일산화탄소중독에서 지연신경정신장애의 장기적인 예후 = Long-term outcome of delayed neuropsychiatric sequelae after carbon monoxide poisoning

다국어 초록 (Multilingual Abstract)

Objective: Delayed neuropsychiatric sequelae (DNS) following carbon monoxide (CO) poisoning, which may result from a demyelinating leukoencephalopathy, is a disease with a poor prognosis. This study examined the factors affecting the long-term prognosis of DNS and the efficacy of hyperbaric oxygen therapy (HBOT) in patients with DNS.
Methods: This retrospective study included 84 patients with DNS following CO poisoning from January 2013 to June 2016. HBOT was given to 24 patients. The patients were divided into an improvement group and non-improvement group based on their clinical condition on a telephone interview at intervals between 3 months and 3 years after the onset of DNS. The improvement group was defined as having Cerebral Performance Category (CPC) scores in their daily life that improve to 1 or 2 grade.
Results: Of the 594 patients, DNS were found in 18.2%, and 70.2% (59 of 84) of the patients with DNS improved. The prognostic factors for the improvement of DNS were an age of 45 years or less (odds ratio [OR], 12.068; 95% confidence interval [CI], 2.393-60.858; P<0.005), CPC score of 1 or 2 group at the time of DNS onset (OR, 12.361; 95% CI, 3.161- 48.330; P<0.005), and a lucid interval longer than 20 days (OR, 5.164; 95% CI, 1.393-19.141; P<0.01). HBOT was not associated with the improvement of DNS in CO poisoning (OR, 0.467; 95% CI, 0.172-1.269; P>0.1).
Conclusion: Patients aged less than 45 years, low grade CPC score of 1 and 2, and lucid interval longer than 20 days are more likely to have a good prognosis. On the other hand, HBOT failed to produce a benefit for DNS patients.

참고문헌 (Reference)

1 Hu MC, "Ziprasidone in the treatment of delayed carbon monoxide encephalopathy" 30 : 755-757, 2006

2 Lin WC, "White matter damage in carbon monoxide intoxication assessed in vivo using diffusion tensor MR imaging" 30 : 1248-1255, 2009

3 Cobb N, "Unintentional carbon monoxide-related deaths in the United States, 1979 through 1988" 266 : 659-663, 1991

4 Terajima K, "Serial assessments of delayed encephalopathy after carbon monoxide poisoning using magnetic resonance spectroscopy and diffusion tensor imaging on 3.0T system" 59 : 55-61, 2008

5 Kuroda H, "Novel clinical grading of delayed neurologic sequelae after carbon monoxide poisoning and factors associated with outcome" 48 : 35-43, 2015

6 Weaver LK, "Neuropsychologic and functional recovery from severe carbon monoxide poisoning without hyperbaric oxygen therapy" 27 : 736-740, 1996

7 Murata T, "Neuronal damage in the interval form of CO poisoning determined by serial diffusion weighted magnetic resonance imaging plus 1Hmagnetic resonance spectroscopy" 71 : 250-253, 2001

8 Devine SA, "MRI and neuropsychological correlates of carbon monoxide exposure : a case report" 110 : 1051-1055, 2002

9 Chang CC, "Longitudinal study of carbon monoxide intoxication by diffusion tensor imaging with neuropsychiatric correlation" 35 : 115-125, 2010

10 Thom SR, "Intravascular neutrophil activation due to carbon monoxide poisoning" 174 : 1239-1248, 2006

11 Annane D, "Hyperbaric oxygen therapy for acute domestic carbon monoxide poisoning : two randomized controlled trials" 37 : 486-492, 2011

12 Buckley NA, "Hyperbaric oxygen for carbon monoxide poisoning" 4 : CD002041-, 2011

13 Weaver LK, "Hyperbaric oxygen for acute carbon monoxide poisoning" 347 : 1057-1067, 2002

14 Thom SR, "Functional inhibition of leukocyte B2 integrins by hyperbaric oxygen in carbon monoxide-mediated brain injury in rats" 123 : 248-256, 1993

15 Hu H, "Factors affecting the prognosis of patients with delayed encephalopathy after acute carbon monoxide poisoning" 29 : 261-264, 2011

16 Wang W, "Effects of immune reaction in rats after acute carbon monoxide poisoning" 38 : 239-246, 2011

17 Gorman D, "Early evidence of a regulated response to hypoxaemia in sheep that preserves the brain cortex" 394 : 174-178, 2006

18 Chen M, "Differential roles of NMDA receptor subtypes in ischemic neuronal cell death and ischemic tolerance" 39 : 3042-3048, 2008

19 Thom SR, "Delayed neuropsychologic sequelae after carbon monoxide poisoning : prevention by treatment with hyperbaric oxygen" 25 : 474-480, 1995

20 Choi IS, "Delayed neurologic sequelae in carbon monoxide intoxication" 40 : 433-435, 1983

21 Hsiao CL, "Delayed encephalopathy after carbon monoxide intoxication--long-term prognosis and correlation of clinical manifestations and neuroimages" 13 : 64-70, 2004

22 Chang KH, "Delayed encephalopathy after acute carbon monoxide intoxication : MR imaging features and distribution of cerebral white matter lesions" 184 : 117-122, 1992

23 Xiang W, "Combined application of dexamethasone and hyperbaric oxygen therapy yields better efficacy for patients with delayed encephalopathy after acute carbon monoxide poisoning" 11 : 513-519, 2017

24 Weaver LK, "Clinical practice : carbon monoxide poisoning" 360 : 1217-1225, 2009

25 Weaver LK, "Carbon monoxide poisoning : risk factors for cognitive sequelae and the role of hyperbaric oxygen" 176 : 491-497, 2007

26 Lo CP, "Brain injury after acute carbon monoxide poisoning: early and late complications" 189 : W205-W211, 2007

27 Safar P., "Brain failure and resuscitation" Churchill Livingstone 155-184, 1981

28 Thom SR, "Antagonism of carbon monoxide-mediated brain lipid peroxidation by hyperbaric oxygen" 105 : 340-344, 1990

29 Min SK, "A brain syndrome associated with delayed neuropsychiatric sequelae following acute carbon monoxide intoxication" 73 : 80-86, 1986