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目的:评估脑电图反应性分级(ECBER)在急性一氧化碳(CO)中毒后迟发性脑病(DEACMP)早期诊断及预后结局的临床价值。方法:选择74例临床诊断为急性CO中毒昏迷的患者,依据是否发生DEACMP将其分为发生DEACMP的观察组(31例)和未发生DEACMP的对照组(43例)。比较两组患者年龄、既往病史、中毒后昏迷时间、脑电图(EEG)评分及ECBER分级等临床指标差异。以临床诊断为金标准,评估ECBER分级对DEACMP的早期诊断敏感性、特异性及准确性。应用多因素Logistic回归分析与发病3个月患者生存率相关的危险因素。结果:观察组与对照组相比,其既往病史评分、中毒后昏迷时间、EEG评分及ECBER分级等临床指标差异均有统计学意义(t=2.361,t=2.822,t=3.398,t=3.279;P<0.05)。ECBER早期诊断DEACMP的灵敏度、特异度和准确率分别为83.9%、76.7%和79.7%。多因素Logistic回归分析显示,ECBER分级是发病3个月DEACM患者生存率的危险因素(OR=3.624,P<0.05)。结论:ECBER能够早期诊断DEACMP,并且能较好地评估急性CO中毒昏迷的患者短期预后结果。
Objective: To evaluate the clinical value of ECBER in the early diagnosis and prognosis of delayed encephalopathy (DEACMP) after acute carbon monoxide (CO) poisoning. Methods: A total of 74 patients with clinical coma were enrolled in the study. The patients were divided into two groups: DEACMP observation group (31 cases) and control group (43 cases) without DEACMP. The differences of clinical indexes such as age, past medical history, coma time after poisoning, EEG score and ECBER grade were compared between the two groups. With clinical diagnosis as the gold standard, the sensitivity, specificity and accuracy of ECBER classification for early diagnosis of DEACMP were evaluated. Multivariate logistic regression analysis was used to analyze the risk factors associated with survival at 3 months after onset. Results: Compared with the control group, the scores of past medical history, coma time after poisoning, EEG score and ECBER grade in the observation group were statistically significant (t = 2.361, t = 2.822, t = 3.398, t = 3.279 ; P <0.05). The sensitivity, specificity and accuracy of ECAC for the early diagnosis of DEACMP were 83.9%, 76.7% and 79.7%, respectively. Multivariate logistic regression analysis showed that the ECBER classification was a risk factor for survival of patients with DEACM 3 months after onset (OR = 3.624, P <0.05). Conclusion: The ECBER can diagnose DEACMP early and evaluate the short-term prognosis of patients with coma of acute CO poisoning.