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老年患者一氧化碳中毒:入院时的乳酸值有多重要?

Carbon monoxide intoxication in geriatric patients: How important are lactate values at admission?

机构信息

Department of Emergency Medicine, Alaşehir State Hospital, Manisa, Turkey.

Department of Emergency Medicine, Bingöl State Hospital, Bingöl, Turkey.

出版信息

Hum Exp Toxicol. 2020 Jun;39(6):848-854. doi: 10.1177/0960327120903484. Epub 2020 Jan 31.

Abstract

PURPOSE

The aim of this study was to investigate the demographic and clinical characteristics and treatment modalities of elderly patients with carbon monoxide (CO) intoxication. The secondary aim was to evaluate the importance of plasma lactate values in the diagnosis of acute CO intoxication in geriatric patients.

METHODS

Data on geriatric patients who were admitted to the emergency department of Atatürk University Medical Faculty between January 2013 and April 2016 were analyzed retrospectively.

RESULTS

Of the 197 cases included in the study, 97 were in the intoxication group and 100 were in the control group; 82.5% of the intoxication cases had mild neurological symptoms and 17.5% had severe neurological symptoms. Carboxyhemoglobin levels were significantly higher in patients with severe neurological symptoms ( = 0.031). All patients with severe neurological symptoms received hyperbaric-oxygen therapy ( < 0.001). In the intoxication group, lactate levels were significantly higher than in the control group ( = 0.001). The specificity for lactate 4 mmol/L and above was found as 98.0% with a positive predictive value and negative predictive value of 84.5% and 53.3%, respectively.

CONCLUSION

High initial lactate levels may be a guide for cases with nonspecific symptoms in geriatric patients with suspected CO intoxication.

摘要

目的

本研究旨在探讨老年一氧化碳(CO)中毒患者的人口统计学和临床特征及治疗方式。次要目的是评估血浆乳酸值在诊断老年 CO 中毒患者中的重要性。

方法

回顾性分析了 2013 年 1 月至 2016 年 4 月期间入住阿塔图尔克大学医学院急诊部的老年患者的数据。

结果

本研究共纳入 197 例患者,其中 97 例为中毒组,100 例为对照组;中毒组 82.5%的患者有轻度神经症状,17.5%的患者有重度神经症状。重度神经症状患者的碳氧血红蛋白水平显著升高( = 0.031)。所有重度神经症状患者均接受高压氧治疗( < 0.001)。在中毒组,乳酸水平明显高于对照组( = 0.001)。乳酸水平为 4 mmol/L 及以上的特异性为 98.0%,阳性预测值和阴性预测值分别为 84.5%和 53.3%。

结论

对于疑似 CO 中毒的老年患者,初始高乳酸水平可能有助于诊断无特异性症状的病例。

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