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。     

高压氧治疗一氧化碳中毒临床疗效观察

我地区处于内蒙古东部，为边陲小镇，与俄罗斯以及外蒙接壤，为高寒地区，冬季漫长，取暖时间较长，以经济煤业为主，故本地区一氧化碳中毒现象时有发生。我院自1993年4月以来将NG-90型单人纯氧加压舱应用于临床，其应用范围广，治疗一氧化碳中毒取得尤为满意效果，现报告如下。     

纳络酮治疗急性一氧化碳中毒疗效观察

急性CO中毒近年发病有增长趋势，尤其是以CO有害气体的混合气体(煤气)中毒更较以往常见，传统治疗方法病死率较高，愈后神经系统后遗症严重。我们1999-01／2004-01用纳络酮治疗114例，配合高压氧治疗，疗效满意，现报告如下。     

大剂量纳洛酮治疗急性重度一氧化碳中毒临床疗效观察

急性一氧化碳（CO）中毒是急性中毒中最常见的一种，占中毒死因的首位。近年来发病有增高趋势，传统治疗方法病死率较高，特别是重度CO中毒，假预后神经系统后遗症严重，为此，笔者自2000年5月～2003年6月采用纳洛酮治疗重度CO中毒患者81例，取得较好疗效，现报告如下。     

神经节苷脂治疗一氧化碳中毒疗效观察

目的观察神经节苷脂（GM1）治疗一氧化碳中毒患者的疗效。方法将30例一氧化碳中毒患者随机分成GM1组和对照组，在同时给予常规治疗的基础上分别采用GM140mg或胞二磷胆碱0．75g加入250ml生理盐水中静脉滴注，每日1次，共2周，观察两组病人治疗前后日常活动量表（ADL）评分的变化及不良反应。结果治疗后GM1组及对照组ADL评分与治疗前相比差异有显著改善（P〈0．05）。GM1组疗效与对照组相比有非常显著性，P〈0．01。两组均未发现不良反应。结论GM1治疗一氧化碳中毒疗效显著。     

一氧化碳中毒致心肌坏死的临床研究

目的 探讨一氧化碳中毒致急性心肌损伤及心肌坏死的诊断及治疗.方法 采用回顾性分析对高压氧治疗组、溶栓治疗组、抗凝治疗组进行比较.结果 高压氧疗组治愈率与溶栓组、抗凝组比较,差异均有统计学意义(P＜0.05),溶栓组与抗凝组比较,差异均有统计学意义(P＜0.05).结论 一氧化碳中毒致心肌坏死是由于急性缺氧引起,而不是冠状动脉闭塞引起缺血缺氧.因此,高压氧治疗效果明显.     

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。     

急性一氧化碳中毒多脏器受损及其氧治疗探讨

急性一氧化碳中毒多脏器受损及其氧治疗探讨黄建群，任晓东一氧化碳（ＣＯ）毒性效应虽然已引起广泛的重视，但急性ＣＯ中毒的发病率、死亡率在急性中毒中仍居首位［工业卫生与职业病，１９９１，１７：２８］。急性ＣＯ中毒导致中枢神经损害早为人熟知，而脑外脏器受损尚...     

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。     

营养管理在老年人一氧化碳中毒治疗中的作用

一氧化碳中毒是包括我国在内世界上许多发展中国家较常见的家庭生活意外中毒.同时,一氧化碳也是意外生活中毒当中致死人数最多的毒物[1].患者因中毒等应激因素导致机体处于高分解代谢状态,出现负氮平衡,继而出现营养不良、免疫功能降低、生命器官系统功能损害、继发感染.对于如何有效地进行一氧化碳中毒的基本治疗,国内外学者已经进行了多方面的研究,但如何进行一氧化碳中毒患者早期的营养管理,目前只进行了初步的研究.而针对老年人重症一氧化碳中毒治疗中的营养管理问题,尚未在国内外的报道中出现.不可否认的是,在一氧化碳中毒治疗中,通过营养管理以达到有效地营养支持应是综合治疗中不可缺少的一部分[2].     

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.     

高压氧联合机械通气治疗重度急性一氧化碳中毒的疗效简

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.     

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.     

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.     

Cutaneous blisters and carbon monoxide poisoning

We present the cases of three patients with skin blisters following carbon monoxide (CO) poisoning. Their blisters appeared to be related to the severity of the poisoning (HbCO levels of more than 40%). Two of the three patients died despite aggressive initial 100% surface oxygen followed by hyperbaric oxygen therapy. The pathophysiology of this type of blister remains unresolved. It could result from pressure necrosis alone or from a combination of pressure necrosis and direct CO inhibition of tissue oxidative enzymes. Although skin involvement as a result of CO poisoning is less frequently reported today than in the past (perhaps because of misidentified burns or because of more aggressive resuscitation and treatment protocols), the physician should recognize that such blisters may signal severe CO poisoning.     

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.     

急性一氧化碳中毒心脏损害的临床分析

目的 :探讨急性一氧化碳 (CO)中毒对心脏的损害 ,使急性CO中毒患者得到更全面的治疗。方法 :回顾性分析近年来我院收治的急性CO中毒患者的临床表现、心电图及心肌酶改变。结果 :15 8例急性CO中毒患者中 87.3%出现昏迷 ,12 .7%出现心力衰竭 ,随机将其中 6 5例中毒患者作心电图及心肌酶检查 ,发现 5 6例出现心电图改变 ,4 4例出现心肌酶改变。结论 :急性CO中毒不仅对神经系统造成损害 ,对心脏的损害也很严重 ,需要给予相应的治疗。     

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。