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...

Observation on the therapeutic effect of hyperbaric oxygen on acute encephalopathy and myocardial damage secondary to carbon monoxide poisoning in 105 cases

Objective To observe and study the therapeutic effect of hyperbaric oxygen(HBO)on acute encephalopathy and myocardial damage secondary to carbon monoxide(CO)poisoning.Methods A total of 451 cases of CO poisoning admitted to the Department of Hyperbaric Oxygen of Central Hospital of Zibo Mining Group Co.,Ltd.were retrospectively analyzed,including 105 cases of acute encephalopathy with secondary myocardial damage of different degrees.After dehydration,nerve nutrition,circulation improvement,waking up,organ protection,anti-infection,and other supportive symptomatic treatments,HBO was given for 2-3 courses.The myocardial enzyme levels of carboxyhemoglobin(COHb),cardiac troponin(cTnI),creatine kinase(CK),creatine kinase myocardial isoenzyme(CK-MB),and lactate dehydrogenase(LDH)were measured in all patients before and after treatment;the dynamic abnormal changes were monitored by 12-lead electrocardiograph(EKG);and the cerebrospinal fluid pressure was measured by lumbar puncture.Results The blood biochemical test results after CO poisoning in 105 patients were as follows:the level of COHb was 40.3%~54.7%,with an average of(44.5±7.9)%;myocardial enzymes such as cTnI,CK,CK-MB,and LDH were significantly increased with 5-10 times of the normal values.The EKG of 105 patients showed significant abnormalities.The intracranial pressure was from 185 to 230 cmH2O,with an average of(210.6±22.9)cmH2O.After 2-3 courses of combined treatment,the level of COHb in 105 patients was 1.3%~4.7%,with an average of(3.2±0.6)%;the myocardial enzymes such as cTnI,CK,CK-MB and LDH returned to normal values.The intracranial pressure ranged from 160 to 178 cmH2O,with an average of(166.4±11.9)cmH2O.After treatment,95(90.5%)patients’EKG gradually returned to normal;among the 10 patients(9.5%)with abnormal EKG,5 patients had insufficient myocardial blood supply,3 patients had atrial premature beat,and 2 patients had ventricular premature beat.There were significant differences in these indicators before and after treatment(P<0.05,or P<0.01).Conclusion CO poisoning is prone to secondary acute encephalopathy and myocardial damage.HBO combined therapy is highly effective for treating secondary acute encephalopathy and myocardial damage caused by CO poisoning,therefore it can provide a reference for clinical treatment.