高压氧对急性CO中毒患者血清心脏肌钙蛋白T含量的影响(论著)

目的：观察高压氧（HBO）对急性一氧化碳（CO）中毒患者血清心脏肌钙蛋白T（troponinT，TnT）含量变化的影响，并探讨HBO对心肌损伤的疗效及机理。方法：对17例急性CO中毒患者，分别于HBO治疗前和1次治疗后评定Glasgow分数，同时测定血清TnT。对其中6例急性中、重度CO中毒患者在5次HBO治疗后复测血清TnT含量。结果：HBO治疗前后比较，急性轻度CO中毒患者血清TnT含量无显著差异（P＞0．05），急性中、重度CO中毒患者血清TnT含量显著下降（P＜0．05）；而6例急性中、重度CO中毒患者血清TnT含量，在HBO治疗1次、5次后均较治疗前非常明显下降（P＜0．01）。结论：急性中、重度CO中毒均有心肌损伤；HBO治疗可降低血清TnT，表明是治疗急性CO中毒心肌损伤的有效方法。     

高压氧对急性一氧化碳中毒大鼠血清蛋白脂质蛋白质抗原、抗体的影响

目的 观察急性一氧化碳中毒(acute carbon monoxide poioning,ACOP)大鼠血清中蛋白脂质蛋白质(proteolipid protein,PLP)抗原、抗体的变化,探讨免疫机制在ACOP中的作用以及高压氧(HBO)治疗可能的作用机制.方法 202只大鼠按随机数字表法分为3组:染毒组(CO组),高压氧组(HBO组),常压氧组(NBO组).采用静态一氧化碳吸入法建立ACOP大鼠模型.染毒前及染毒后即刻、100 min和3、7、10、20 d取腹主动脉血,用ELISA法测定血清PLP抗原、抗体的含量.结果 染毒后即刻CO组、HBO组和NBO组PLP抗原及抗体均较染毒前升高(P＜0.05).HBO组100 min时PLP抗原低于CO组(P＜0.05);3、7 d时PLP抗体低于CO组(P＜0.05);3、10 d时HBO组PLP抗体低于NBO组(P＜0.05);7、20 d时NBO组PLP抗体低于CO组(P＜0.05).结论 ACOP后大鼠存在自身免疫反应及髓鞘损伤,及时、规律的HBO治疗可减轻髓鞘损伤.     

高压氧和抗血小板聚集剂预防一氧化碳中毒迟发脑病

目的 观察高压氧（HBO）和抗血小板聚集剂综合疗法对一氧化碳中毒（COP）迟发脑病的预防效应。方法 中，重度急性一氧化碳中毒患者共401例，随机分成HBO治疗组（HBO）组204例和HBO＋抗血小板聚集剂治疗组（HBO＋抗Pla组）197例。HBO治疗压力0.2MPa，每日1次，共20次，在患者COP后第15，20，25，30，45，60天判定是否出现迟发脑病。结果 COP患者401例中，HBO组204例，出现迟发脑病23例，占11．27％。HB＋抗Pla组197例，出现迟发脑病7例，占3．55％。两组比较差异有非常显著性（P＜0．01）。结论 HBO和抗血小板聚集剂综合治疗急性COP，使其迟发脑病的发生率较单纯HBO治疗明显降低，取得显著的预防效应。     

Hyperbaric oxygen treatment for carbon monoxide poisoning in pregnancy: a case report.

Carbon monoxide (CO) poisoning is one of the most common forms of poisoning in the United States. When CO poisoning occurs in the pregnant patient, it is extremely toxic to the mother and fetus in terms of central nervous system disorders and delayed central nervous system sequelae. Controversy exists in treating the pregnant patient with hyperbaric oxygen (HBO) because of the unknown effects of high partial pressures of oxygen on the fetus. HBO therapy is beneficial in CO poisoning because of its effect of first increasing oxygen concentration and causing a shift in the oxygen dissociation curve from the left to the right. Second, by causing a diminished CO interaction with cytochrome oxidase, HBO allows mitochondria to use oxygen more effectively. Third, HBO may reduce lipid peroxidation which may be responsible for neurological deterioration and delayed central nervous system sequelae. Fourth, decreased CO influence through HBO may reduce changes in the myocardium as a result of CO poisoning, if cardiovascular disease is already present. A case study of successful HBO therapy used during pregnancy is presented and effects of CO on the fetus are discussed.     

