高压氧联合机械通气治疗重度急性一氧化碳中毒的疗效

目的探讨高压氧联合机械通气治疗重度急性一氧化碳中毒的疗效。方法选取2010年1月~2012年12月于我院MICU进行治疗的28例重度CO中毒患者为研究对象,将其分为对照组(高压氧组)和观察组(高压氧联合机械通气组)各14例,两组患者均同时给予预防感染、防治脑水肿、促进脑细胞代谢等治疗。结果观察组平均住院时间、昏迷时间短于对照组;迟发性脑病发生率低于对照组;总有效率高于对照组。治疗后6 h,24 h观察组的血氧分压(PaO2)、碱剩余增加高于对照组,血二氧化碳分压(PaCO2)、CRP、TNF-α、心肌酶谱水平均低于对照组。结论高压氧联合机械通气治疗重度急性一氧化碳中毒可明显减轻病情,缩短住院时间,改善预后。     

红细胞置换联合机械通气治疗老年重度一氧化碳中毒的疗效

一氧化碳(CO)极易与血红蛋白(Hb)结合,形成碳氧Hb(COHb),使Hb丧失携氧的能力和作用,造成组织窒息,尤其重度患者多伴有深度昏迷,各种反射消失,大小便失禁,四肢厥冷,血压下降,呼吸急促等[1],死亡率较高,因此对于CO中毒患者及早进行缺氧状况的改善对于预后有着积极的作用,而老年患者因其机体状况更差于年轻患者,故其治疗更为复杂[2].本文中就红细胞置换联合机械通气在老年重度CO中毒中的效果进行观察.     

高压氧联合纳洛酮治疗急性重度一氧化碳中毒51例疗效观察

目的研究纳洛酮联合高压氧治疗急性重度一氧化碳中毒的临床效果。方法治疗组为纳洛酮联合高压氧对51例患者进行治疗,对照组为高压氧对47例患者进行治疗。结果治疗组平均昏迷时间显著低于对照组(P<0.01),治疗组有效率高于对照组(P<0.05)。结论纳洛酮和高压氧联合应用,对重度一氧化碳中毒的患者,具有苏醒早、提高治愈率、降低后遗症等优点,纳洛酮要早期足量全程使用。     

纳洛酮联合高压氧治疗急性重度一氧化碳中毒的疗效观察

目的观察纳洛酮联合高压氧治疗急性重度一氧化碳中毒的临床疗效。方法选取2010年1月—2013年6月东莞市樟木头医院收治的急性重度一氧化碳中毒患者36例,将其随机分为观察组和对照组,每组18例。对照组仅予以高压氧治疗,观察组予以高压氧联合纳洛酮治疗,比较两组患者临床疗效、病死率、昏迷时间及迟发性脑病发生率。结果观察组总有效率为94.4%(17/18),高于对照组的72.2%(13/18)(P0.05);观察组病死率为0,低于对照组的16.7%(3/18)(P0.05);观察组昏迷时间短于对照组〔(19.7±6.0)h比(26.3±6.4)h(P0.05)〕;观察组迟发性脑病发生率为0,低于对照组的22.2%(4/18)(P0.05)。结论纳洛酮联合高压氧治疗急性重度一氧化碳中毒疗效良好,且能降低患者病死率和迟发性脑病发生率、缩短昏迷时间。     

高压氧治疗急性一氧化碳中毒性心律失常158例疗效观察

我院急诊科自 1 993年 1月 1日至 2 0 0 3年 1月 1日收治了 2 96例急性一氧化碳中毒 (CO)并发中毒性心律失常患者 ,均有明确的CO中毒史 ,既往无心脏病史。分成高压氧 (HBO)组和对照组 ,比较其结果如下。1　临床资料1 1　一般资料 :2 96例均为急性一氧化碳 (CO)中毒引起心律失常的患者 ,均按中国人民解放军总后勤部《临床疾病诊断依据治愈好转标准》诊断。按收治时是否进行过HBO治疗分为两组 :( 1 )HBO治疗组 :共 1 5 8例 ,其中男 9O例 ,女 68例 ,年龄 1 7～ 64岁 ,平均 42± 7 8岁 ;心律失常发生时间 :l个月以内 47例 ,1～ 3个月 69…     

高压氧联合纳洛酮治疗一氧化碳中毒疗效观察

目的 观察高压氧联合纳洛酮治疗急性一氧化碳中毒的疗效。方法42例符合急性一氧化碳中毒的患者随机分为2组，治疗组22例，对照组20例。在常规治疗的基础上，治疗组给予高压氧联合纳洛酮治疗，对照组只给予高压氧治疗；每10d为一疗程，4个疗程后评价疗效。结果治疗组治愈19例（86．36％），显效3例（13．64％），无效0例（0％）；对照组治愈10例（50．00％），显效7例（35．00％），无效3例（15．00％），差异有统计学意义（P〈0．05）；两组后遗症比较差异有统计学意义。结论高压氧联合纳洛酮治疗急性一氧化碳中毒疗效显著。     

