Hubalewska-Hoła Alicja, Pach Dorota, Pach Janusz, Sowa-Staszczak Anna, Winnik Lidia, Huszno Bohdan
Department of Clinical Toxicology, Jagiellonian University, Medical College, 31-501 Kraków ul. Kopernika 17, Poland.
Przegl Lek. 2003;60(4):226-32.
The results of myocardial (99mTc-MIBI SPECT) perfusion scintigraphy according to clinical evaluation, ECG, biochemical factors of necrosis and indicators of carbon monoxide (CO) poisoning severity are described in the paper. Under examination there were 88 young (mean age 26 +/- 8.5) acutely CO poisoned patients without previous cardiac illness history, treated at the Department of Clinical Toxicology Jagiellonian University Medical College in Krakow in 1996 to 2002. Measurement of COHb level, blood lactate concentration, duration of exposure and ECG examination were performed on admission. The enzymes activity ALT, AST, CK, MB-CK, was evaluated after 24-48 h. The severity of CO poisoning was estimated basing on age, duration of exposure, COHb level, blood lactate concentration and the patient neurological state on admission. 99mTc-MIBI SPECT was performed on days 1 to 5 post admission. The abnormalities in scintigraphic scans were assessed according to arbitrary accepted scale (0-IV). Conventional biomarkers creatine kinase, ALT and AST were insufficient for evaluation the heart injury in CO cutely poisoned patients. A statistically significant differences in the blood lactate concentration with regard to degree of scintigraphic changes have been observed. The ECG curves monitored from admission to discharge were analyzed in the study. Tachycardia was observed in all the patients but no statistically significant differences were found between the subgroups divided according to the degree of scintigraphic scans. Conductivity disturbances were detected mainly in patients qualified to higher then the first degree of scintigraphic changes. ECG signs of myocardial ischemia were the most frequent in patients with biggest pathological changes in 99mTc-MIBI scans. The changes in 99mTc-MIBI SPECT were observed in the majority of acutely CO poisoned patients. The mutual dependence of patient's condition based on neurological symptoms, carbon monoxide poisoning severity scoring and the degree of scintigraphy changes was found. The examination performed indicate that 99mTc-MIBI SPECT scintigraphy can be method of choice for evaluation the heart injury in patients after acute CO intoxication.
本文描述了根据临床评估、心电图、坏死生化因素以及一氧化碳（CO）中毒严重程度指标得出的心肌（99mTc-MIBI单光子发射计算机断层扫描）灌注闪烁扫描结果。接受检查的是88名年轻（平均年龄26±8.5岁）的急性CO中毒患者，他们此前无心脏病史，于1996年至2002年在克拉科夫雅盖隆大学医学院临床毒理学系接受治疗。入院时进行了COHb水平、血乳酸浓度、暴露时间的测量以及心电图检查。24 - 48小时后评估了ALT、AST、CK、MB - CK的酶活性。根据年龄、暴露时间、COHb水平、血乳酸浓度以及患者入院时的神经状态评估CO中毒的严重程度。入院后第1至5天进行了99mTc-MIBI单光子发射计算机断层扫描。根据任意接受的量表（0 - IV级）评估闪烁扫描中的异常情况。传统生物标志物肌酸激酶、ALT和AST不足以评估急性CO中毒患者的心脏损伤。观察到血乳酸浓度与闪烁扫描变化程度存在统计学显著差异。本研究分析了从入院到出院监测的心电图曲线。所有患者均观察到心动过速，但根据闪烁扫描程度划分的亚组之间未发现统计学显著差异。传导障碍主要在闪烁扫描变化程度高于一级的患者中检测到。99mTc-MIBI扫描中病理变化最大的患者中心肌缺血的心电图征象最为常见。大多数急性CO中毒患者观察到了99mTc-MIBI单光子发射计算机断层扫描的变化。发现基于神经症状的患者状况、一氧化碳中毒严重程度评分与闪烁扫描变化程度之间存在相互依赖性。所进行的检查表明，99mTc-MIBI单光子发射计算机断层扫描闪烁扫描可作为评估急性CO中毒后患者心脏损伤的首选方法。
