Should hyperbaric oxygen be used to treat the pregnant patient for acute carbon monoxide poisoning? A case report and literature review

Carbon monoxide (CO) is the leading cause of death due to poisoning. Although uncommon, CO poisoning does occur during pregnancy and can result in fetal mortality and neurological malformations in fetuses who survive to term. Uncertainty arises regarding the use of hyperbaric oxygen (HBO) as a treatment for the pregnant patient because of possible adverse effects on the fetus that could be induced by oxygen at high partial pressures. While the dangers of hyperoxia to the fetus have been demonstrated in animal models, careful review of animal studies and human clinical experience indicates that the short duration of hyperoxic exposure attained during HBO therapy for CO poisoning can be tolerated by the fetus in all stages of pregnancy and reduces the risk of death or deformity to the mother and fetus. A case is presented of acute CO poisoning during pregnancy that was successfully treated with HBO. Recommendations are suggested for the use of HBO during pregnancy.     

Carbon monoxide poisoning: easy to treat but difficult to recognise.

Carbon monoxide (CO) poisoning is a common medical emergency and a frequent cause of deliberate or accidental death. It can cause acute and chronic central nervous system damage which may be minimised by prompt treatment with 100% oxygen or hyperbaric oxygen therapy. However, recognition of this intoxication can be difficult. Failure to diagnose it may have disastrous effects on the patient, and other members of the household who could subsequently become intoxicated. Guidance on the correct diagnosis of this condition is provided in the light of a number of studies screening emergency room populations. Guidelines for treatment with hyperbaric oxygen therapy are also reviewed.     

院前院内急救一体化配合高压氧在急性CO中毒患者中的应用

目的 探究院前院内急救一体化护理配合高压氧治疗在急性一氧化碳(carbon monoxide,CO)中毒患者中应用的意义。方法 选取2019年3月至2022年3月在浙江大学医学院附属第二医院临平院区进行治疗的急性CO中毒患者110例,根据治疗方式将患者分为对照组(53例)和研究组(57例)。对照组患者行高压氧联合常规救治,研究组给予患者院前院内急救一体化治疗配合高压氧治疗。比较两组患者的院前院内急救时间、中毒症状消失时间、住院时间、中毒严重度、器官功能损害程度、并发症发生率、焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)、生活质量水平评分(物质状态、社会功能、躯体功能)及护理满意度。结果 研究组患者的院前急救时间、院内急救时间、首次使用高压氧时间、中毒症状消失时间、住院时间,中毒严重度、器官功能损害程度、SAS评分、SDS评分均低于对照组,差异具有统计学差异(P<0.05);生活质量水平评分(物质状态、社会功能、躯体功能)及护理满意度均高于对照组,差异具有统计学意义(P&...     

高压氧治疗毒鼠强中毒的临床效果观察

目的：探讨高压氧治疗在毒鼠中毒中的作用。方法：对十年来66例毒鼠中毒的病人进行回顾性分析，其中进行高压氧治疗34例病人作为治疗组，按常规治疗32例病人作为对照组，对照组给予苯巴比妥、大剂量的维生素B6、二巯基丙磺酸钠，神经营养药，对症支持治疗，治疗组在上述治疗的基础上加高压氧治疗，结果：治疗组治愈27例，好转6例，无效1例，昏迷患清醒时间平均7天；对照组治愈16例，好转8例，无效8例，清醒平均时间11天，两组经统计学检验差异有显意义。结论：高压氧治疗毒鼠强中毒疗效好，能缩短昏迷时间，提高治愈率，是治疗毒鼠强中毒的好方法。值得临床推广使用。     

高压氧治疗一氧化碳中毒迟发脑病临床分析

目的 探讨高压氧治疗一氧化碳中毒迟发脑病的临床意义。方法 对38例一氧化碳中毒迟发脑病患者进行高压氧治疗，治疗前、后分别对患者进行脑电图、长谷川痴呆量表检测和临床疗效分析。结果 高压氧治疗后脑电图、痴呆量表较治疗前明显改善；临床症状改善的总有效率为84．2％，临床症状的改善与脑电图的好转呈平行关系。结论 高压氧对一氧化碳中毒迟发脑病有显著疗效；脑电图对临床治疗和疗效的判定有指导意义。     

急危重症一氧化碳中毒患者早期呼吸机替代高压氧治疗临床观察

目的 探讨呼吸机在抢救高压氧治疗禁忌的急危重症CO中毒患者中的价值.方法 选取1990年11月~2000年11月份收住我院的急危重症CO中毒患者45例作为对照组,给予常规导管/面罩吸氧氧疗.选取2002年11月~2011年11月份收住我院的急危重症CO中毒患者43例作为观察组,给予气管插管,建立人工气道,予以呼吸机治疗（BILEVEL模式）.两组患者均给予了防治脑水肿、促进脑细胞功能恢复、防治并发症、维持内环境稳定等综合治疗.结果 观察组平均神志恢复时间短于对照组;并发症少于对照组;平均住院时间短于对照组;迟发性脑病少于对照组;死亡率低于对照组.结论 存在高压氧治疗禁忌证的CO中毒的急危重症患者,在早期使用呼吸机治疗可明显减轻病情,缩短住院时间,改善预后.     

Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial

OBJECTIVE: To assess neurological sequelae in patients with all grades of carbon monoxide (CO) poisoning after treatment with hyperbaric oxygen (HBO) and normobaric oxygen (NBO). DESIGN: Randomised controlled double-blind trial, including an extended series of neuropsychological tests and sham treatments in a multiplace hyperbaric chamber for patients treated with NBO. SETTING: The multiplace hyperbaric chamber at the Alfred Hospital, a university-attached quarternary referral centre in Melbourne providing the only hyperbaric service in the State of Victoria. PATIENTS: All patients referred with CO poisoning between 1 September 1993 and 30 December 1995, irrespective of severity of poisoning. Pregnant women, children, burns victims and those refusing consent were excluded. INTERVENTION: Daily 100-minute treatments with 100% oxygen in a hyperbaric chamber--60 minutes at 2.8 atmospheres absolute for the HBO group and at 1.0 atmosphere absolute for the NBO group--for three days (or for six days for patients who were clinically abnormal or had poor neuropsychological outcome after three treatments). Both groups received continuous high flow oxygen between treatments. MAIN OUTCOME MEASURES: Neuropsychological performance at completion of treatment, and at one month where possible. RESULTS: More patients in the HBO group required additional treatments (28% v. 15%, P = 0.01 for all patients; 35% v. 13%, P = 0.001 for severely poisoned patients). HBO patients had a worse outcome in the learning test at completion of treatment (P = 0.01 for all patients; P = 0.005 for severely poisoned patients) and a greater number of abnormal test results at completion of treatment (P = 0.02 for all patients; P = 0.008 for severely poisoned patients). A greater percentage of severely poisoned patients in the HBO group had a poor outcome at completion of treatment (P = 0.03). Delayed neurological sequelae were restricted to HBO patients (P = 0.03). No outcome measure was worse in the NBO group. CONCLUSION: In this trial, in which both groups received high doses of oxygen, HBO therapy did not benefit, and may have worsened, the outcome. We cannot recommend its use in CO poisoning.     

一氧化碳中毒迟发性脑病危险因素的1:2配对条件Logistic回归分析

目的探讨一氧化碳中毒迟发性脑病(DEACMP)发病的危险因素。方法采用以该院为基础的1:2配对病例对照研究,对确诊的DEACMP患者70例及对照组患者140例进行条件Logistic回归分析。结果单因素分析表明,在中毒环境中时间、有昏迷史、及时的高压氧治疗、脑血管病史、饮酒、中毒后精神刺激、中毒后劳累、中毒后失眠等8个危险因素与DEACMP的发生相关;而多因素Logistic回归分析表明,在中毒环境中时间、昏迷史、中毒后精神刺激、中毒后失眠是DEACMP的危险因素,其OR值依次为1.112、16.460、4.050、7.077;及时的高压氧治疗是其保护因素,其OR值为0.228。结论预防CO中毒的发生,积极有效地抢救急性CO中毒患者,中毒后尽量避免精神刺激、劳累等危险因素对预防D EACMP的发生有积极意义。     

高压氧治疗一氧化碳中毒迟发性脑病52例

目的:探讨高压氧治疗一氧化碳中毒迟发性脑病的疗效。方法:对52例一氧化碳中毒迟发脑病患者进行高压氧治疗,治疗前、后分别对患者进行脑电图、临床疗效分析。结果:高压氧治疗后临床症状明显改善,脑电图也较治疗前明显改善。临床症状的改善与疗程和脑电图的好转呈平行关系。结论:高压氧治疗一氧化碳中毒迟发性脑病疗效显著;疗效与治疗疗程有关,脑电图对临床治疗和疗效的判定有指导意义。     

Carbon monoxide poisoning: a case report of reversible cardiormyopathy

Acute carbon monoxide poisoning is the most common cause of poison-related deaths in the U.S. A 21-year-old white woman was referred to Ruby Memorial Hospital after exposure to carbon monoxide (CO) from a faulty furnace. She developed acute weakness, dyspnea, nausea and vomiting. An electrocardiogram revealed sinus tachycardia, non-specific ST-T wave abnormalities, and a prolonged QTc interval. The chest X-ray revealed pulmonary edema and the 2-D echocardiography revealed decreased left ventricular systolic function with an ejection fraction of 25%. She was treated with high-flow oxygen and supportive medical therapy with complete resolution of the left ventricular dysfunction six weeks later. She has been followed for over one year without medical therapy and without recurrence of her symptoms. This case illustrates that the depressant effect of CO poisoning on the myocardium can be reversed in the short term with supportive medical therapy and recovery sustained in the long term without medical therapy.     

