Brown D B, Mueller G L, Golich F C
92nd Medical Group SAT, Fairchild AFB, WA 99011-5300.
Aviat Space Environ Med. 1992 Nov;63(11):1011-4.
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.
一氧化碳（CO）中毒是美国最常见的中毒形式之一。当孕妇发生CO中毒时，就中枢神经系统紊乱和延迟性中枢神经系统后遗症而言，对母亲和胎儿具有极高的毒性。由于高氧分压对胎儿的影响未知，在治疗孕妇CO中毒方面存在争议。高压氧（HBO）疗法对CO中毒有益，因为它首先能提高氧浓度，并使氧解离曲线从左向右移动。其次，通过减少CO与细胞色素氧化酶的相互作用，HBO可使线粒体更有效地利用氧气。第三，HBO可能减少脂质过氧化，而脂质过氧化可能是导致神经功能恶化和延迟性中枢神经系统后遗症的原因。第四，如果已经存在心血管疾病，HBO减少CO的影响可能会减轻CO中毒对心肌的改变。本文介绍了孕期成功使用HBO疗法的一个案例研究，并讨论了CO对胎儿的影响。
