일산화탄소 중독의 지연성 후유증에 관한 임상적 연구

A Clinical Study of Delayed Sequelae in Carbon Monoxide Intoxication

A total of 34 patients admitted to Korea University Medical Center with the diagnosis of delayed sequeale of carbon monoxide intoxication were studied and evaluated in terms of various clinical aspects and compared with 57 control patients randomly selected from a total of 128 patients who had admitted to the Medical Center with the diagnosis of acute carbon monoxide intoxication. The results were as follows: 1) The proportion of the 34 cases of dealyed sequelae to the 128 admitted cases with acute CO intoxication was 26.6% during the same period. 2) In the cases of delayed sequelae, the age of onset ranged from 23 to 79 years (mean age =34.6. years) and the age groups with the highest incidence were in the 50s(35.3%) and the 60s (29.4%). The age of onset of the delayed sequelae group was significantly old than the control (P < 0.0005). 3) Compared with the control, the patients with the delayed sequelae showed a much longer duration of impairment of consciousness (P <0.05)，were fewer in number who had been administered oxygen therapy (P < 0.01), and had more concomitant physical illness (P < 0.01) at the time of their acute intoxication 4) The lucid interval ranged from 3 to 43 days (mean = 16.8 days) and the lucid interval with the highest incidence was in the 2nd week *38.2%) and the 3rd week (32.5%). A possible factor influencing the lucid interval seems to have been the severity of the impairment of consciousness. 5) The characteristic symptoms manifested in patients with the delayed sequelae were mental confusion, impairment of orientation, memory, calculation and judgement, apathy or dullness, and incontinence. 6) The proportion of an abnormal EEG finding in the delayed sequelae cases was 87.5%. Diffuse irregular slow waves of 1.5-6Hz were prominent on both hemispheres, particulaly predominent on both frontal areas. 7) The proportion of an abonormal brain CT findings in the delayed sequelae cases was 46.7% and the characteristic findings included an enlarged ventricle, low density of cerebral white matter and infarction of basal ganglia. 8) Among the cases of delayed sequelae, 70.6% were discharged in an improved state. As compared with the not improved patients,the improved patients were significantly younger (P < 0.05) and had much longer length of stay in the hospital (P < 0.005). In addition, the improved patients tended to show evidence ofimprovement on subsequent EEG follow-up and no observable lesion of basal ganglia on brain CT scan.