一氧化碳中毒繼發(fā)腦梗死患者的臨床相關(guān)因素分析及預(yù)后評估研究
發(fā)布時間：2019-03-08 14:21
【摘要】：[目的]探討一氧化碳中毒(Carbon monoxide,CO)繼發(fā)腦梗死患者的臨床相關(guān)因素及預(yù)后,為臨床一氧化碳中毒繼發(fā)腦梗死患者的治療及預(yù)后的評估提供參考。[方法]采用回顧性研究方法,收集、分析2011年1月至2016年09月期間到延邊大學(xué)附屬醫(yī)院就診的151例急性一氧化碳中毒患者的相關(guān)人口統(tǒng)計學(xué)及臨床基本信息資料。根據(jù)患者頭部影像學(xué)、一氧化碳中毒繼發(fā)腦梗死組患者第90天改良Rankin評分(ModifiedRankinScale,mRS)、假愈期天數(shù),采用多因素Logistic回歸分析并明確一氧化碳中毒相關(guān)臨床因素及預(yù)后危險因素。[結(jié)果]1.一氧化碳中毒繼發(fā)腦梗死組與未繼發(fā)腦梗死組中,多因素Logistic回歸分析示:校正單因素分析中與新發(fā)腦梗死相關(guān)的危險因素(糖尿病、高血壓、吸煙、飲酒、體重指數(shù)、纖維蛋白原測定)后,糖尿病(OR 12.673,95%C/4.100-39.175,P0.001)、高血壓(OR3.315,95%CI1.247-8.811,P=0.016)、飲酒(OR 3.272,95%C/1.083-9.885,P=0.036)是一氧化碳中毒繼發(fā)腦梗死的獨立危險因素。2.一氧化碳中毒繼發(fā)腦梗死患者預(yù)后良好組與預(yù)后不良組中多因素Logistic回歸分析示:校正單因素分析中與預(yù)后不良組的危險因素(飲酒、總膽固醇濃度、使用依達(dá)拉奉治療、輔助通氣、纖維蛋白原測定)后,飲酒(OR45.454,95%CI 1.190-9.434,P=0.022)是一氧化碳中毒繼發(fā)腦梗死預(yù)后不良的獨立危險因素,使用依達(dá)拉奉(OR 0.274,95%CI0.107-0.701,P=0.007)是一氧化碳中毒繼發(fā)腦梗死預(yù)后不良的保護(hù)因素。輔助通氣組與未輔助通氣組就入院NIHSS評分、第90天NIHSS評分、NIHSS評分下降數(shù)值方差分析示:第90天NIHSS評分(F=4.589,P=0.034),NIHSS下降數(shù)值(F=8.009,P=0.006)差異有統(tǒng)計學(xué)意義。3.一氧化碳中毒遲發(fā)性腦病2-30天組與30-60天組中多因素Logistic回歸分析模型示:校正單因素分析中與延長假愈期的危險因素[糖尿病、高血壓、吸煙、飲酒、低密度脂蛋白膽固醇濃度(Low density lipoprotein cholesterol,LDL)、高密度脂蛋白膽固醇濃度(High density lipoprotein cholesterol,HDL)]后,糖尿病(OR 59.087,95%CI 5.826-7.054,P=0.001)、高血壓(OR 19.040,95%CI 2.714-133.576,P=0.003)、吸煙(OR 10.640,95%CI1.748-64.760,P=0.010)、飲酒(OR 29.429,95%CI3.666-236.231,P=0.001)是延長假愈期時間的獨立危險因素。[結(jié)論]影響一氧化碳中毒繼發(fā)腦梗死患者預(yù)后及遲發(fā)性腦病假愈期的危險因素較多,如糖尿病、高血壓、飲酒等,應(yīng)早期評估一氧化碳中毒的患者,治療上使用依達(dá)拉奉、輔助通氣等積極干預(yù)措施可能改善其預(yù)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.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R595.1;R743.3
本文編號：2436897
[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.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R595.1;R743.3
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