Hess Dean R
Massachusetts General Hospital and Harvard Medical School. He is also Editor in Chief of Respiratory Care.
Respir Care. 2017 Oct;62(10):1333-1342. doi: 10.4187/respcare.05781. Epub 2017 Aug 14.
Carbon monoxide (CO) is usually recognized as a toxic gas that can be used to assess lung function in the pulmonary function laboratory. The toxicity of CO relates to its high affinity for hemoglobin and other heme molecules, producing carboxyhemoglobin (HbCO). Despite that blood HbCO levels are commonly measured in patients with CO poisoning, the clinical presentation often does not correlate with the HbCO level, and clinical improvement in the patient's condition does not correlate with HbCO clearance. In patients with CO poisoning, administration of 100% O is standard practice. If available, hyperbaric O can be used, although this is controversial. Measurement of exhaled CO might be useful to estimate HbCO, such as in smoking cessation programs, but assessment of HbCO using pulse oximetry can be misleading. Endogenous CO is generated as the result of heme oxygenase activity. It is becoming increasingly recognized that the results of heme oxygenase activity, specifically CO production, might have important physiologic functions. These include effects on vascular function, inflammation, apoptosis, cell proliferation, and signaling pathways. Given the abundance of basic science supporting a therapeutic role for CO, clinical trials are exploring this potential.
一氧化碳（CO）通常被认为是一种有毒气体，可用于肺功能实验室评估肺功能。CO的毒性与其对血红蛋白和其他血红素分子的高亲和力有关，会产生碳氧血红蛋白（HbCO）。尽管通常会检测CO中毒患者的血液HbCO水平，但临床表现往往与HbCO水平不相关，且患者病情的临床改善与HbCO清除也不相关。对于CO中毒患者，给予100%氧气是标准治疗方法。如有条件，可使用高压氧，但这存在争议。测量呼出的CO可能有助于估计HbCO，例如在戒烟项目中，但使用脉搏血氧饱和度仪评估HbCO可能会产生误导。内源性CO是血红素加氧酶活性的产物。人们越来越认识到，血红素加氧酶活性的结果，特别是CO的产生，可能具有重要的生理功能。这些功能包括对血管功能、炎症、细胞凋亡、细胞增殖和信号通路的影响。鉴于有大量基础科学研究支持CO的治疗作用，临床试验正在探索这种潜力。
