Department of Pediatrics, Hacettepe University School of Medicine, Ihsan Dogramaci Children's Hospital, Sihhiye, Ankara 06100, Turkey.
Eur J Emerg Med. 2010 Aug;17(4):192-6. doi: 10.1097/MEJ.0b013e328320ad48.
Carbon monoxide (CO)-induced cardiotoxicity has been investigated infrequently in children and reports of its cardiovascular effects are limited to isolated case reports. Our aims were to describe acute cardiac effects and associated factors with myocardial injury in children with CO poisoning.
We reviewed the medical records of children below 17 years of age who were diagnosed with CO poisoning at pediatric emergency department between July 2004 and June 2007. Patients who had carboxyhemoglobin level at least 10% were included. Myocardial injury was defined as elevated cardiac biomarkers (creatine kinase-MB or troponin-t). Carboxyhemoglobin level, electrocardiogram (ECG) findings, cardiac biomarkers, and echocardiograph results were recorded for each patient.
Cardiac biomarkers were drawn in 107 patients, of which 16 patients (15%) had cardiac biomarkers confirmed diagnosis of myocardial injury. Sinus tachycardia was present in 32% of patients on baseline ECG. None of the patients had ischemic changes on ECG. Echocardiograph was performed in 27 patients (25% of patients with biomarkers drawn), of which nine patients had low ejection fraction and abnormal left ventricular function. Determinators of myocardial injury included a Glasgow Coma Scale (GCS) score <or=14 and hypotension (for GCS score <or=14 and hypotension, relative risk: 90 and 95% confidence interval: 9.9-813.
Myocardial injury may exist in children with CO poisoning without abnormal ECG findings. GCS score <or=14 and hypotension were associate factors with myocardial injury.
一氧化碳（CO）引起的心脏毒性在儿童中研究较少，其心血管效应的报道仅限于孤立的病例报告。我们的目的是描述儿童 CO 中毒中心肌损伤的急性心脏效应和相关因素。
我们回顾了 2004 年 7 月至 2007 年 6 月期间在儿科急诊部门诊断为 CO 中毒的 17 岁以下儿童的病历。包括至少 10%的碳氧血红蛋白水平的患者。心肌损伤定义为升高的心脏生物标志物（肌酸激酶-MB 或肌钙蛋白-t）。每位患者均记录了碳氧血红蛋白水平、心电图（ECG）发现、心脏生物标志物和超声心动图结果。
在 107 例患者中抽取了心脏生物标志物，其中 16 例（15%）有心脏生物标志物确诊为心肌损伤。32%的患者在基线心电图上出现窦性心动过速。心电图上没有患者出现缺血性改变。对 27 例（抽取心脏生物标志物的患者中有 25%）患者进行了超声心动图检查，其中 9 例患者射血分数低且左心室功能异常。心肌损伤的决定因素包括格拉斯哥昏迷量表（GCS）评分≤14 和低血压（对于 GCS 评分≤14 和低血压，相对风险：90 和 95%置信区间：9.9-813）。
CO 中毒的儿童可能存在无异常心电图发现的心肌损伤。GCS 评分≤14 和低血压是与心肌损伤相关的因素。
