Chan M Y, Au T Ts, Leung K S, Yan W W
Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
Department of Intensive Care Unit, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
Hong Kong Med J. 2016 Feb;22(1):46-55. doi: 10.12809/hkmj144529. Epub 2016 Jan 15.
This study aimed to describe the clinical profiles of all patients with carbon monoxide poisoning admitted to a regional hospital in order to enhance the vigilance of health care professionals for delayed neurological sequelae associated with carbon monoxide poisoning and to identify the prognostic factors associated with their development. This study also aimed to assess the impact of hyperbaric oxygen therapy on the development of delayed neurological sequelae in these patients.
This was a historical cohort study in which all patients with a diagnosis of carbon monoxide poisoning managed in a regional hospital in Hong Kong from 12 February 2003 to 8 November 2013 were recruited. Main outcome measures included delayed neurological sequelae.
Of the clinical profiles of 93 patients analysed, 24 patients received hyperbaric oxygen therapy and did not develop delayed neurological sequelae. Seven patients who did not receive hyperbaric oxygen therapy developed delayed neurological sequelae. Comparison of groups with and without delayed neurological sequelae (excluding hyperbaric oxygen therapy-treated patients) revealed that loss of consciousness (P=0.038), Glasgow Coma Scale score of 3 (P=0.012), elevated troponin level (P<0.001), higher creatine kinase level (P=0.008), and intubation requirement (P=0.007) were possible prognostic factors for the development of delayed neurological sequelae.
Although not statistically significant, this study showed a 100% protective effect of hyperbaric oxygen therapy against development of severe delayed neurological sequelae in patients with severe carbon monoxide poisoning. Further study with better study design is warranted. Loss of consciousness, low Glasgow Coma Scale score, intubation requirement, elevated troponin and higher creatine kinase levels were possible prognostic factors for development of delayed neurological sequelae in patients with severe carbon monoxide poisoning. A well-defined treatment protocol, appropriate follow-up duration and neuropsychiatric tests together with a hospital-based hyperbaric chamber are recommended for management of patients with severe carbon monoxide poisoning.
本研究旨在描述入住一家地区医院的所有一氧化碳中毒患者的临床特征，以提高医护人员对与一氧化碳中毒相关的迟发性神经后遗症的警惕性，并确定与其发生相关的预后因素。本研究还旨在评估高压氧治疗对这些患者迟发性神经后遗症发生的影响。
这是一项历史性队列研究，纳入了2003年2月12日至2013年11月8日在香港一家地区医院接受治疗的所有诊断为一氧化碳中毒的患者。主要结局指标包括迟发性神经后遗症。
在分析的93例患者的临床特征中，24例接受了高压氧治疗且未发生迟发性神经后遗症。7例未接受高压氧治疗的患者发生了迟发性神经后遗症。对有和没有迟发性神经后遗症的两组患者（不包括接受高压氧治疗的患者）进行比较发现，意识丧失（P=0.038）、格拉斯哥昏迷量表评分为3分（P=0.012）、肌钙蛋白水平升高（P<0.001）、肌酸激酶水平较高（P=0.008）以及需要插管（P=0.007）可能是迟发性神经后遗症发生的预后因素。
尽管无统计学意义，但本研究显示高压氧治疗对重度一氧化碳中毒患者严重迟发性神经后遗症的发生具有100%的保护作用。有必要采用更好的研究设计进行进一步研究。意识丧失、格拉斯哥昏迷量表评分低、需要插管、肌钙蛋白升高和肌酸激酶水平较高可能是重度一氧化碳中毒患者迟发性神经后遗症发生的预后因素。建议采用明确的治疗方案、适当的随访时间和神经精神测试，并配备医院内的高压氧舱来管理重度一氧化碳中毒患者。