高压氧治疗一氧化碳中毒继发急性脑病及心肌损害105例疗效观察

目的:探讨高压氧(HBO)治疗一氧化碳(CO)中毒继发急性脑病及心肌损害的临床疗效。方法:回顾性分析2015年3月至2020年3月山东淄博矿业集团中心医院高压氧科收治的CO中毒患者451例,其中发生急性脑病105例,且均继发不同程度的心肌损害。给予脱水、营养神经、改善循环、促醒、保护脏器、抗感染及其他支持对症治疗的同时...     

急性一氧化碳中毒危险分层与常压氧或高压氧综合治疗预后研究

目的 分析急性一氧化碳中毒(ACOP)患者的治疗方法与一氧化碳中毒迟发脑病(DEACMP)发病特点.方法 对我院高压氧科2007年1月至2009年2月经急诊首诊的201例有昏迷史的ACOP患者进行回顾性分析,根据ACOP中毒时间分组,A组患者昏迷时间<2 h,B组患者昏迷时间>2 h,B组根据昏迷时间及年龄再次分组.A组予高压氧(HBO)或常压氧(NBO)治疗,B组予HBO综合治疗,统计各组DEACMP的发病率.结果 有意识障碍的ACOP患者总的DEACMP发生率为3.5%,A组无DEACMP发生,B组DEACMP的发病率为10.3%.B组中昏迷时间>6 h的患者DEACMP发生率27.3%,与昏迷时间在2～6 h的患者DEACMP比较差异有统计学意义(P<0.01).B组不同年龄患者的DEACMP发生率差异无统计学意义(P>0.05).结论 ACOP患者中毒昏迷程度及时间为DEACMP的发病高危因素,根据发生DEACMP的危险程度分层后进行HBO综合治疗可使DEACMP发生率明显降低.     

Usefulness of 99mTc ethyl cysteinate dimer brain SPECT to detect abnormal regional cerebral blood flow in patients with acute carbon monoxide poisoning

99mTc ethyl cysteinate dimer (99mTc-ECD) brain single photon emission computed tomography (SPECT) was used to detect abnormal regional cerebral blood flow (rCBF) in patients with acute carbon monoxide (CO) poisoning. Ten patients with acute CO poisoning and no past histories of psychoneurological disorders were enrolled in this study. After oxygen treatment, all of the 10 patients were investigated using 99mTc-ECD brain SPECT and brain computed tomography (CT) scan. Brain CT scan findings were normal in all of the 10 patients. 99mTc-ECD brain SPECT showed the hypoperfusion lesions of the basal ganglia and brain cortex in five and seven patients, respectively. Only three of the 10 patients had normal 99mTc-ECD brain SPECT findings. This study suggests that, in comparison with brain CT scan, 99mTc-ECD brain SPECT is a better tool for the early detection of hypoperfusion brain lesions in acute CO poisoning in patients with normal brain CT findings.     

ACOP对大鼠血中NO、ET-1和CEC的影响及高压氧的作用

目的 探讨急性一氧化碳中毒（ACOP）对大鼠血管内皮及其细胞功能的影响和高压氧治疗（HBOT）的作用。方法 参照Jiang式染毒法制成ACOP大鼠模型,有相应对照地、分别对中毒后即刻和次日起每日1次HBOT的第1,3,7,14天后,血中一氧化氮（NO）、内皮素－1（ET－1）水平和循环内皮细胞（CEC）计数进行测定。结果（1）ACOP后即刻机体血中NO水平显著降低,ET－1水平和CEC计数显著升高（P＜0．05）;（2）HBOT后中毒大鼠血中NO水平显著回升（P＜0．05）,ET－1水平和CEC计数显著回降;其后上述指标都趋于恢复到正常水平。结论 （1）ACOP可导致机体严重的血管内皮及其细胞功能的损伤;（2）0．2MPa（绝对压）HBOT对ACOP导致的血管内皮及其功能损伤具有显著的改善和作用;（3）血中NO、ET－1水平和CEC计数指标的单独或联合检测,可作为临床上判断ACOP患者血管内皮及其功能损伤程度、评估疗效、预测预后的重要手段。     

