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·来稿摘登·一氧化碳中毒引起痴呆一例报告河南省电力医院神经内科郝红(邮政编码:郑州450052)患者,女,58岁,因智能减退伴小便失禁一周入院。患者20天前因煤气中毒出现昏迷、频繁抽搐及小便失禁,经治疗两天后神志清醒,病情好转。一周前出现精神异常及智能减退,伴小便失禁.查神志清楚,反应迟钝,不能正确回答问题。有幻视及幻听,计算力及定向力丧失,烦躁多语。脑电图为中度弥散性异常,头颅 CT 扫描未见异常。给予胞二磷胆碱、ATP、辅酶 A、细胞色素 C 等,并配合高压氧仓治疗,病情减轻,但智能减退无改善。讨论:一氧化碳中毒主要是一氧化碳与血红蛋白结合成氧合血红蛋白导致组织缺氧,中枢神经系统受累较重。主要病理改变是脑血管痉挛,脑水肿,皮层和基底节局灶性软化等,约9％的患者发生远并期发症,如瘫痪、失语,精神异常及智能障碍等。为预防远期并发症,急性期治疗中应注意以下几点:①吸氧,最好在中毒38小时内进行高压氧仓治疗.②脱水治疗减轻脑水肿,③解除脑血管痉挛。④应用高渗糖,大量维生素 C 及能量合剂。
· Citation Report · A case of dementia caused by carbon monoxide poisoning Hao Hong (Postcode: Zhengzhou 450052), female, 58 years old, hospitalized for one week due to schizophrenia with incontinence. Patients 20 days ago due to gas poisoning coma, frequent convulsions and urinary incontinence, consciousness after two days of treatment, his condition improved. A week ago, mental disorders and mental decline, accompanied by urinary incontinence. Check the conscious, unresponsive, can not correctly answer the question. There are visual hallucinations and auditory hallucinations, loss of calculating power and orientation, irritability and more language. EEG was moderately diffuse abnormalities, no abnormal CT skull. Given citicoline, ATP, coenzyme A, cytochrome C, etc., and hyperbaric oxygen chamber treatment, reduce the disease, but did not improve the intelligence decline. Discussion: Carbon monoxide poisoning is mainly the combination of carbon monoxide and hemoglobin into oxyhemoglobin resulting in tissue hypoxia, central nervous system involvement. The main pathological changes are cerebral vasospasm, cerebral edema, focal cortical and basal ganglia softening, about 9% of patients with distant complications, such as paralysis, aphasia, mental disorders and mental retardation. In order to prevent long-term complications, we should pay attention to the following points in the treatment of acute phase: (1) Oxygen inhalation is best performed in hyperbaric oxygen chamber for 38 hours after poisoning. (2) Dehydration therapy can relieve cerebral edema and (3) relieve cerebral vasospasm. ④ application of hypertonic sugar, a large number of vitamin C and energy mixture.