急性一氧化碳中毒患者心肌酶及左心室射血分数分析

目的探讨心肌酶及左心室射血分数（LVEF）在急性一氧化碳中毒患者心肌损伤诊断中的意义。方法对76例急性一氧化碳中毒患者分为轻、中、重度3组,分别检测心肌酶及LVEF,比较3组患者的心肌酶及LVEF异常比值。结果76例急性一氧化碳中毒患者心肌酶谱检查60例异常,占78．9％。异常率与中毒程度有关,轻度、中度、重度组人院36h心肌酶谱异常率分别为14．3％、85．7％、100％,3组间的差异有统计学意义（P〈0．05或P〈0．01）,LVEF检查轻度、中度、重度组异常率分别为：0、17．9％（5例）、70．6％（24例）,重度组LVEF异常率显著高于轻、中度组。3组间差异有统计学意义（P〈0．01）。结论急性一氧化碳中毒可造成一定程度的心肌损害,中毒程度越重,心肌酶越高,LVEF异常越明显,重度中毒对心肌代谢及心脏收缩功能均有明显影响。故心肌酶结合LVEF更能准确反映出急性一氧化碳中毒时心肌损害严重程度。     

急性一氧化碳中毒心肌损害68例临床分析

目的评价急性一氧化碳（CO）中毒时心肌酶变化及心电图的改变对心肌损害的诊断价值。方法回顾性分析2004年10月-2008年3月急诊入院的急性CO中毒患者68例,分为轻度、中度和重度中毒组。同时在健康体检中随机选取60例健康人为对照组。68例患者入院24h内采静脉血,对照组清晨抽空腹静脉血,测定心肌酶并完成12导联心电图描记。结果急性CO中毒患者中有23例（占33．8％）血清心肌酶谱改变。中、重度中毒者多有不同程度的心肌酶升高,与健康对照组相比,差异有统计学意义（P〈0．01）,中、重度中毒与轻度中毒相比,差异亦有统计学意义（P〈0．01）。心电图异常改变有52例（占76．5％）。经治疗68例患者均康复出院,在CO中毒纠正后,心肌酶和心电图均恢复正常。结论心肌酶升高是预测急性CO中毒心肌损害的理想指标。     

重度急性有机磷农药中毒并发呼吸窘迫综合征的危险因素分析

目的探讨重度急性有机磷农药重度中毒并发急性呼吸窘迫综合征（ARDS）的危险因素。方法回顾性分析9年来收治的75例重度急性有机磷农药中毒病例，以ARDS为因变量，与其可能相关的8项因素为变量进行统计学分析，以确定ARDS的高危因素。结果多变量及单变量分析显示，老年患者较青少年和中年人更易发生ARDS（P〈0．01）。中毒前其重要脏器已有基础病变者较无此病变者易发生ARDS，且差异均有统计学意义（P〈0．01）；空腹经口中毒较餐后中毒、延缓治疗较及时治疗容易发生ARDS，差异有统计学意义（P〈0．05或P〈0．01）；出现误吸时，能增加发生ARDS的机会；复能剂剂量小，使用时间短，增加发生ARDS的机会，且差异有统计学意义（P〈0．05）。结论重度急性有机磷农药中毒具有年龄高、重要脏器有基础疾病、空腹经口中毒、复能剂剂量小，使用时间短均是高危因素，应加强监测，以减少ARDS的发生。     

鼠神经生长因子对一氧化碳中毒续发脑病患名血浆NSE、NO含量变化的影响

目的观察鼠神经生长因子对一氧化碳中毒续发脑病患者神经元特异性烯醇化酶（NSE）、一氧化氮（NO）的影响及治疗效果。方法所有患者于入院后随机分为治疗组（29例）、对照组（27例）,治疗组在基础治疗时加用鼠神经生长因子t8Ixg（〉9000AU）,肌肉注射,1次／次,30d为1疗程。所有患者在入院时、治疗10d、30d,均应用简明痴呆量表进行评定（MMSE）,并检测血浆NSE、NO水平。结果治疗10d时,治疗组NO水平较治疗前上升（P〈0．05）。治疗30d,治疗组MMSE评分、NO水平上升,NSE水平下降,与治疗前比较有统计学差异（P〈0．01）;对照组MMSE评分、NO水平升高较治疗前上升（P〈0．01）,NSE水平较治疗前无下降（P〉0．05）,两组间MMSE评分、NSE、NO水平比较差异有统计学意义（P〈0．05或P〈0．01）。结论鼠神经生长因子可保护一氧化碳中毒续发脑病患者神经元,改善智能。     