不同氧疗方式对急性一氧化碳中毒大鼠血气的影响

目的 观察不同氧疗方式对急性一氧化碳中毒(acute carbon monoxide poisoning,ACOP)大鼠血气的影响.方法 将70只雄性Wistar大鼠随机分成健康对照组10只;染毒即刻组12只;余48只CO染毒后再分为4组,分别为空气组、鼻导管组、面罩组、HBO组各12只.制备ACOP动物模型,给予3种不同方式的氧疗,自腹主动脉取血行血气分析.结果 pH值:染毒即刻即出现明显下降(P<0.01),鼻导管及面罩吸氧后均低于正常(P<0.05),HBO治疗后接近正常(P>0.05).PaO2及PaCO2:染毒后各组差异无统计学意义(P>0.05).乳酸及COHb%:染毒即刻即出现明显升高(P<0.01),经鼻导管吸氧后高于正常(P<0.05);面罩及高压氧治疗后接近正常(P>0.05).HCO3-:染毒后各组均明显低于正常(P<0.01).结论 ACOP后不同氧疗方式均可改善ACOP缺氧和大鼠的代谢性酸中毒,在3种方式的氧疗中,HBO组清除大鼠体内COHb最显著.     

高压氧对急性一氧化碳中毒大鼠下丘脑-垂体-肾上腺轴的作用研究

目的:探讨高压氧(HBO)治疗对急性一氧化碳(CO)中毒大鼠下丘脑-垂体-肾上腺(HPA)轴的作用。方法:将36只大鼠按照随机数字表法分为正常对照组、CO中毒组和HBO治疗组各12只。建立急性CO中毒大鼠模型,给予HBO治疗7 d后,采用转录组测序(RNA-seq)进行各组大鼠脑组织基因检测,采用实时定量PCR(RT-...     

高压氧对急性一氧化碳中毒患者血浆一氧化氮、内皮素-1含量的影响

目的　观测急性一氧化碳 (CO)中毒患者血浆一氧化氮 (NO)、内皮素 - 1(ET- 1)含量的变化及高压氧 (HBO)的影响。方法　 6 6例 CO中毒的患者被分为轻、中、重度三组 ,分别用硝酸还原酶法、放免分析法测定治疗前后三组患者及对照组的 NO、ET- 1含量的变化。结果　 HBO治疗前不同中毒程度组患者的血浆 ET- 1的含量较对照组明显升高 ,而 NO的含量则显著降低 (P<0 .0 1) ,同时各组间差异均有显著性 ;HBO治疗前后比较发现 ,HBO治疗 1次后 NO、ET- 1较治疗前有明显变化 ,但仍明显高于对照组 ;而 10次 HBO治疗后接近对照值。结论　急性 CO中毒患者血浆 ET- 1的升高及 NO的降低参与 CO造成的意识障碍的发生过程 ;这两个指标的变化可用于判断 CO中毒意识障碍程度及 HBO的疗效 ;HBO治疗对 NO、ET- 1含量的变化有有益的调节作用 ,可改善 CO的病理损害作用。     

Partnering with a medical specialty society to perform online public health surveillance

While accidental carbon monoxide (CO) poisoning is common, it is felt to be largely preventable through targeted public education. Development of effective education programs requires accurate epidemiologic information about the condition. Many acute, severe cases of CO poisoning are treated with hyperbaric oxygen (HBO2) at hospital-based facilities staffed by members of the Undersea and Hyperbaric Medical Society (UHMS). In 2008, the Centers for Disease Control and Prevention (CDC) began sponsoring a UHMS proposal to use online reporting by UHMS members of cases treated with HBO2. This report describes development and implementation of the internet-based surveillance system, as well as its first year of operation. From August 2008 to July 2009, a total of 740 cases were reported by the 82 hyperbaric facilities participating nationwide. Extensive epidemiologic information about CO poisoning in the United States has been collected, and the utility of partnering with a medical specialty society for disease-specific surveillance demonstrated.     

