在英格兰农村和城市急诊部门就诊的选定患者群体中筛查一氧化碳暴露：一项前瞻性观察研究。
Screening for carbon monoxide exposure in selected patient groups attending rural and urban emergency departments in England: a prospective observational study.
机构信息
Department of Emergency Medicine, Frimley Park NHS Foundation Trust, Camberley, UK.
出版信息
BMJ Open. 2012 Dec 13;2(6). doi: 10.1136/bmjopen-2012-000877. Print 2012.
OBJECTIVES
Carbon monoxide (CO) exposure does not produce a classical toxidrome and so it is thought that it may easily be missed, allowing patients to continue to be exposed to CO. The aim of this study was to determine the proportion of raised carboxyhaemoglobin (COHb) levels in a targeted population of patients presenting to four emergency departments (EDs) in England.
DESIGN
A prospective observational study undertaken over a 9-month period.
SETTING
Four EDs; one in a rural/suburban area and three serving urban populations.
PARTICIPANTS
1758 patients presenting to the EDs with chest pain, exacerbation of chronic obstructive pulmonary disease (COPD), non-traumatic headache, seizures or flu-like symptoms.
MAIN OUTCOME
Measures COHb levels measured using a pulse CO-oximeter or venous sample. Patients with COHb levels ≥2.5% (non-smokers) or ≥5% (smokers) completed a questionnaire assessing potential sources. Patients were defined to be positive for CO exposure if they had a positive COHb and either an identified source or no other reason for their raised level.
RESULTS
Proportion of positive patients was: overall-4.3%; COPD-7.5%; headache-6.3%; flu-like-4.3%; chest pain-3.3%; seizures-2.1%. A variety of gas and solid (predominantly charcoal) fossil fuel sources were identified.
CONCLUSIONS
This study showed that 4.3% of patients presenting to EDs with non-specific symptoms had unexpectedly raised COHb levels 1.4% of patients had a source of CO identified. Study limitations included non-consecutive recruitment, delays in COHb measurements and a lack of ambient CO measurements, which precludes precise determination of incidence. However, this study should alert clinicians to consider CO exposure in patients presenting with non-specific symptoms, in particular headache and exacerbation of COPD, and if necessary refer patients for suitable public-health follow-up, even in the presence of low COHb readings. Further research should include standardised scene assessments.
目的
一氧化碳（CO）暴露不会产生典型的中毒症状，因此人们认为可能很容易被忽视，使患者继续暴露于 CO 中。本研究的目的是确定在英国四个急诊科（ED）就诊的特定人群中升高的碳氧血红蛋白（COHb）水平的比例。
设计
一项为期 9 个月的前瞻性观察研究。
地点
四个 ED；一个位于农村/郊区，三个服务于城市人口。
参与者
1758 名因胸痛、慢性阻塞性肺疾病（COPD）加重、非创伤性头痛、癫痫发作或流感样症状就诊于 ED 的患者。
主要结果
使用脉冲 CO-血氧计或静脉样本测量 COHb 水平。COHb 水平≥2.5%（非吸烟者）或≥5%（吸烟者）的患者完成了一份评估潜在来源的问卷。如果患者的 COHb 呈阳性且有明确的来源或没有其他原因导致其升高，则定义为 CO 暴露阳性。
结果
阳性患者的比例为：总体为 4.3%；COPD 为 7.5%；头痛为 6.3%；流感样症状为 4.3%；胸痛为 3.3%；癫痫发作为 2.1%。确定了各种气体和固体（主要是木炭）化石燃料来源。
结论
本研究表明，在因非特异性症状就诊于 ED 的患者中，有 4.3%的患者 COHb 水平意外升高，有 1.4%的患者确定了 CO 的来源。研究局限性包括非连续招募、COHb 测量延迟以及缺乏环境 CO 测量，这使得无法精确确定发病率。然而，本研究应提醒临床医生在出现非特异性症状（特别是头痛和 COPD 加重）的患者中考虑 CO 暴露，如果有必要，即使 COHb 读数较低，也应将患者转介给合适的公共卫生随访。进一步的研究应包括标准化的现场评估。
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