Raphael J C, Elkharrat D, Jars-Guincestre M C, Chastang C, Chasles V, Vercken J B, Gajdos P
Service de Réanimation Médicale, Hôpital Raymond Poincaré, Garches, France.
Lancet. 1989 Aug 19;2(8660):414-9. doi: 10.1016/s0140-6736(89)90592-8.
The value of hyperbaric oxygen in the treatment of acute carbon monoxide intoxication was assessed in 629 adults who had been poisoned at home in the 12 h before admission to hospital. In patients without initial impairment of consciousness (group A) the effect of 6 h of normobaric oxygen (NBO) (group A0, n = 170) was compared with that of 2 h of hyperbaric oxygen (HBO) at 2 atmospheres absolute (ATA) plus 4 h NBO (group A1, n = 173). At the 1 month follow-up 66% of A0 and 68% of A1 patients had recovered. In patients with initial impairment of consciousness the effect of one session of HBO (group B1, n = 145) was compared with that of two sessions (group B2, n = 141); all group B patients also received 4 h of NBO. At 1 month of follow-up 54% group B1 and 52% group B2 patients had recovered. The 7 patients left with neuropsychiatric sequelae (3 B1, 4 B2) and the 4 who died (2 B1, 2 B2) had all presented with coma. HBO was not useful in patients who did not lose consciousness during carbon monoxide intoxication, irrespective of their carboxyhaemoglobin level, nor were two sessions of HBO in patients who sustained only a brief loss of consciousness. The prognosis is poorest for those presenting with coma; the trial needs to be pursued in this group of patients until the power of the study is sufficient to demonstrate the value or otherwise of HBO.
对629名在入院前12小时内在家中中毒的成年人评估了高压氧治疗急性一氧化碳中毒的价值。在意识无初始障碍的患者（A组）中，比较了常压氧（NBO）6小时（A0组，n = 170）与2个绝对大气压（ATA）的高压氧（HBO）2小时加NBO 4小时（A1组，n = 173）的效果。在1个月的随访中，A0组66%的患者和A1组68%的患者已康复。在有意识初始障碍的患者中，比较了1次HBO治疗（B1组，n = 145）与2次治疗（B2组，n = 141）的效果；所有B组患者也接受了4小时的NBO治疗。在1个月的随访中，B1组54%的患者和B2组52%的患者已康复。留下神经精神后遗症的7名患者（3名B1组，4名B2组）和死亡的4名患者（2名B1组，2名B2组）均出现昏迷。一氧化碳中毒期间未失去意识的患者，无论其碳氧血红蛋白水平如何，HBO均无作用；仅短暂失去意识的患者接受2次HBO治疗也无作用。出现昏迷的患者预后最差；需要在这组患者中继续进行试验，直到研究能力足以证明HBO的价值与否。
