目的：探讨脑脊液压力升高对急性一氧化碳中毒迟发性脑病的早期诊断价值及对其预后的影响。方法选取120例中重度急性一氧化碳中毒患者，所有患者均在急性一氧化碳中毒后1周之内行腰椎穿刺术检查，测脑脊液压力。观察脑脊液压力升高对迟发性脑病的早期诊断价值及对其预后的影响。结果120例急性一氧化碳中毒患者中有38例患者发生了迟发性脑病，其迟发性脑病发生率为31.67%；在38例迟发性脑病患者中，有34例患者脑脊液压力升高，其异常率为89.47%；38例迟发性脑病患者经治疗后有32例均不同程度好转，其中完全治愈6例，生活全部或部分自理26例，死亡4例，昏迷状态2例。而痊愈的6例患者脑脊液压力均<150 mmH2O，死亡或昏迷的6例患者脑脊液压力均>200 mmH2O，生活全部或部分自理的26例患者脑脊液压力均在150～180 mmH2O之间。结论一氧化碳中毒急性期脑脊液压力升高对于迟发性脑病及其预后具有预测价值。%Objective To explore the association of increased cerebrospinal fluid pressure with delayed encepha⁃lopathy after acute carbonmonoxide poisoning. Methods One hundred twenty cases of severe acute carbon monoxide poi⁃soning patients were included in the present study. All patients underwent lumbar puncture for measurement of cerebro⁃spinal fluid pressure (mmH2O) within seven days following acute carbon monoxide poisoning. Results Thirty-eight pa⁃tients of total 120 patients had a delayed encephalopathy and the incident rate of delayed encephalopathy was 31.67%. In⁃creased cerebrospinal fluid pressure was detected in 34 cases of delayed encephalopathy patients and the abnormal rate was 89.47%. Thirty-two of 38 patients with delayed encephalopathy demonstrated improvement to varying degrees af⁃ter treatment:6 cases had complete recovery, 26 regained or partially regained the ability to live independently, four died and two were in coma. Cerebrospinal fluid pressure was less than 150 mmH2O in six patients who achieved full recovery, while cerebrospinal fluid pressure was great than 200 mmH2O in six patients who died or were in coma. Cerebrospinal flu⁃id pressure was around 150~180 mmH2O in patients who regained or partially regained the ability to live independently. Conclusion Elevated cerebrospinal fluid pressure at the early phase of carbon monoxide poisoning may have a predictive value in diagnosis and prognosis of delayed encephalopathy.
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