一氧化碳中毒病人發生神經後遺症的獨立影響因子研究

Predicting the neurological sequelae for patients with CO intoxication

李瑞琦(Jui-Chi Li)

指導教授 ： 周照偉

義守大學/電機資訊學院/資訊管理學系/碩士(2015年)

https://doi.org/10.6343/ISU.2015.00207

摘要

目前對於一氧化碳中毒後預測神經學後遺症的危險因子目前並無共識．為了尋求此問題的解答，我們設計了一個回溯性的病例對照研究（case-control study），收集南臺灣某大型醫院在2005年1月1日到2013年12月31日期間一氧化碳中毒的病人來研究希望能統一預測神經學後遺症的危險因子。我們總共納入了301位病人，以有神經學後遺症的病人（81位）為病例組，並選無神經學後遺症病人（220位）為對照組。我們收集病人的年齡、性別、過去病史、一氧化碳中毒原因與暴露時間、症狀、實驗室檢查結果（包括一氧化碳血紅素carboxyhemoglobin [COHb]濃度）、高壓氧治療、插管、住院時間與住院類別等，使用SPSS 20.0統計軟體來分析比較何者為預測產生神經學後遺症的因子．我們得到的結果是病例組平均年齡為39.8 ± 13.3歲，對照組為38.6 ± 13.9歲， 病例組男性占60.5%，對照組為58.2%。而燒炭自殺是最常見的一氧化碳中毒原因（90%），其次是瓦斯不完全燃燒（6%）。我們發現一氧化碳血紅素（COHb）的濃度高低與有無高壓氧治療並不是預測產生神經學後遺症的預測因子。經過多變項邏輯斯迴歸分析分析後，發現唯一的獨立預測因子是一氧化碳中毒暴露的時間。暴露的時間越長，神經學的後遺症機會越高，暴露超過5小時的病人，產生神經後遺症的機會是小於3小時的2.36倍．因此，當我們在想辦法治療一氧化碳中毒之餘，應該力求減少一氧化碳中毒與減短其暴露時間，包括自殺防治、居家瓦斯使用安全與早期認知一氧化碳中毒症狀等，這可能才是最有效的治本之道。

關鍵字

一氧化碳中毒 ； 神經後遺症

並列摘要

So far, the risk factor of the forecast neurological sequelae after carbon monoxide poisoning is controversial. In order to find the answer to this question, we conducted a retrospective case-control study which includes the patients who are poisoned by carbon monoxide from 2005 Jan 1st to 2013 Dec 31st in one of the southern Taiwan medical centers. We collected 301 patients in our study. There are 81 patients who had neurological sequelae in the case group. The control group includes 220 patients who didn’t had neurological sequelae. We collected the patients’ age, gender, past history, the cause of carbon monoxide poisoning, the exposure period, symptom, laboratory data which included the concentration of carboxyhemoglobin [COHb], hyperbaric oxygen therapy, intubation, hospital time, the length of hospital stay, and the unit of hospitalization. We use statistic software SPSS 20.0 to analysis the risk factor of the forecast neurological sequelae after carbon monoxide poisoning.
The average age of case is 39.8±13.3 years old and the age of control is 38.6±13.9 years old. There are 60.5% patients of the case group are male, and 58.2% of the control group (P value=0.72). The major cause of carbon monoxide poisoning is charcoal burning (90%). Second cause is gas incomplete combusting (6%). We found that the concentration of carboxyhemoglobin [COHb] and hyperbaric oxygen therapy are both not the risk factor of the forecast neurological sequelae after carbon monoxide poisoning. We found the only independent risk factor is the exposure period of carbon monoxide after analyzing in the logistic regression model. The longer period of carbon monoxide the patients exposure, the higher possibility have the neurological sequelae. The odds ratio of patients who expose carbon monoxide more than five hours are 2.36 compare with the patients expose under three hours.
Therefore, while we seek the best way of treating the carbon monoxide poisoning, we may also try to eliminate the carbon monoxide poisoning and to shorten the exposure period in the same time. The act including suicide prevention, home safety of gas consuming and the knowledge of early symptoms of carbon monoxide poisoning which may be the most effective path to solve this problem.

並列關鍵字

C O intoxicatio ； Neurologic sequelae

參考文獻

2.邱彥文、王建楠、吳政龍、蘇世斌(2005)．淺談一氧化碳中毒．基層醫學， 2 0 ( 11 )，302-307.

6.陳瓊芳、宋文舉(2002)．一氧化碳中毒．中華民國兒童胸腔醫學會刊， 3(1)， 1-10.

3.林佳谷、陳叡瑜 (2007)．一氧化碳性格．工業安全衛生月刊，215(1)，28-34.

8.陳耀仁、蔡素如、蔡岳霖(2008)，遲發性缺氧性腦病變後之復健:病例報告，台灣復健醫誌 2008; 36(2): 111-117.

1.呂博弘、陳春萬、張振平 (2006)．陽台通風影響瓦斯熱水器一氧化碳累積之研究．勞工安全衛生研究季刊，14(4)，299-307.