高压氧对CO中毒大鼠海马中钙离子cGMP及血浆NO含量的影响

目的　测定一氧化碳（ＣＯ）中毒大鼠海马中钙离子（［Ｃａ２＋ ］ｉ）浓度与环磷酸鸟苷（ｃＧＭＰ）含量以及血浆一氧化氮（ＮＯ）含量的变化,同时观察高压氧（ＨＢＯ）在其间的作用。方法　８６ 只实验大鼠被随机分成１１ 组,分别为正常（对照）组;ＣＯ 中毒后１、３、５、１０、２０ 天５个组（ＣＯ组）;ＣＯ中毒后＋ ＨＢＯ１、３、５、１０、２０天５ 个组（ＣＯ＋ ＨＢＯ组）。分别用流式细胞仪测定大鼠海马中钙离子浓度和用酶免法测定海马神经元内ｃＧＭＰ含量,再用分光光度法测定大鼠血浆ＮＯ含量。结果　ＣＯ组海马中［Ｃａ２＋ ］ｉ浓度在ＣＯ中毒后第３、５、１０ 天和ｃＧＭＰ含量在第１、３、５、１０ 天明显低于对照组（Ｐ＜ ０．０１）,均于第２０ 天接近对照组（Ｐ＞ ０．０５）;血浆ＮＯ浓度在中毒后第１、３、５、１０ 天明显低于对照组（Ｐ＜ ０．０１）,至第２０ 天仍未恢复正常（Ｐ＜ ０．０５）。而ＣＯ＋ ＨＢＯ组海马中［Ｃａ２＋ ］ｉ浓度和ｃＧＭＰ含量以及血浆ＮＯ浓度在ＣＯ中毒后虽有变化但与ＣＯ组比,各时期数值均较接近对照组。并在第１０ 天后恢复正常。结论　ＣＯ中毒后,大鼠海马神经元细胞内钙离子、ｃＧＭＰ与血浆ＮＯ含量均降低,并持续较长时间。ＣＯ中     

高压氧治疗对有机磷中毒兔多脏器损害的影响

目的 探讨高压氧（HBO）治疗急性有朵磷中毒后多脏器功能的损害与减轻患者病损程度、降低病死率的效果。方法 制作大白兔急性有机磷中毒模型。应用多人加压舱治疗，压力0．2MPa（2ATA），吸氧60min。治疗前、后抽血检测血BUN、血清ALT、CK与LDH酶，并测定脑－脊髓诱发电位。结果HBO治疗前、后、兔血BUN、ALT、CK、LDH及脑－脊髓诱发电位各项比较均有显著性差异（P＜0．05）。结论 HBO治疗可减轻兔急性有机磷中毒后多脏器功能的损害。     

