Santos Luís Ramos, Alves-Correia Magna, Câmara Margarida, Lélis Manuela, Caldeira Carmo, Brazão Maria Luz, Nóbrega José Júlio
Internal Medicine Department. Hospital dos Marmeleiros, SESARAM. Funchal, Portugal.
Intensive Care Department. Hospital Central do Funchal, SESARAM. Funchal. Hyperbaric Medicine Unit. Hospital Central do Funchal, SESARAM. Funchal, Portugal.
Acta Med Port. 2018 Mar 29;31(3):146-151. doi: 10.20344/amp.9811.
Carbon monoxide poisoning may occur in several contexts.
Retrospective of 37 carbon monoxide poisoning cases that underwent hyperbaric oxygen during wildfires in Funchal in August 2016.
The studied sample included 37 patients, mean age of 38 years, 78% males. Ten were firefighters, four children and two pregnant victims. Neurological symptoms were the most reported. Median carboxyhemoglobin level was 3.7% (IQR 2.7). All received high-flow oxygen from admission to delivery of hyperbaric oxygen. Persistence of symptoms was the main indication for hyperbaric oxygen. Median time to hyperbaric oxygen was 4.8 hours (IQR 9.5), at 2.5 ATA for 90 minutes, without major complications. Discharge in less than 24 hours occurred in 92% of the cases. Thirty days follow-up: five patients presented clinical symptoms of late neurological syndrome; twelve patients were lost to follow-up. Carboxyhemoglobin levels on admission and mean time to hyperbaric oxygen were no different between those who did and did not develop the syndrome at 30 days (p = 0.44 and p = 0.58, respectively).
Late neurological syndrome at 30 days occurred in 20% and no new cases were reported at 12 months.
Use of hyperbaric oxygen appears to have reduced the incidence of the syndrome. This seems to be the first Portuguese series reporting use of hyperbaric oxygen in carbon monoxide poisoning due to wildfires. The authors intend to alert to the importance of referral of these patients because the indications and benefits of this treatment are well documented. This is especially important given the ever-growing issue of wildfires in Portugal.
一氧化碳中毒可能在多种情况下发生。
回顾性分析2016年8月丰沙尔野火期间接受高压氧治疗的37例一氧化碳中毒病例。
研究样本包括37例患者，平均年龄38岁，78%为男性。其中10例为消防员，4例儿童，2例孕妇。神经系统症状报告最多。碳氧血红蛋白水平中位数为3.7%（四分位间距2.7）。所有患者从入院到接受高压氧治疗期间均接受高流量吸氧。症状持续是进行高压氧治疗的主要指征。高压氧治疗的中位时间为4.8小时（四分位间距9.5），在2.5个绝对大气压下治疗90分钟，无重大并发症。92%的病例在24小时内出院。30天随访：5例患者出现迟发性神经综合征的临床症状；12例患者失访。在30天时出现和未出现该综合征的患者入院时的碳氧血红蛋白水平及高压氧治疗的平均时间无差异（p值分别为0.44和0.58）。
30天时迟发性神经综合征的发生率为20%，12个月时未报告新病例。
高压氧的使用似乎降低了该综合征的发生率。这似乎是葡萄牙首个报告在野火导致的一氧化碳中毒中使用高压氧的系列研究。作者旨在提醒注意转诊这些患者的重要性，因为这种治疗的指征和益处已有充分记录。鉴于葡萄牙野火问题日益严重，这一点尤为重要。
