Lu Qiang, Lv Weiwei, Tian Jiang, Zhang Lijie, Zhu Baoping
Department of Neurology, Peking Union Medical College Hospital, Beijing, China.
Department of infectious disease control, Anshan prefecture Center for Disease Control and Prevention, Liaoning, China; Department of infectious disease control, Liaoning Center for Disease Control and Prevention, Shenyang, China.
PLoS One. 2015 Jun 12;10(6):e0129121. doi: 10.1371/journal.pone.0129121. eCollection 2015.
Carbon monoxide (CO) poisoning can be fatal but is preventable. From October 2010 to February 2011, Anshan Prefecture reported 57 cases of non-occupational CO poisoning in District A, with two deaths. We conducted an investigation to identify risk factors and recommend preventive measures.
We defined a possible case of non-occupational CO poisoning as onset of at least two of the following symptoms: fatigue, headache, dizziness, nausea, vomiting, cyanosis, loss of consciousness, coma, and shock from October 1, 2010, to February 28, 2011, in a resident of Anshan Prefecture with non-occupational exposure to CO poisoning. We defined a probable case as onset of at least one of the following symptoms: cyanosis, loss of consciousness, coma and shock, plus at least one of the following symptoms: fatigue, headache, dizziness, nausea, vomiting, among possible cases. A confirmed CO poisoning case was a possible case or probable case plus hemoglobin (Hb) CO higher than 10%. We searched for cases by reviewing medical records and records of hyperbaric oxygen tank usage. In a case-control investigation, we compared home heating practices of 30 case-persons and 120 control-persons who were individually matched to each case by neighborhood.
Overall, 56% (39/70) of case-patients' households burned coal for home-heating. In the case-control investigation, 40% (12/30) of case-persons' households compared with 5.8% (7/120) of control-persons' households placed stoves in bedrooms (Mantel-Haenszel odds ratio [ORM-H] = 11, 95% confidence interval [CI] = 3.0-41); 53% (16/30) of case-patients' households and 33% (40/120) of control-patients' households did not extinguish the fire before sleeping (ORM-H = 3.6, 95% CI = 1.1-12); 13% (4/30) of case-patients' households and 3% (4/120) of control-patients' households had not installed the ventilation pipe vertically (ORM-H = 7.3, 95% CI = 1.0-56). Overall, 77% (23/30) of case-patients' households and 39% (47/120) of control-patients' households had at least one of those three risk factors (ORM-H = 10, 95% CI = 2.5-40; population attributable risk percentage: 78%).
Dangerous practices with coal-burning stoves inside the home accounted for the majority of CO poisoning incidents. Community health centers should provide instruction to and supervision of residents on proper installation and use of home heating stoves as well as inspection of installation.
一氧化碳（CO）中毒可能致命，但可预防。2010年10月至2011年2月，鞍山市A区报告了57例非职业性CO中毒病例，其中2例死亡。我们开展了一项调查以确定危险因素并推荐预防措施。
我们将2010年10月1日至2011年2月28日期间鞍山市非职业性接触CO中毒的居民中出现至少以下两种症状：疲劳、头痛、头晕、恶心、呕吐、发绀、意识丧失、昏迷和休克定义为可能的非职业性CO中毒病例。我们将至少出现以下一种症状：发绀、意识丧失、昏迷和休克，加上至少以下一种症状：疲劳、头痛、头晕、恶心、呕吐，在可能病例中定义为很可能病例。确诊的CO中毒病例为可能病例或很可能病例加上碳氧血红蛋白（Hb）CO高于10%。我们通过查阅病历和高压氧舱使用记录来查找病例。在一项病例对照研究中，我们比较了30例病例患者和120例对照者的家庭取暖方式，对照者按邻里关系与每个病例进行个体匹配。
总体而言，56%（39/70）的病例患者家庭使用煤炭取暖。在病例对照研究中，40%（12/30）的病例患者家庭将炉灶放置在卧室，而对照者家庭为5.8%（7/120）（Mantel-Haenszel优势比[ORM-H]=11，95%置信区间[CI]=3.0-41）；53%（16/30）的病例患者家庭和33%（40/120）的对照患者家庭在睡觉前未熄灭火源（ORM-H=3.6，95%CI=1.1-12）；13%（4/30）的病例患者家庭和3%（4/120）的对照患者家庭未垂直安装通风管道（ORM-H=7.3，95%CI=1.0-56）。总体而言，77%（23/30）的病例患者家庭和39%（47/120）的对照患者家庭至少有这三种危险因素中的一种（ORM-H=10，95%CI=2.5-40；人群归因危险度百分比：78%）。
家庭内燃煤炉灶的危险使用方式占CO中毒事件的大多数。社区卫生中心应就家庭取暖炉灶的正确安装和使用以及安装检查向居民提供指导并进行监督。