急性脑出血患者测定糖化血红蛋白的临床意义

目的：探讨糖化血红蛋白测定对判定急性脑出血患者血糖升高的意义。方法：测定122例脑出血患者（脑出血组）和56例健康体检人员（对照组）糖化血红蛋白与空腹血糖值,进行统计分析。结果：脑出血组血糖水平及糖化血红蛋白水平均明显高于正常对照组（P〈0．01）。性别之间差异无统计学意义;血糖升高的无糖尿病脑出血组血糖与正常对照组比较差异有统计学意义（P〈0．01）。糖化血红蛋白水平与正常对照组比较差异无统计学意义（P〉0．05）。与脑出血合并糖尿病组比较两项差均异有统计学意义（P〈0．01）。结论：糖化血红蛋白测定对判定急性脑出血患者血糖升高的来源具有重要意义。     

小儿急性有机磷中毒血清心肌酶变化及临床意义

目的探讨急性有机磷中毒（AOPP）患儿血清心肌酶变化及其临床意义。方法120例中毒患儿（中毒组）入院后第1、3、5、10天分别取静脉血测定血清心肌酶并做心电图。120例患儿根据病情严重程度分为轻、中、重度中毒组，分别为24例、69例、27例；同时测定门诊健康查体儿童40例血清心肌酶作对照组。结果急性有机磷中毒患儿血清心肌酶迅速升高，第3天达高峰，与对照组比较差异有统计学意义（P〈0．01），轻、中、重度中毒组与对照组之间两两比较差异有统计学意义（P〈0．01或P〈0．05）。中毒程度越重，血清酶升高越明显，心电图异常发生率越高，以心脏为主的组织损害越重。结论血清心肌酶测定可作为判断急性有机磷中毒程度、指导治疗及估计预后的一项临床有效指标之一。     

溶血性贫血患者与正常人血红蛋白浓度的比较

目的通过比较溶血性贫血（HA）患者与正常人的血红蛋白浓度,探讨平均红细胞血红蛋白浓度（MCHC）对溶血性贫血诊断的临床意义。方法统计HA、小细胞HA（先天遗传小细胞或合并IDA）、缺铁性贫血（IDA）、巨幼细胞性贫血（MA）各50例患者外周血象平均红细胞血红蛋白量（MCH）、MCHC、平均红细胞体积（MCV）数据,以健康人群50名为对照组,比较各实验组与对照组的MCH、MCHC、MCV均值。结果外周血象MCHC比较显示HA患者MCHC明显比MA、IDA及对照组要高,差异有统计学意义（P〈0．01）;小细胞HA患者和MA患者外周血象MCHC与对照组差异无统计学意义（P〉0．05）,而小细胞HA患者MCV明显比对照组低（P〈0．01）,MA患者MCV则明显高于对照组（P〈0．01）;外周血象MCHC最低的IDA患者与对照组及其他实验组差异有统计学意义（P〈0．01）。结论MCHC可作为早期溶血性贫血的诊断指标。     

食管癌患者血清sMICA检测的临床意义

目的评价sMICA的检测对食管癌患者的临床诊断价值，进一步探讨sMICA与食管癌患者病理临床特征关系。方法应用酶联免疫法对60例术前食管癌患者和其中35例术后患者及30例健康人血清sMICA含量进行测定，并进行分析。结果食管癌组患者血清sMICA含量明显高于健康组，两组差异有统计学意义（P〈0．01）；腺癌组患者血清sMICA明显高于鳞癌组患者，差异有统计学意义（P〈0．01）；在TNM分期中，Ⅱ、Ⅲ、Ⅳ期食管癌患者血清sMICA含量依次增高，三期间总体差异有统计学意义（P〈0．01），且任意两期间比较有差异；有淋巴结转移的患者血清sMICA含量高于无淋巴结转移的患者，差异有统计学意义（P〈0．01）；Ⅲ期患者术前血清sMICA含量高于术后，差异有统计学意义（P〈0．01）。结论血清sMICA的检测有助于食管癌的临床辅助诊断，检测sMICA对判断食管癌生物学行为及预后有一定临床意义。     

