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目的观察急性一氧化碳(CO)中毒患者清醒后脑电图(EEG)及脑干听觉诱发电位(BAEP)的动态变化,探讨二者对急性CO中毒后迟发性脑病(DEACMP)发病的预测价值。方法选取2006年2月—2010年12月在新乡医学院第一、第二、第三附属医院及新乡市中心医院住院治疗的急性CO中毒昏迷且经抢救清醒的患者83例,根据患者是否出现DEACMP将其分为DEACMP组(32例)及非DEACMP组(51例)。患者分别于急性中毒清醒后1～5 d、8～12 d、18～22 d、28～32 d、38～42 d及52～57 d进行6次EEG和BAEP检测,比较不同时点DEACMP组及非DEACMP组EEG、BAEP异常率,计算EEG、BAEP单独检测及二者联合检测预测DEACMP的敏感度、特异度。结果 (1)DEACMP组第1次、第4次、第5次、第6次EEG检测异常率均高于非DEACMP组,差异有统计学意义(P<0.05);DEACMP组第1次、第3次、第4次、第5次、第6次BAEP检测异常率均高于非DEACMP组,差异有统计学意义(P<0.01)。(2)83例急性CO中毒患者首次EEG检查共58例(69.9%)异常,其中27例发展为DEACMP。EEG检测预测DEACMP的敏感度为84.4%(27/32),特异度为39.2%(20/51)。首次BAEP检查共23例(27.7%)异常,其中19例发展为DEACMP。BAEP检查预测DEACMP的敏感度为59.4%(19/32),特异度为92.2%(47/51)。EEG联合BAEP检测,若其中一项阳性即视为阳性,则联合检测预测DEACMP的敏感度为93.7%,特异度为36.1%;若二者均为阳性时才视为阳性,则联合检测预测DEACMP的敏感度为50.1%,特异度为95.2%。动态EEG测定或BAEP测定若出现异常-好转-重新异常的情况,则高度预示DEACMP的发生。结论急性CO中毒后早期动态检测EEG及BAEP对预测DEACMP的发生具有重要意义和临床价值,值得推广应用。
Objective To observe the dynamic changes of electroencephalogram (EEG) and brainstem auditory evoked potential (BAEP) in patients with acute carbon monoxide (CO) poisoning after wakefulness, and to investigate their predictive value in the pathogenesis of delayed encephalopathy after acute carbon monoxide poisoning. Methods From February 2006 to December 2010, 83 patients with acute CO poisoning who were hospitalized in the first, second and third affiliated hospitals of Xinxiang Medical College and Xinxiang Central Hospital were coma and rescued. According to whether the patients appeared DEACMP is divided into DEACMP group (32 cases) and non-DEACMP group (51 cases). The patients were subjected to EEG and BAEP for 6 times at 1 ~ 5 d, 8 ~ 12 d, 18 ~ 22 d, 28 ~ 32 d, 38 ~ 42 d and 52 ~ 57 d respectively after acute awake. And non-DEACMP group EEG, BAEP abnormal rate, calculated EEG, BAEP alone test and the combination of the two to predict DEACMP sensitivity, specificity. Results (1) The abnormal rates of EEG in the first, fourth, fifth and sixth DEACMP group were significantly higher than those in non-DEACMP group (P <0.05) 3, 4, 5, 6 BAEP were higher than non-DEACMP group, the difference was statistically significant (P <0.01). (2) A total of 58 patients (69.9%) were abnormal in the first EEG examination of 83 patients with acute CO poisoning, of which 27 patients developed DEACMP. The sensitivity and specificity of EEG detection for DEACMP were 84.4% (27/32) and 39.2% (20/51) respectively. The first BAEP examination of 23 cases (27.7%) abnormalities, of which 19 cases developed as DEACMP. The sensitivity and specificity of BAEP were 59.4% (19/32) and 92.2% (47/51), respectively. EEG combined with BAEP test, if one of the positive is considered as positive, the combined test predicts DEACMP sensitivity was 93.7% and specificity of 36.1%; if both were positive as positive, the combined test predicts DEACMP The sensitivity was 50.1% and the specificity was 95.2%. Dynamic EEG or BAEP measured abnormalities - improved - re-abnormalities, the situation is highly predictable DEACMP. Conclusion The early dynamic detection of EEG and BAEP after acute CO poisoning is of great significance and clinical value in predicting the occurrence of DEACMP, which is worth popularizing and applying.