急性一氧化碳中毒156例临床分析

目的：分析急性一氧化碳中毒患者的发病特征,探讨急性一氧化碳中毒的防治策略。方法：对156例急性一氧化碳中毒病例进行回顾性分析。结果：156例急性一氧化碳中毒患者中,女性多于男性,男女之比为1∶1.64;平均年龄21.75岁,高发年龄段是18-27岁,占78.84%;燃气热水器使用不当是急性一氧化碳中毒的主要原因占91.67%;中毒事件的高发季节为冬春季节占94.23%;临床表现主要为头晕、头痛、意识障碍等神经系统症状;以高压氧为主的综合治疗措施可取得满意疗效,总有效率达94.23%,治愈率为87.82%,中毒6h内高压氧治疗（A组）与中毒6h后高压氧治疗（B组）相比可提高治愈率（P〈0.05）。结论：深圳地区急性一氧化碳中毒的发病具有明显的性别、年龄、中毒源、季节特征,需引起重视,广泛开展针对性宣传教育和采取有效防范措施是遏制急性一氧化碳中毒的重要手段,一旦中毒应尽早行高压氧为主的综合性治疗。     

大鼠急性一氧化碳中毒后迟发性脑病模型的建立

目的:建立大鼠急性一氧化碳(CO)中毒致迟发性脑病模型,以探讨其发病机制. 方法:质量240～280 g雄性SD大鼠,于动物实验高压氧舱内行急性CO暴露,以Morris水迷宫中搜索目标的逃避潜伏期(escape latency)来评价大鼠的认知记忆能力,并于染毒后3,7,10,20 d取脑组织,常规制备石蜡病理切片,行HE染色观察急性CO中毒后大鼠脑皮质及海马神经元的病理性改变. 结果:大鼠在2000×10-6体积分数CO浓度和3000×10-6体积分数CO浓度下分别暴露40 min和20 min后全部昏迷,Morris水迷宫测试发现CO暴露组大鼠逃避潜伏期显著落后于空气对照组(F=4.74,P=0.047),病理学检查发现CO暴露组大鼠的皮质及海马有明显的神经元变性坏死. 结论:本实验建立的模型基本模拟了CO中毒后迟发性脑病患者中枢神经系统损伤的行为学特征改变,且有相应的病理学检测结果作为其佐证.     

Carbon monoxide poisoning in children riding in the back of pickup trucks.

OBJECTIVE - To describe the case characteristics of a series of children poisoned with carbon monoxide while traveling in the back of pickup trucks. DESIGN - Pediatric cases referred for treatment of carbon monoxide poisoning with hyperbaric oxygen between 1986 and 1991 were reviewed. Those cases that occurred during travel in the back of pickup trucks were selected. Clinical follow-up by telephone interview ranged from 2 to 55 months. SETTING - A private, urban, tertiary care center in Seattle, Wash. PATIENTS - Twenty children ranging from 4 to 16 years of age. INTERVENTION - All patients were treated with hyperbaric oxygen. MAIN OUTCOME MEASURES - Characteristics of the poisoning incident and clinical patient outcome. RESULTS - Of 68 pediatric patients treated for accidental carbon monoxide poisoning, 20 cases occurred as children rode in the back of pickup trucks. In 17 of these, the children were riding under a rigid closed canopy on the rear of the truck, while three episodes occurred as children rode beneath a tarpaulin. Average carboxyhemoglobin level on emergency department presentation was 18.2% +/- 2.4% (mean +/- SEM; range, 1.6% to 37.0%). Loss of consciousness occurred in 15 of the 20 children. One child died of cerebral edema, one had permanent neurologic deficits, and 18 had no recognizable sequelae related to the episode. In all cases, the truck exhaust system had a previously known leak or a tail pipe that exited at the rear rather than at the side of the pickup truck. CONCLUSIONS - Carbon monoxide poisoning is a significant hazard for children who ride in the back of pickup trucks. If possible, this practice should be avoided.     

Diagnosis and treatment of a 16-year-old Chinese patient with concurrent hereditary hemochromatosis and Gilbert's syndrome

Gilbert’s syndrome and hereditary hemochromatosis predominantly affect Caucasians with a low incidence in Asians. Here we report the case of a 16-year-old Chinese boy, who was admitted with hepatalgia, jaundice, hyperpigmentation, and splenomegaly to our hospital. After excluding chronic hepatitis, autoimmune disorders, and alcohol or drug injury, genetic analyses of the patient and his parents revealed simultaneous manifestations of Gilbert’s syndrome and hereditary hemochromatosis, though his parents did not develop related symptoms. The presented case indicates that diagnoses of Gilbert’s syndrome and hereditary hemochromatosis should be taken into consideration when chronic hepatitis is suspected without a clear etiology.     

