Myers R A, Britten J S
Department of Hyperbaric Medicine, Maryland Institute for Emergency Medical Services Systems, Baltimore 21201-1595.
Crit Care Med. 1989 Feb;17(2):139-42. doi: 10.1097/00003246-198902000-00007.
Traditionally, the carboxyhemoglobin (HbCO) level has been used to estimate the severity of carbon monoxide (CO) poisoning. Through extensive clinical experience, we have found this to be an inaccurate correlation; thus, other variables such as pHa or psychometric abnormalities have been assessed to determine severity from CO poisoning. In a 5-yr experience with 247 patients, on admission 114 had an arterial blood gas and HbCO determinations, and 88 also had psychometric testing. The data were evaluated to determine any relationship between pH and HbCO level; a weak correlation (r approximately equal to -0.3) was discovered. A comparison of psychometric testing with HbCO level showed a much stronger statistical relationship. The definition of HbCO poisoning severity may be better determined by psychometric testing than by the HbCO level because psychometric testing measures actual neurologic disability. The weak correlation between both psychometric testing and the HbCO level with pHa reinforces the clinical impression that patients with acidosis, alkalosis, or normal blood gases could have equally severe neurologic symptomatology at HbCO levels ranging from 1% to 62%.
传统上，碳氧血红蛋白（HbCO）水平一直被用于评估一氧化碳（CO）中毒的严重程度。通过广泛的临床经验，我们发现这是一种不准确的关联；因此，其他变量如动脉血pH值（pHa）或心理测量异常已被评估，以确定CO中毒的严重程度。在对247例患者进行的5年观察中，入院时114例患者进行了动脉血气分析和HbCO测定，88例还进行了心理测量测试。对数据进行评估以确定pH值与HbCO水平之间的任何关系；发现了一种弱相关性（r约等于-0.3）。心理测量测试与HbCO水平的比较显示出更强的统计学关系。与HbCO水平相比，通过心理测量测试可能能更好地确定HbCO中毒的严重程度，因为心理测量测试测量的是实际的神经功能障碍。心理测量测试和HbCO水平与pHa之间的弱相关性强化了临床印象，即在HbCO水平为1%至62%的范围内，酸中毒、碱中毒或血气正常的患者可能有同样严重的神经症状。
