作者：王昆，李军文，曾翔，郭雅乐，王兆兰

单位：

1.610500四川省成都市，成都医学院护理学院　2.610095四川省成都市第一人民医院护理部　3.610075四川省成都市，成都中医药大学护理学院

Units：

1.School of Nursing, Chengdu Medical College, Chengdu 610500, China2.Nursing Department, Chengdu First People's Hospital, Chengdu 610095, China3.School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China

关键词：

一氧化碳中毒；急性一氧化碳中毒迟发性脑病；发病率；影响因素分析；Meta分析

Keywords：

Carbon monoxide poisoning; Delayed encephalopathy after acute carbon monoxide poisoning; Incidence;Root cause analysis; Meta-analysis

CLC：

R 595.1

DOI：

10.12114/j.issn.1008-5971.2023.00.275

Funds：

四川省科学技术厅2022年重点研发计划项目（22JDKP0019）

摘要：

目的　通过Meta分析方法分析急性一氧化碳中毒迟发性脑病（DEACMP）的发生率及其影响因素。方法　计算机检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库、PubMed、Web of Science、Embase、Cochrane Library中关于DEACMP影响因素的文献，同时采用溯源法追溯相关参考文献。检索时限为建库至2023年8月。由两名研究人员独立进行文献检索、资料提取并采用纽卡斯尔-渥太华量表（NOS）进行文献质量评价。采用Review Manager 5.4软件进行Meta分析。结果　最终纳入文献21篇，共涉及5 957例急性一氧化碳中毒（ACMP）患者，其中DEACMP患者1 054例；其NOS评分为7～9分。Meta分析结果显示，DEACMP发生率为21%〔95%CI（16%，27%）〕。一氧化碳（CO）暴露时间延长、中重度中毒、格拉斯哥昏迷量表（GCS）评分降低、昏迷时间延长、年龄增长、QTc间期延长、颅脑CT/影像学检查结果异常、有心血管病史、肌酸激酶（CK）升高、C反应蛋白（CRP）升高是DEACMP的危险因素，高压氧治疗是DEACMP的保护因素（P＜0.05）。通过变换效应模型的方法进行敏感性分析，结果显示，除短暂性意识丧失和白细胞计数外，其他各影响因素的Meta分析结果未发生改变。漏斗图分析结果显示，报道DEACMP发生率的文献分布基本对称，提示不存在明显的发表偏倚。结论　DEACMP发生率为21%；且CO暴露时间延长、中重度中毒、GCS评分降低、昏迷时间延长、年龄增长、QTc间期延长、颅脑CT/影像学检查结果异常、有心血管病史、CK升高、CRP升高是DEACMP的危险因素，而高压氧治疗是其保护因素。

Abstract：

Objective To analyze the incidence and risk factors of delayed encephalopathy after acute carbonmonoxide poisoning (DEACMP) using Meta-analysis. Methods The literature on the influencing factors of DEACMP weresearched by computer from CNKI, Wanfang Data, VIP, China Biology Medicine disc, PubMed, Web of Science, Embase andCochrane Library, and the relevant references were traced by traceability method. The search deadline was from the establishmentof the database to August 2023. Literature search and data extraction were conducted independently by two researchers, andNewcastle-Ottawa Scale (NOS) was used to evaluate literature quality. Meta-analysis was performed using Review Manager 5.4software. Results Finally, 21 articles were included, involving a total of 5 957 patients with acute carbon monoxide poisoning(ACMP) , including 1 054 patients with DEACMP; and their NOS scores were 7-9 points. The meta-analysis results showed thatthe incidence of DEACMP in ACMP patients was 21% [95%CI (16%, 27%) ] . Prolonged exposure to carbon monoxide (CO) ,moderate to severe poisoning, decreased Glasgow Coma Scale (GCS) score, prolonged coma time, increased age, prolonged QTcinterval, abnormal brain CT/imaging results, history of cardiovascular disease, elevated creatine kinase (CK) , and elevatedC-reactive protein (CRP) were risk factors for DEACMP, while hyperbaric oxygen therapy was a protective factor for DEACMP(P < 0.05) . Sensitivity analysis was carried out by the method of transforming the effect model, and the results showed that themeta-analysis results of other influencing factors did not change except the transient loss of consciousness and white blood cell count. The funnel plot analysis results showed that distribution of the literature reporting the incidence of DEACMP was basicallysymmetrical, indicating that there was no significant publication bias. Conclusion The incidence of DEACMP is 21%. Inaddition, prolonged exposure to CO, moderate to severe poisoning, decreased GCS score, prolonged coma time, increased age,prolonged QTc interval, abnormal brain CT/imaging results, history of cardiovascular disease, elevated CK, and elevated CRP arerisk factors for DEACMP, while hyperbaric oxygen therapy is its protective factor.

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