不同高压氧治疗方案对急性一氧化碳中毒受损心肌的疗效分析

目的 探讨不同高压氧(hyperbaric oxygen,HBO)治疗方案对急性一氧化碳(carbon monoxide,CO)中毒受损心肌的影响.方法 对2006年10月至2010年3月收治的155例重症CO中毒患者进行HBO常规治疗(常规组,75例)和HBO改进治疗(改进组,80例).(1)常规组治疗方案:治疗压力0.25 MPa,加压20 min,稳压后吸氧2次,每次30 min,中间间歇10 min,减压20 min出舱.每日1次,12次为1个疗程,治疗9-68次.(2)改进组方案:前5 d采用HBO常规治疗,以后采用减小治疗压力、缩短吸氧时间、增加吸氧间隔、间歇给氧的治疗方案,治疗压力0.20 MPa,稳压吸氧4次,每次10min,中间间歇5 min,减压20 min出舱.连续治疗3 d后间隔1 d,10 d为1个疗程.2组患者使用相同的药物治疗方案.统计分析常规组和改进组ST-T变化及血清心肌酶变化.结果 改进组与常规组相比ST-T恢复率(56%,28%)明显升高(P＜0.05),HBO治疗第3天和第6天ST-T加重率(第3天21%、25%.第6天16%、27%)明显降低(P＜0.01);2组血清心肌酶恢复率和加重率比较差异有统计学意义(P＜0.05.P＜0.01).结论 HBO改进方案对CO中毒患者受损心肌疗效较好.

Abstract：

Objective To investigate the effects of different hyperbaric oxygen ( HBO) treatment profiles on damaged myocardium induced by acute carbon monoxide poisoning. Methods One hundred and fifty-five serious cases of acute carbon monoxide ( CO) poisoning admitted into the hospital for treatment from October 2006 to March 2010 were randomly divided into the routine HBO treatment group (the routine group,75 cases) and the improved HBO treatment group (the improved group,80 cases). The treatment profile of the routine HBO treatment group: the patients were compressed for 20 min to the treatment pressure of 0.25 Mpa. Following stabilization at the said pressure, the patients breathed oxygen twice for 30 min plus 10 min, once a day. The whole treatment course consisted of 12 sessions, with the patients receiving HBO treatments from 9 to 68 times. The treatment profile of the improved HBO treatment group: the patients were given routine HBO treatment in the first 5 days, then, received improved HBO treatment, with a treatment profile of lower pressure (0.20 Mpa) , shorter oxygen-breathing time, lengthening of oxygen-breathing intervals and intermittent oxygen breathing. Total oxygen-breathing time was 4 times, each for 10 min plus 3 times each for 5 min. Then, the patients were decompressed to the surface following 20-min oxygen-breathing decompression. The patients received treatment for a succession of 3 days, then, had 1-day interval, and the whole treatment course consisted of 10 sessions. Changes in ST-T and myocardial enzymes of both the routine HBO treatment group and the improved HBO treatment group were measured and analyzed. Results ST-T recovery rate of the improved HBO treatment group increased (56% ,28% ) obviously, when compared with that of the routine HBO treatment group(P ＜ 0. 05). ST-T worse rate decreased significantly following HBO treatment on the 3rd and 6th days (21% and 25% on the 3rd day, 16% and 27% on the 6th day) respectively (P＜0.01). Statistical differences could be seen in the myocardial recovery rate and worse rate, when a comparison was made between them (P＜0. 05, P＜0. 01). Conclusions The improved HBO treatment profile showed better therapeutic effect on damaged myocardium induced by CO poisoning. This treatment profile should be used instead of other treatment profiles.     

Hyperbaric oxygen for neurologic indications--action plan for multicenter trials in: stroke, traumatic brain injury, radiation encephalopathy & status migrainosus

The 2008 Toronto Hyperbaric Medicine Symposium was convened to discuss research into neurologic indications for hyperbaric oxygen therapy (HBO2T). Four topics were particularly addressed: acute ischemic stroke; acute traumatic brain injury; brain radiation necrosis; and status migrainosus. Four multicenter trials were designed and proposed to evaluate the efficacy of HBO2T for these indications and are presented here in addition to brief reviews of the rationale behind each.     

Hyperbaric treatment of patients with carbon monoxide poisoning in the United States.

