.037), lower inefficiency(P = 0.037) and the lower incidence of DEACMP(P = 0.031) in the treatment of ACMP cases. But there is no significant difference between two group in mortality of ACMP(P = 0.613).(2)The test group in which was used by glucocorticoid combined hyperbaric oxygen has a higher cure rate(P = 0.017), higher overall efficiency(P = 0.009), lower inefficiency(P = 0.009) in the treatment of DEACMP cases. But there is no significant difference between two group in mortality of DEACMP(P = 0.605).(3)Compared with the control group, the test group had presented a small amount of adverse reactions(3.33%).These conclusions are consistent with Meta-analysis. Finally, results of delphi expert study show that:(1)experts believes that the main purpose of using glucocorticoids is to prevent and treat the cerebral edema;(2)The glucocorticoids should be used for the patients immediately after they have the preliminary diagnosis, most experts believes(79.49%), medication time to no more than a week;(3)In the choice of methylprednisolone and dexamethasone, more experts(93.72%) tend to recommend the use of methylprednisolone;(4)In view of the different degree of disease, experts also have shown the suggested dosage of dexamethasone and methylprednisolone;(5)Most experts believe that glucocorticoids can improve the efficacy and prognosis in treatment of delayed encephalopathy after acute carbon monoxide poisoning during their clinical diagnosis and treatment, but there is a small amount of adverse reactions.These conclusions are consistent with meta analysis and retrospective study conclusion.Conclusions Based on the research results, we have the following conclusions:(1)Current evidence suggests that: Although there are a small number of adverse reactions, but the efficacy of corticosteroids combined with hyperbaric oxygen is better than conventional high pressure oxygen therapy in acute carbon monoxide poisoning and delayed encephalopathy after acute carbon monoxide poisoning. But the results need further research and argumentation.(2)We should monitor all adverse reactions closely during we using the glucocorticoids in treating acute carbon monoxide poisoning and delayed encephalopathy after acute carbon monoxide poisoning and correct they promptly.(3) We have presented the true opinions of the experts using glucocorticoids to treat the disease through the delphi method. The opinions has certain authority and reference value and lay a foundation of establish the clinical standard regimen. this study also illustrates that the establishment of the regimen in addition to these methods such as theory analysis, literature review, clinical trials, using the Delphi method to collect the opinions of experts also can be regarded as a rapid, effective and feasible assist method in this field. But it is only auxiliary method, do not use it as a kind of estimation method alone. The opinions still need combined with the clinical trials to fix, establish the feasible specification eventually. |
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