Koren G, Sharav T, Pastuszak A, Garrettson L K, Hill K, Samson I, Rorem M, King A, Dolgin J E
Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada.
Reprod Toxicol. 1991;5(5):397-403. doi: 10.1016/0890-6238(91)90002-w.
We report the results of the first prospective, multicenter study of acute carbon monoxide (CO) poisoning in pregnancy. We collected and followed cases of CO poisoning occurring during pregnancy between December 1985 and March 1989. The sources of CO were malfunctioning furnaces (n = 16), hot water heaters (n = 7), car fumes (n = 6), and methylene chloride inhalation (n = 3). Pregnancy outcome was adversely affected in 3 of 5 pregnancies with severe toxicity; two stillbirths, and one cerebral palsy with tomographic findings consistent with ischemic damage. All adverse outcome occurred in cases treated with high flow oxygen, whereas the 2 cases of severe toxicity with normal outcomes followed hyperbaric oxygen therapy. All 31 babies exposed in utero to mild or moderate CO poisoning exhibited normal physical and neurobehavioral development. Severe maternal CO toxicity was associated with significantly more adverse fetal cases when compared to mild maternal toxicity (P less than 0.001). It is concluded that while severe CO poisoning poses serious short- and long-term fetal risk, mild accidental exposure is likely to result in normal fetal outcome. Because fetal accumulation of CO is higher and its elimination slower than in the maternal circulation, hyperbaric oxygen may decrease fetal hypoxia and improve outcome.
我们报告了首例关于妊娠期急性一氧化碳（CO）中毒的前瞻性多中心研究结果。我们收集并跟踪了1985年12月至1989年3月期间妊娠期发生的CO中毒病例。CO的来源包括故障的熔炉（n = 16）、热水器（n = 7）、汽车尾气（n = 6）以及吸入二氯甲烷（n = 3）。5例重度中毒的妊娠中，有3例的妊娠结局受到不利影响；2例死产，1例患脑瘫，其断层扫描结果与缺血性损伤相符。所有不良结局均发生在接受高流量氧气治疗的病例中，而2例重度中毒但结局正常的病例接受了高压氧治疗。所有31例宫内暴露于轻度或中度CO中毒的婴儿均表现出正常的身体和神经行为发育。与轻度母体中毒相比，重度母体CO中毒与更多不良胎儿病例显著相关（P小于0.001）。结论是，虽然重度CO中毒会给胎儿带来严重的短期和长期风险，但轻度意外暴露可能导致正常的胎儿结局。由于胎儿体内CO的蓄积高于母体循环且其消除速度较慢，高压氧可能会减少胎儿缺氧并改善结局。