不同氧浓度复苏囊正压呼吸在早产儿原发性呼吸暂停中的应用

目的观察不同氧浓度复苏囊正压呼吸在早产儿原发性呼吸暂停中的有效性及其安全性。方法将需要复苏囊正压呼吸的70例原发性呼吸暂停早产儿随机分为三组,A组用21％氧气正压人工呼吸（n=23）;B组用40％氧气正压人工呼吸（n=25）;C组用100％氧气正压人工呼吸（n=22）。比较三组抢救有效率及有效者PaO2、PaCO2情况。结果有效率B组为88．0％,A组为56．5％,C组为95．5％,三组差异有统计学意义（x2=12．21,P〈0．01）,而B组与A组、C组与A组之间差异有统计学意义（X2=6．01,P〈0．05;x2=9．23,P〈0．01）,但B组与C组间差异无统计学意义（x2=0．15,P〉0．05）。三组间有效者PaO2值差异有统计学意义（P〈0．01）,其中A组、B组与C组间差异有统计学意义（P〈0．01）;而有效者PaCO2值差异无统计学意义（P〉0．05）。结论用40％氧气复苏囊正压呼吸（不接储氧器的自动充气式气囊）既可保证早产儿原发性呼吸暂停中抢救的成功率,又可减少用高浓度氧导致氧中毒的发生,临床上简单易行。     

新生儿缺氧缺血性脑病患儿血清MMP-9水平动态变化及意义

目的研究新生儿缺氧缺血性脑病（HIE）血清中基质金属蛋白酶-9（MMP-9）水平的动态变化,探讨血清中MMP-9水平和新生儿脑缺氧缺血后脑损伤程度之间的关系。方法用酶联免疫吸附法测定88例HIE患者发病后1、3、7d血清MMP-9浓度,并与26例健康新生儿对照组比较。结果（1）HIE患者发病后1、3、7d,血清MMP-9水平均高于对照组,差异有统计学意义,第3天明显升高,第7天有下降趋势。（2）轻度、中度、重度HIE患者血清MMP-9水平,与对照组相比差异有统计学意义（P〈0．05）;组间两两比较,差异有高度统计学意义（P〈0．01）,其中重度表达最高。（3）轻度、中度、重度HIE患者发病后第3天血清MMP-9水平,组间两两比较,差异均有高度统计学意义（P〈0．01）,重度组表达显著高于轻、中度组。结论HIE患者发病早期血清MMP-9水平即有升高,提示MMP-9在HIE的发病过程中起着重要的作用。病情越严重,血清MMP-9,MMP-2升高越明显,提示血清MMP-9水平可能是判断病情的严重程度及病情进展的辅助指标。     

Occult carbon monoxide poisoning in patients with neurologic illness

To investigate occult carbon monoxide poisoning in patients with neurologic illness, we prospectively studied 168 patients who presented to the emergency department between December 1987 and February 1988 with neurologic symptoms for evidence of carbon monoxide exposure. Patients with known carbon monoxide poisoning were excluded. The mean carboxyhemoglobin level was 3.1 percent; there were no significant differences in carboxyhemoglobin between categories of neurologic illness (F(5,162) = 1.35; p less than 0.25). Five patients (3 percent) had a carboxyhemoglobin greater than 10 percent, with levels ranging from 11.7 percent to 29.5 percent. After controlling for the effects of active and passive exposure to cigarette smoke, problems with the home heating system (odds ratio 9.6; p less than 0.03) and the presence of cohabitants with concurrent headache or dizziness (odds ratio 21.6; p less than 0.0001) were associated with an increased risk of a carboxyhemoglobin greater than 10 percent. A rule for obtaining carboxyhemoglobin tests only on patients who used gas stoves for heat or who had symptomatic cohabitants would have correctly identified all patients with carboxyhemoglobins greater than 10 percent, correctly excluded 77 percent of patients with lower levels, and eliminated the need for testing in 75 percent of cases. We conclude that unrecognized carbon monoxide poisoning occurs in a small but important fraction of patients with wintertime neurologic illness and can be identified by a characteristic risk factor profile.     