纳洛酮联合高压氧治疗急性一氧化碳中毒42例疗效观察

本研究用纳洛酮配合高压氧治疗一氧化碳（CO）中毒，收效较好，现对其治疗机制进行初步探讨。     

无创正压机械通气治疗重度急性有机氟中毒的临床研究

目的评价无创正压机械通气治疗重度急性有机氟中毒的临床应用价值。方法急性重度有机氟中毒患者9例,在应用糖皮质激素、俯卧位通气等治疗基础上应用无创正压机械通气;记录治疗期间患者的血PH值、心率(HR)、呼吸频率(RR)、动脉血;氧合指数(PaO2/FIO2)及并发症。结果 9例患者中好转8例,1例病情加重改有创通气,10天后死亡;8例好转患者治疗后的心率、呼吸频率明显下降,动脉血氧合指数上升,与治疗前比较差异有统计学意义(P<0.05)。结论无创正压机械通气能有效缓解重度急性有机氟中毒患者症状,改善低氧。     

高压氧治疗重度一氧化碳中毒2例

例1,女性,30岁,住院号051403。在家取暖被熏,于次日晨方被家人发现,当时卧于地上,唤之不应,时有抽搐。在当地医务人员给予降颅压,对症等治疗5天后转入我院。来我院时仍处于昏迷状态。经给予能量合剂以促进线粒体呼吸链的重建,胞二磷胆碱以改善脑     

纳洛酮配合高压氧治疗老年人急性一氧化碳中毒的疗效观察

目的观察纳洛酮配合高压氧治疗老年人急性一氧化碳(CO)中毒的临床疗效。方法将68例急性CO中毒的患者随机分为2组。2组常规治疗相同,对照组(35例)加用高压氧治疗,观察组(33例)加用纳洛酮和高压氧治疗,观察比较两组疗效。结果观察组与对照组有效率分别为97.0%和77.1%,昏迷时间分别为(20.53±6.45)h和(26.17±7.56)h,发生迟发性脑病例数分别为0例和6例,两组比较均有显著差异(P<0.05)。结论纳洛酮配合高压氧治疗老年人急性CO中毒能明显提高有效率,缩短昏迷时间,减少迟发性脑病的发生,且无不良反应。     

Treatment of acute carbon monoxide poisoning with hyperbaric oxygen: A review of 115 cases

From January 1978 through March 1984, 115 cases of acute carbon monoxide poisoning were treated with hyperbaric oxygen. Exposure resulted from accidental sources (n = 39), attempted suicide (n = 47), and smoke inhalation (n = 29). Forty-one victims were never unconscious, 30 victims were unconscious at the scene but awoke before arriving at the hospital, and 44 victims were unconscious in the ED. Eleven patients (9.6%) died, and two victims (1.9% of the survivors) experienced major sequelae. All these patients were comatose on arrival. The remaining 102 patients recovered fully. Carboxyhemoglobin levels did not correlate with clinical findings, thereby demonstrating the variability between carbon monoxide exposure and impairment of the cellular cytochrome system. Hyperbaric oxygen therapy facilitates the rapid removal of carbon monoxide from the hemoglobin and cytochrome systems while reoxygenating compromised tissues, and it can be an effective treatment in reducing mortality and morbidity.     

The occurrence of delayed neuropsychologic sequelae in acute carbon monoxide poisoning patients after treatment with hyperbaric or normobaric oxygen therapy

This study aimed at assessing which one of the 2 therapies is better for treating carbon monoxide (CO) poisoning from the perspective of reducing delayed neuropsychologic sequelae (DNS).We used Taiwan''s National Health Insurance Research Database (NHIRD) to conduct a nationwide population-based cohort study to assess which therapy is better for CO poisoning patients. To accurately identify patients with DNS, the definition of DNS is included neurological sequelae, and cognitive and psychological sequele. The independent variable was therapy and the dependent variable was DNS occurred within 1 year after discharge from a medical institution. The control variables were age, gender, the severity of CO poisoning, and comorbidities present before CO poisoning admission.The risk of developing DNS in patients treated with Hyperbaric Oxygen (HBO) was 1.87-fold (P < .001) than normobaric oxygen (NBO) therapy. The severity of CO poisoning and comorbidities were also found to have significant influences on the risk of developing DNS.HBO may be a risk therapy for treating CO poisoning.     