INTRODUCTION: Hyperbaric oxygen (HBO2) is effective therapy for carbon monoxide (CO) poisoning. In recent years, many hyperbaric physicians in the US have felt that numbers of patients referred for treatment of CO poisoning have decreased. Further, since the 2002 Weaver et al study (5), there has been discussion regarding the best treatment protocol. This study was conducted to determine numbers of patients treated with HBO2 annually over the past decade in the US and whether there is a consensus about the number of treatments per patient. MATERIALS AND METHODS: A survey was mailed to all US facilities listed in the 2001 UHMS Chamber Directory. Two subsequent mailings were sent to survey nonresponders, followed by telephone contacts. RESULTS: Of the 320 facilities listed in the directory, 10 were nonresponders, 26 had closed since publication and 80 do not treat CO poisoning, leaving 204 facilities. From 1992-2002, a total of 16,367 patients were treated with HBO2 for CO poisoning, an average of 1,488 +/- 121 patients/year (mean < or = SD). While the total number of patients treated annually did not decrease during the period studied, the number treated per facility did decline as a result of an increase in number of treating facilities. Only 46 facilities (23%) automatically give more than 1 hyperbaric treatment per CO-poisoned patient. Among those that do, 20 facilities (10%) give 3 treatments per patient. Conversely, 136 (67%) sometimes give more than one treatment and 12 facilities (8%) never retreat. CONCLUSIONS: Approximately 1,500 CO-poisoned patients are treated with HBO2 in the US annually, a number that has remained relatively constant since 1992. The majority of facilities does not routinely give more than one hyperbaric treatment, but will give repetitive treatment in certain situations.     

Hyperbaric oxygen therapy: types of injury and number of sessions--a review of 1506 cases.

OBJECTIVE: The aim of this work was to identify clinical data indicative of the number of hyperbaric oxygen therapy HBO2 sessions that should be prescribed for adjuvant treatment of tissue injuries of differing severity. PATIENTS: A total of 1730 cases of patients treated with HBO2 using an open protocol (without a predetermined number of sessions) was examined in this study. METHOD: A retrospective study involving charts review was conducted. Severity had been previously determined for the treatment of acute (fasciitis, myositis, gangrene, contaminated/infected perineal or lower extremity traumatic injuries) or chronic (osteomyelitis, pressure sore, diabetic or ischemic ulcer) injuries. Only patients that met or exceeded the supposed effective minimal treatment doses (5 sessions for acute, 10 sessions for chronic injuries) were included in the present study. RESULTS: The data analysis included 1506 cases. These consisted of 1014 patients with acute injuries, who required 11 to 18 sessions (depending on injury severity), and 492 patients with chronic injuries, who required a greater (p < 0.001) number of sessions (approximately 30/patient, independent of injury severity). Global mortality was 79/1506 patients. CONCLUSION: These results seem to support the initial indication of 15 HBO2 sessions for the treatment acute injuries, and 30 for treatment of chronic injuries. Prospective studies may better determine the number of sessions for the treatment of different types of injuries.     

高压氧对一氧化碳中毒大鼠海马神经细胞线粒体膜电位与细胞凋亡的影响

目的 观察一氧化碳中毒（COP）后脑损伤时线粒体膜电位及细胞凋亡数量的变化以及高压氧（HBO）对其影响。方法Wistar大鼠共128只,采用配伍组设计,按随机抽样原则将动物分成4组16小组。正常对照组8只;CO组COP后第1,5,10,15,20天各8只;CO＋HP组高气压处理后第1,5,10,15,20天各8只：CO＋HBO组HBO处理后第1,5,10,15,20天各8只。用流式细胞仪测定COP大鼠在不同时间段海马神经细胞线粒体膜电位及海马神经细胞凋亡细胞相对百分比（％）的变化和HBO治疗后的改变。结果CO组在COP后大鼠海马神经细胞线粒体膜电位在第1,5,10天降低（P＜0．01－0．05）;CO＋HBO组在第1,5天降低（P＜0．01－0．05）。CO组COP后大鼠海马神经细胞凋亡细胞相对百分比在第1,5,10,15,20天高于对照组（P＜0．01）;而CO＋HBO组只在第1,5,10天高于对照组（P＜0．01）。结论COP后大鼠海马神经细胞线粒体膜电位降低,凋亡细胞数增加,并持续很长时间,而HBO处理可缩短线粒体膜电位降低的减少凋亡细胞数百分比。