急性一氧化碳中毒血浆NT-proBNP的变化及其与LVEF之间的关系

目的：探讨血浆N末端B型脑钠肽原（NT-proBNP）在急性一氧化碳中毒（ACOP）患者心功能评价中的临床意义。方法回顾性观察2010年10月～2014年2月在我科住院的急性一氧化碳中毒患者68例,按照中毒程度分为轻、中、重3组。取同一时期30例健康体检者作为对照。患者入院后2h内抽取静脉血测定血浆NT-proBNP水平,24h内超声心动图检测左室射血分数（LVEF）。结果和对照组比较,ACOP轻、中、重度组血浆NT-proBNP水平升高,LVEF则下降,与对照组比较有显著性差异（P〈0.01）。轻、中、重度ACOP 3组NT-proBNP相互比较,重度组高于中度及轻度组,中度组高于轻度组,有显著性差异（P〈0.01）,而LVEF则呈相反变化趋势,NT-proBNP和LVEF具有负相关。结论 ACOP患者血浆NT-proBNP升高,LVEF则下降,且NT-proBNP随中毒程度加深而显著升高,与左室射血功能密切相关,可作为ACOP的常规检查,对ACOP后心功能评估有着重要意义。     

Serum levels of NT-ProBNP as an early cardiac marker of carbon monoxide poisoning

Acute carbon monoxide (CO) poisoning may cause cardiotoxicity. The natriuretic peptides, including atrial natriuretic peptide, brain natriuretic peptide (BNP), N-BNP, and NT-proBNP (N-terminal pro brain natriuretic peptide), are endogenous cardiac hormones that may be secreted upon myocardial stress. The aim of this study was to assess the plasma NT-proBNP level in acute CO poisoning and to compare it with healthy control. After approval by the ethical committee, 15 healthy controls and 15 patients admitted to the Gaziantep University Hospital (Gaziantep, Turkey) between January 2005 and July 2005 with the diagnosis of carbon monoxide poisoning were studied. Echocardiography was performed to all patients. Serum NT-proBNP, creatine kinase (CK), creatine kinase-MB (CK-MB), and troponin-T were also analyzed, along with the carboxyhemoglobin (COHb) level. The correlation between serum NT-proBNP and COHb level was investigated. Electrocardiography (ECG) was performed to all patients and healthy controls, and the results were compared. Differences in troponin, CK, and CK-MB levels were not statistically significant between groups (p > 0.05). The level of NT-proBNP and COHb were found to be increased in the study group. There was a positive correlation between the COHb and the NT-proBNP (r = 0.829, p < 0.01), and between the COHb and the CK (r = 0.394, p < 0.01). There was no difference between groups in other parameters, all of which were within normal range. Thus, in this study we showed that the plasma NT-proBNP level may contribute to the early diagnosis of cardiotoxicity in patients with carbon monoxide poisoning.     