高压氧治疗一氧化碳中毒疗效的BAEP评估

目的：探讨高压氧治疗一氧化碳中毒的疗效。方法：收集29例一氧化碳中毒患者,对高压氧治疗前后的脑干听觉诱发电位（BAEP）异常率进行统计学比较。结果：高压氧治疗前后BAEP的总异常率、Ⅰ波与Ⅴ波异常率、Ⅰ～Ⅴ峰间期异常率比较,差异有统计学意义（P〈0.01）。结论：急性一氧化碳中毒患者经高压氧治疗后,BAEP异常率降低,高压氧治疗一氧化碳中毒有效。     

高压氧协同药物综合治疗急性亚硝酸盐中毒9例分析

目的探讨0.25 MPa高压氧(HBO)协同药物综合治疗急性亚硝酸盐中毒的疗效,通过分析急性亚硝酸盐中毒的机制明确高压氧综合治疗的临床意义。方法 0.25 Mpa HBO协同清水洗胃催吐、药物(特效解毒剂亚甲蓝拮抗、维生素C注射液、葡萄糖补液)综合治疗9例中度急性亚硝酸盐中毒患者。根据患者病情,分别给予亚甲蓝40 mg或80mg静推,维生素C 3.0～5.0 g静滴,HBO 1次/d,疗程1～2次。结果 9例中度急性亚硝酸中毒患者全部治愈。结论0.25 MPa HBO协同药物综合治疗中度急性亚硝酸盐中毒患者有效。临床上除正确应用亚甲蓝等药物外,对病情较严重者应尽早高压氧治疗。     

高压氧治疗急性一氧化碳中毒298例疗效分析

目的分析高压氧治疗急性一氧化碳中毒的临床疗效。方法回顾性分析2008年1月-2011年1月我院收治的298例急性一氧化碳中毒患者,分为轻、中、重度中毒,均给予高压氧治疗,然后对其疗效予以观察。结果经高压氧治疗及随后半年随访,轻度中毒患者均痊愈,治愈率100％;中度中毒患者中5例好转,2例发生迟发性脑病,治愈率95％;重度中毒患者中10例好转,2例死亡,7例发生迟发性脑病,治愈率85％。结论高压氧可有效治疗急性一氧化碳中毒。     

成功救治劳力性热射病合并急性颅脑损伤1例

目的 报告1 例合并急性颅脑损伤的劳力性热射病的临床诊治过程。 方法 报道并分析我科1 例劳力性热射病合并急性颅脑损伤的患者的临床表现、影像学诊断、临床治疗及疗效,结合文献进行回顾性分析。 结果 患者男性,18 岁,因剧烈运动后发热伴意识丧失36 h 于2012 年8 月4 日入院。根据病史及入院时化验检查结果可明确诊断为劳力性热射病,结合入院后临床表现及影像学检查可诊断为急性颅脑损伤;经积极降温、持续床旁血液净化、高压氧及对症支持治疗后各化验指标基本恢复正常,意识恢复,基本交流尚可,肌力功能处于恢复过程。 结论 劳力性热射病合并急性颅脑损伤结合临床表现及早期影像学检查等有助于早期诊治。     

高压氧治疗一氧化碳中毒迟发性脑病52例

目的：探讨高压氧治疗一氧化碳中毒迟发性脑病的疗效。方法：对52例一氧化碳中毒迟发脑病患者进行高压氧治疗,治疗前、后分别对患者进行脑电图、临床疗效分析。结果：高压氧治疗后临床症状明显改善,脑电图也较治疗前明显改善。临床症状的改善与疗程和脑电图的好转呈平行关系。结论：高压氧治疗一氧化碳中毒迟发性脑病疗效显著;疗效与治疗疗程有关,脑电图对临床治疗和疗效的判定有指导意义。     

高压氧对早期脑梗死患者运动功能恢复的影响

目的:观察高压氧对早期脑梗死患者运动功能恢复的影响。方法:60例脑梗死随机分为康复治疗组和高压氧治疗组,康复治疗组给予常规康复治疗(医疗体操、神经肌肉促进技术、功能性电刺激、电动起立床等训练),高压氧治疗组除给予常规康复治疗外,还结合高压氧治疗,采用中型高压氧舱,面罩吸纯氧60分钟,中间通风换气休息5分钟,加压20分钟,减压25分钟,治疗全程90分钟,1次/d,10次为1个疗程。治疗前和治疗后给予Fugl-Meyer运动功能和改良Bathel指数评定,并对评定结果进行分析。结果:治疗4周后高压氧治疗组各项评分明显高于对照组(P<0.05)。结论:高压氧治疗能促进早期脑梗死患者运动功能的恢复。