一氧化碳中毒不同时段高压氧治疗的疗效分析

目的探讨对一氧化碳中毒患者采用高压氧治疗的不同时机对治疗效果的影响。方法对我院2011年1月至2013年4月收治的84例一氧化碳中毒患者随机分为观察组和对照组各42例,两组采用常规的抗感染、水电解质平衡、呼吸道护理措施进行治疗,观察组在一氧化碳中毒12 h内就进行高压氧治疗,对照组在一氧化碳中毒12 h后进行高压氧治疗。比较两组患者治疗20天后的临床疗效、超氧化物歧化酶(SOD)、碳氧血红蛋白(HBCO)、TNF-ɑ、IL-6及治疗后相关后遗症发生率的差异。结果治疗前两组患者的SOD、HBCO、TNF-ɑ、IL-6比较不具有统计学意义(P0.05);治疗后两组的SOD、HBCO、TNF-ɑ、IL-6与治疗前进行组内比较差异具有统计学意义(P0.05),治疗后两组各种临床指标均显著好转;治疗后两组间SOD、HBCO、TNF-ɑ、IL-6比较差异具有统计学意义(P0.05)。治疗后两组患者的疗效分布、总有效率比较差异均不具有统计学意义(P0.05)。治疗过程中,观察组的平均昏迷时间、迟发性脑病发生率显著低于对照组且差异具有统计学意义(P0.05);两组病死率比较差异不具有统计学意义(P0.05)。结论本研究发现在发生一氧化碳中毒后12 h内进行高压氧治疗能够有效降低治疗后迟发型脑病的发生率。     

一氧化碳中毒应用不同氧疗法的疗效观察

目的探讨对一氧化碳中毒患者采用不同氧疗方法治疗的临床疗效。方法对我院2011年1月至2013年4月收治的64例一氧化碳中毒患者随机分为观察组和对照组各32例,两组采用常规的抗感染、水电解质平衡、呼吸道护理措施进行治疗,观察组在常规治疗基础上加用高氧液静脉液体给氧治疗,对照组在常规治疗的基础上加高压氧舱进行治疗。比较两组患者治疗20天后的临床疗效、超氧化物歧化酶(SOD)、碳氧血红蛋白(HBCO)、TNF-ɑ、IL-6及治疗后遗症的差异。结果治疗前两组患者的SOD、HBCO、TNF-ɑ、IL-6比较两组间差异不具有统计学意义(P0.05);治疗后两组的SOD、HBCO、TNF-ɑ、IL-6与治疗前进行组内比较差异具有统计学意义(P0.05),治疗后两组各种临床指标均显著好转;治疗后两组间SOD、HBCO、比较差异不具有统计学意义(P0.05),TNF-ɑ、IL-6比较差异具有统计学意义(P0.05)。治疗20天后,两组的疗效分布、总有效率比较差异不具有统计学意义(P0.05)。两组病死率比较差异不具有统计学意义(P0.05),两组迟发型脑病、平均昏迷时间比较差异具有统计学意义(P0.05),观察组的迟发型脑病、平均昏迷时间均显著低于对照组。结论对一氧化碳中毒患者采用高氧液静脉液体给氧治疗与高压氧舱进行治疗的疗效相当,但是治疗后后遗症发生率更低。     

Assessment of myocardial injury in the emergency department independently predicts the short-term poor outcome in patients with severe carbon monoxide poisoning receiving mechanical ventilation and hyperbaric oxygen therapy

ObjectivesPatients with severe carbon monoxide (CO) poisoning are often prone to unconsciousness and respiratory distress and as a result will receive mechanical ventilation and hyperbaric oxygen (MV-HBO) therapy. Factors associated with poor outcome at discharge are less defined in this patient population. This study was conducted to identify the prognostic predictors of short-term poor outcome in severely CO-poisoned patients receiving MV-HBO therapy.MethodsThe departmental database and the medical records of 81 patients treated with MV-HBO therapy were reviewed. Demographic and clinical data were extracted for analysis. HBO therapy with 2.5 or 2.8 atmosphere absolute (ATA) was administered to these patients. Short-term poor outcome was defined as an in-hospital death or neurologic sequelae at discharge. All patients were divided into two groups: those with a poor outcome and those without a poor outcome.ResultsNine patients died while in the hospital, 32 patients had neurologic sequelae at discharge, and the incidence of poor outcome was 50.6%. Parameters that were assessed in the emergency department (ED) and highly associated with patients with a poor outcome included myocardial injury, typical findings on brain computed tomography related to CO poisoning, and higher serum levels of alanine transaminase, aspartate aminotransferase, blood urea nitrogen, creatinine, creatine kinase, creatine kinase-myocardial band, troponin-I, and C-reactive protein. These poor outcomes were also correlated with prolonged lag times from the end of CO exposure to ED arrival and from ED arrival to HBO therapy. In a multivariate analysis, myocardial injury was the only independent predictor of poor outcome (odds ratio, 8.2; 95% confidence interval, 1.012–67.610; p = 0.049).ConclusionsThe results of this study indicate that myocardial injury assessed at ED arrival independently predicts the short-term poor outcome in severely CO-poisoned patients who receive MV-HBO therapy. Emergency physicians could use this objective marker to identify patients with an increased risk of poor outcome at discharge and refine the treatment protocol by shortening the time of patient transport and administering HBO therapy as soon as possible.     