乌司他丁联合低分子肝素治疗急性重度一氧化碳中毒疗效观察

目的探讨乌司他丁联合低分子肝素对急性重度一氧化碳中毒（SACMP）的治疗作用。方法 108例SACMP患者随机分为对照组和治疗组,每组54例。所有患者均给高压氧、脱水、营养脑神经治疗。治疗组在此基础上,给低分子肝素钙5000 U皮下注射,b.i.d.×10 d,乌司他丁30万U静脉注射,q8 h×7 d。结果 24 h内清醒率治疗组77.8%比对照组66.7%高,差异有统计学意义（P〈0.05）;14 d和3个月有效率治疗组分别为92.6%和96.3%高于对照组的79.6%和85.2%,差异有统计学意义（P〈0.05）;24 h和14 d时血栓栓塞总发生率治疗组分别为3.70%和0,显著低于照组的25.93%和9.26%,差异有统计学意义（P〈0.05）;迟发性脑病发生率对照组7.41%（4/54）高于治疗组的1.85%（1/54）,两组比较差异均无统计学意义（P〉0.05）,将迟发性脑病患病率和死亡率合并比较对照组显著高于治疗组,差异有统计学意义（P〈0.05）。结论在高压氧、脱水、营养脑神经治疗的基础上,乌司他丁联合低分子肝素治疗SACMP,患者意识恢复快、有效率高、血栓栓塞事件显著减少,迟发型脑病和死亡患者减少。     

急性一氧化碳中毒后发生急性肺损伤的相关危险因素分析

目的 探讨急性一氧化碳中毒后发生急性肺损伤的相关危险因素.方法 整理2007年1月至2009年12月于哈尔滨市第一医院就诊,诊断为“急性一氧化碳中毒”患者180例的临床资料,分为发生急性肺损伤组和未发生急性肺损伤组,收集了指标:年龄、性别、中毒媒介、有无误吸、中毒程度、入院时动脉血氧分压、动脉血乳酸;入院时血常规白细胞计数;入院时生化肌酸激酶浓度.进行了单因素分析、Logistic回归分析,筛选出急性一氧化碳中毒后发生急性肺损伤的相关危险因素.结果 该研究总例数180例,男86例,女94例,年龄(42.90±18.99)岁.发生急性肺损伤患者38例,患病率21.11％.通过单因素分析显示年龄、性别、入院时血氧分压发生急性肺损伤组和未发生急性肺损伤组比较差异无统计学意义(P＞0.05).有无误吸;中毒媒介;中毒程度;昏迷时间;入院时动脉血乳酸、入院时血常规白细胞计数、入院时生化肌酸激酶浓度,两组比较差异有统计学意义(P＜0.05).对单因素分析差异有统计学意义的指标进行二项logistic回归分析,显示误吸、重度中毒、煤烟中毒、血动脉乳酸升高的OR值分别为3.06、4.80、2.00、1.20;均是急性一氧化碳中毒后发生急性急性肺损伤的相关危险因素(P＜0.05).结论 误吸、重度中毒、煤烟中毒、血乳酸升高均是急性一氧化碳中毒后发生急性急性肺损伤的危险因素.     

急性CO中毒患者血清S100B、NSE、MBP的动态改变及其意义

目的探讨急性一氧化碳中毒患者血清S100B、神经元特异性烯醇化酶（NSE）、髓鞘碱性蛋白（MBP）的动态改变及其与患者的病情、预后的关系。方法检测30名健康体检者和185例一氧化碳中毒患者入院时SIOOB、NSE、MBP水平,并对其中60例中重型住院病人第2、3天这些指标进行检测,分析其与患者预后的关系。结果入院时,中重型一氧化碳中毒患者血清S100B、NSE水平明显高于对照组和轻型一氧化碳中毒患者;中重型患者血清MBP水平高于轻型,轻型高于对照组。对中重型一氧化碳中毒患者,死亡患者第2天SIOOB、NSE水平明显高于人院时水平,第3天与第2天相比无统计学差异;而MBP水平在3天中无明显改变（P〉0．05）;存活患者中,SIOOB、NSE、MBP3天无明显改变。结论一氧化碳中毒患者入院时MBP水平与患者病情密切相关,而动态检测NSE、SIOOB水平能有效地判断对患者预后。     

Cardiac damage in pediatric carbon monoxide poisoning

BACKGROUND: Cardiovascular disorders including myocardial ischemia and heart failure have been described in both laboratory animals and humans following carbon monoxide poisoning. Carbon monoxide cardiotoxicity may be clinically occult and often remains undiagnosed because of the lack of overt symptoms and specific ischemic changes in the electrocardiogram. Routine myocardial necrosis markers have low diagnostic efficiency, particularly in patients with concomitant skeletal muscle necrosis or multiple organ failure complicating carbon monoxide poisoning. Carbon monoxide-induced cardiotoxicity has been investigated rarely in children. CASE REPORT: This paper describes carbon monoxide poisoning in a 12-year-old child who suffered from occult cardiac damage despite mild symptoms and low carboxy hemoglobin concentrations. Myocardial and mitral valve dysfunctions were observed, suggesting an ischemia-like syndrome. Cardiac damage was completely reversible within 1 month. CONCLUSION: This case report supports that a prolonged carbon monoxide exposure can cause cardiac damage in children even in the absence of specific symptoms, cerebral failure and high carboxyhemoglobin concentrations.     

