| Objective: To investigate the related factors associated with delayed encephalopathy in acute carbon monoxide poisoning.Through the follow-up and analysis of the prognosis of patients with delayed encephalopathy,it provides evidence for the prediction and prognosis of delayed encephalopathy in acute carbon monoxide poisoning.Methods : 1.This trial was a multi-center,real world,prospective cohort research study;We registered patients with acute carbon monoxide poisoning in many grade a class 3 hospital in our province,and recorded in detail their age,gender,type of work,past medical history(hypertension or diabetes),smoking history,coma,Glasgow score at the first visit,poisoning from discovery The time of the first hyperbaric oxygen therapy,electrocardiogram after admission,brain CT/MRI scan,white blood cell count,alanine aminotransferase level,lactate dehydrogenase level.2.At the first,third,sixth,and twelfth months after acute carbon monoxide poisoning,the patients had been followed up by telephone,WeChat,outpatient referral,home visits,and other methods to follow-up the patient’s survival condition,treatment status,prognosis of the disease,and whether or not it occurred delayed encephalopathy and the occurrence of time,disability,motor function,cognitive function,and functional independence.3.Patients with delayed encephalopathy were classified as delayed encephalopathy group;Patients without delayed encephalopathy were classified as non-delayed encephalopathy group.Univariate comparison and logistic regression were used to correct risk factors in age,gender,type of work,past medical history(hypertension or diabetes),smoking history,coma,Glasgow score at the first visit,poisoning from discovery The time of the first hyperbaric oxygen therapy,electrocardiogram after admission,head CT/MRI performance,white blood cell count,alanine aminotransferase level,lactate dehydrogenase level.The prognosis of patients with delayed encephalopathy after 1st,3rd,6th,and 12 th month after poisoning was counted,and the improved Rankin score and FIM score were used for self-analysis.4.This study used SPSS 19.0 statistical software for input and analysis.For the measurement data,a normal distribution test was performed using the Shapiro-Wilk test.The measurement data of normal distribution are tested with homogeneity of variance.The variance homogeneity test was tested by Levene.If the variance is equal,the t test is used for comparison between the two groups.The t’ test is used if the variances are not equal;the results are expressed as mean ± standard deviation((?)±s).Do not obey the normal distribution of measurement data and use nonparametric tests.The Mann-Whitney test was used to compare the mean ranks,expressed as Md(P25,P75).The count data is represented by the composition ratio.The two sets of count data were compared using the chi-square test of the two-table data or Fisher’s exact test.Univariate screening was performed using the above method,and items with statistical differences were used as independent variables(X),and whether or not delayed encephalopathy occurred as a dependent variable(Y)was subjected to a two-class Logistic regression(stepwise regression method)for multivariate analysis.Self-analysis analysis uses single factor repeated measures analysis of variance.If the data did not obey the normal distribution,non-parametric test Friedman test(multiple relevant samples)was used,and the binary data itself was compared and analyzed using generalized estimating equations.P<0.05 was considered statistically significant.Results: 1.In this study,a total of 79 acute carbon monoxide poisoning patients were incorporated in the analysis.It was found that the increase in age and low Glasgow score for the first visit were independent risk factors for delayed encephalopathy(P<0.05).It means that Age and coma severity were positively correlated with the onset of delayed encephalopathy.2.The prognosis of patients with delayed encephalopathy: 1)The incidence of delayed encephalopathy is 16%,and the delayed period of delayed encephalopathy was 3-55 days,and the average onset time was 25.3±15.8 days after acute carbon monoxide poisoning.2)The difference in disability between the 1st,3rd,6th,and 12 th month after poisoning in patients with delayed encephalopathy was statistically significant,χ2(2)=8.57,P<0.05.The difference between the 12 th month and 1st month(P=0.048),12 th month and 3rd month(P=0.005)after poisoning was statistically significant(P<0.05).There was no statistical difference between the 12 th month and the 6th month(P>0.05).3)The difference in motor function between the 1st month,3rd month,6th month,and 12 th month after poisoning in patients with delayed encephalopathy was statistically significant,χ2(2)=15.98,P<0.05;The difference between the 12 th month and 1st month(P=0.013),12 th month and 3rd month(P=0.005)after poisoning was statistically significant(P<0.05).The difference between the 6th month and 1st month(P=0.032),6th month and 3rd month(P=0.013)after poisoning was statistically significant(P<0.05).There was no significant difference between the 12 th month and the 6th month and the 3rd month and the 1st month(P>0.05).4)The cognitive function difference between the 1st,3rd,6th,and 12 th month after poisoning in patients with delayed encephalopathy was statistically significant,χ2(2)=18.23,P<0.05;The difference between the 12 th month and 1st month(P=0.010),12 th month and 3rd month(P=0.002)after poisoning was statistically significant(P<0.05).The difference between the 6th month and 1st month(P=0.021),6th month and 3rd month(P=0.004)after poisoning was statistically significant(P<0.05).There was no significant difference between the 12 th month and the 6th month and the 3rd month and the 1st month(P >0.05).5)The difference in functional independence between the 1st,3rd,6th,and 12 th month after poisoning was statistically significant,χ2(2)=19.45,P <0.05;The difference between the 12 th month and 1st month(P=0.006),12 th month and 3rd month(P=0.001)after poisoning was statistically significant(P<0.05).The difference between the 6th month and 1st month(P=0.026),6th month and 3rd month(P=0.004)after poisoning was statistically significant(P<0.05).There was no significant difference between the 12 th month and the 6th month and the 3rd month and the 1st month(P>0.05).Conclusions: 1.Age and coma are independent risk factors for delayed encephalopathy in patients with carbon monoxide poisoning;risk of delayed encephalopathy in patients older than 40 years and comatose after CO poisoning is significantly higher.2.The improvement of neurological function in patients with delayed encephalopathy occurs mainly during the third to sixth months after poisoning,and the symptoms are improved more slowly after three months and six months before poisoning.3.hyperbaric oxygen therapy may be one of the factors to improve the prognosis of patients with delayed encephalopathy,post-poisoning(3-6 months)continued hyperbaric oxygen therapy on the prognosis of patients may not be obvious,still need more large-scale,multi-factor studies confirmed. |
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