Subacute sequelae of carbon monoxide poisoning

From January 1980 to August 1983, 213 patients with carbon monoxide poisoning were seen; 131 received hyperbaric oxygen and had no sequelae. Eighty-two patients were treated with normobaric oxygen; ten (12.1%) returned with clinically significant sequelae. The specific neurological sequelae included headaches, irritability, personality changes, confusion, and loss of memory. This recurrent symptomatology developed within one to 21 days (mean, 5.7 days) after the initial exposure, although no reexposure occurred. These recurring symptoms resolved rapidly with hyperbaric oxygen therapy. We recommend that hyperbaric oxygen therapy be used whenever CO poisoning symptoms recur.     

功能训练结合高压氧治疗脑卒中后吞咽障碍患者的临床观察

目的探讨功能训练结合高压氧治疗对脑卒中后吞咽障碍患者吞咽困难改善情况。方法将120例脑卒中后吞咽困难患者随机分为试验组和对照组,每组60例,试验组给予高压氧结合吞咽功能训练、针灸及中医中药治疗,对照组给予针灸及中医中药治疗。分别在治疗后的1、2、3、4周进行疗效的判断。结果试验组患者症状改善明显优于对照组,2组在4个时间点的差异均有统计学意义(P0.05)。结论功能训练结合高压氧治疗脑卒中后吞咽障碍是一种有效的方法。     

Serum NSE and S100B protein levels for evaluating the impaired consciousness in patients with acute carbon monoxide poisoning

The aim of this study was to investigate the associations between the levels of neuron-specific enolase (NSE) and S100B protein and coma duration, and evaluate the optimal cut-off values for prediction coma duration ≥ 72 hours in patients with acute carbon monoxide poisoning (ACOP).A total of 60 patients with ACOP were divided into 3 following groups according to their status of consciousness and coma duration at admission: Awake group [Glasgow Coma Scale score (GCS score) ≥ 13 points], Coma < 72 hours group (GCS score < 13 points and coma duration < 72 h), and Coma ≥ 72 hours group (GCS score < 13 points and coma duration ≥ 72 h). The levels of serum NSE and S100B protein were measured after admission.There were significant differences in GCS score, carbon monoxide (CO) exposure time, NSE, and S100B levels between the Coma ≥ 72 h group and the Awake group, and between the Coma < 72 h group and the Awake group. Significant differences in GCS score, NSE, and S100B levels were also found between Coma ≥ 72 h group and Coma < 72 h group. Correlation analysis showed that NSE and S100B were positively correlated (r_s = 0.590, P < .01); NSE and S100B were negatively correlated with GCS score (r_s = -0.583, r_s = -0.590, respectively, both P < .01). The areas under the curve (AUCs) of NSE, S100B, and GCS score to predict the coma duration ≥ 72 hours were 0.754, 0.791, and 0.785, respectively. Pairwise comparisons did not show differences among the 3 groups (all P > .05). The sensitivity and specificity of NSE prediction with a cut-off value of 13 μg/L were 80% and 64%, respectively, and those of S100B prediction with a cut-off value of 0.43 μg/L were 70% and 88%, respectively.The NSE and S100B protein levels were significantly correlated with the degree of impaired consciousness and had the same clinical value in predicting coma duration of ≥ 72 hours in patients with ACOP.     

108例急性一氧化碳中毒患者并发心肌损害分析

目的分析急性一氧化碳中毒(acute carbon monoxide poisoning,ACOP)时临床心电图表现、心肌酶及肌钙蛋白(cTNT)的改变对心肌损害的临床意义。方法对我院2008年11月～2012年12月收治的108例ACOP患者进行心电图、心肌酶及cTNT定量临床观察,并做回顾性分析。结果 108例ACOP患者均有不同程度意识障碍,昏迷82例,占75.9%;心电图异常80例,占74.1%,其中ST-T改变69例,占63.9%;心肌酶活性升高69例,占63.9%;cTNT活性升高25例,占27.8%。心电图的改变及心肌酶、cTNT的活性升高与年龄呈正比,与中毒程度呈正相关,差异有统计学意义,中、重度中毒与轻度中毒者,重度中毒与中度中毒者比较,差异均有统计学意义(P<0.01)。经治疗,101例患者康复出院,5例因中毒时间长合并多脏器功能衰竭死亡,2例发生一氧化碳中毒迟发性脑病。结论 ACOP可以造成心肌不同程度的损害,需要积极进行相应治疗。