Serum Levels of NT-ProBNP as an Early Cardiac Marker of Carbon Monoxide Poisoning

Acute carbon monoxide (CO) poisoning may cause cardiotoxicity. The natriuretic peptides, including atrial natriuretic peptide, brain natriuretic peptide (BNP), N-BNP, and NT-proBNP (N-terminal pro brain natriuretic peptide), are endogenous cardiac hormones that may be secreted upon myocardial stress. The aim of this study was to assess the plasma NT-proBNP level in acute CO poisoning and to compare it with healthy control. After approval by the ethical committee, 15 healthy controls and 15 patients admitted to the Gaziantep University Hospital (Gaziantep, Turkey) between January 2005 and July 2005 with the diagnosis of carbon monoxide poisoning were studied. Echocardiography was performed to all patients. Serum NT-proBNP, creatine kinase (CK), creatine kinase-MB (CK-MB), and troponin-T were also analyzed, along with the carboxyhemoglobin (COHb) level. The correlation between serum NT-proBNP and COHb level was investigated. Electrocardiography (ECG) was performed to all patients and healthy controls, and the results were compared. Differences in troponin, CK, and CK-MB levels were not statistically significant between groups (p > 0.05). The level of NT-proBNP and COHb were found to be increased in the study group. There was a positive correlation between the COHb and the NT-proBNP (r = 0.829, p < 0.01), and between the COHb and the CK (r = 0.394, p < 0.01). There was no difference between groups in other parameters, all of which were within normal range. Thus, in this sudy we showed that the plasma NT-proBNP level may contribute to the early diagnosis of cardiotoxicity in patients with carbon monoxide poisoning.     

早期大剂量纳洛酮治疗急性CO中毒临床观察

目的：探讨院前早期应用大剂量纳洛酮治疗急性CO中毒的疗效与安全性。方法：以随机对照设计对145例急性CO中毒昏迷患者进行临床研究．对照组采用常规治疗方案，治疗组在对照组的基础上接受院前早期应用大剂量纳洛酮。观察两组病例在治疗期间的Glascow评分变化、平均意识觉醒时间以及发病2个月时迟发性脑病的发生率的差异。结果：两组病例在治疗期间的Glascow评分、平均意识觉醒时间以及发病2个月时迟发性脑病的发生率等情况的差异显著。结论：院前早期廊用大剂量纳洛酮治疗急性CO中毒疗效显著．安全性高。     

大剂量胞二磷胆碱治疗急性一氧化碳中毒迟发性脑病

目的 探讨运用大剂量胞二磷胆碱治疗急性一氧化碳中毒迟发性脑病(DEACMP)的临床疗效.方法 将124例DEACMP患者按随机数字表法分为治疗组68例,对照组56例.2组患者在常规治疗的基础上,对照组应用胞二磷胆碱注射液0.5 g配10%葡萄糖300 ml静脉滴注,1次/d,21 d为1个疗程,治疗组将对照组的胞二磷胆碱增至3.0 g.2组患者于入院第0、7、14、21天监测溶血磷脂酸和酸性磷脂酸浓度变化.结果 治疗组总有效率92.6%(63/68),对照组总有效率69.6%(39/56),2组疗效差异有统计学意义(P<0.05);治疗组治疗后溶血磷脂酸酸性磷脂酸浓度较治疗前均明显降低(P<0.01),而对照组变化不明显(均P>0.05).结论 大剂量胞二磷胆碱治疗DEACMP疗效高,不良反应少,值得临床推广.