高压氧疗法治疗妊娠合并一氧化碳中毒：母婴结局。

Hyperbaric oxygen therapy in carbon monoxide poisoning in pregnancy: Maternal and fetal outcome.

机构信息

Necmettin Erbakan University, Meram Faculty of Medicine, Department of Underwater and Hyperbaric Medicine, Konya, Turkey.

出版信息

Am J Emerg Med. 2021 May;43:41-45. doi: 10.1016/j.ajem.2021.01.007. Epub 2021 Jan 10.

DOI:10.1016/j.ajem.2021.01.007

PMID:33497969

Abstract

OBJECTIVE

Closer monitoring and treatment is vital for pregnant carbon monoxide (CO) poisoning cases due to fetal poisoning component. Permanent damage can occur in both the mother and the baby. It may cause stillbirth even though no serious clinical symptoms occur in the mother. Hyperbaric oxygen (HBO) treatment is advised for all pregnant patients regardless of their clinical symptoms. Pregnant CO poisoning patients that received HBO treatment and their fetal status were evaluated in this study.

METHODS

Pregnant patients poisoned with CO treated in the same hyperbaric clinic were evaluated. Pregnant patients that received HBO treatment in a multiplace chamber were evaluated in terms of clinical status, demographic structure, laboratory tests, fetal effects and progress of the fetus until birth and 6 months postpartum.

RESULTS

A total number of 32 pregnant cases were treated. COHb values were over 20% (min 6.9- max 40.2) in 23 patients, 11 patients had a history of syncope. All patients took HBO treatment under 2.4 ATA pressure for 120 min. 3 patients received more than 1 session of HBO treatments due to fetal stress; all other cases took 1 session of HBO treatment. No spontaneous abortus occurred in early follow-ups; only 4 babies were born prematurely. 2 of the babies were lost in the early phases after birth, due to causes non-related to CO poisoning complications (cyanotic heart disease, necrotising enterocolitis). No significant difference were observed in the comparison of laboratory results of patients with syncope and of those who did not have syncope and comparison of patients with COHb value higher than 20% and patients with COHb value lower than 20% (p > 0.05).

CONCLUSION

HBO is not advisable for pregnant patients except for CO poisoning. In this study it is observed that HBO treatment under 2.4 ATA pressure for 120 min has no harmful effects on the mother and the fetus. It is observed that continuation of HBO treatment in the cases with fetal distress findings has beneficial effects. COHb levels and syncope were shown to have no significant effect on clinical symptoms and on blood tests.

摘要

目的

由于胎儿中毒成分，对孕妇一氧化碳（CO）中毒病例进行更密切的监测和治疗至关重要。母亲和婴儿都可能受到永久性损害。即使母亲没有出现严重的临床症状，也可能导致死胎。建议所有孕妇接受高压氧（HBO）治疗，无论其临床症状如何。本研究评估了接受 HBO 治疗的孕妇 CO 中毒患者及其胎儿状况。

方法

评估在同一高压诊所接受 CO 中毒治疗的孕妇患者。评估在多舱中接受 HBO 治疗的孕妇患者，评估内容包括临床状况、人口结构、实验室检查、胎儿影响以及胎儿出生直至产后 6 个月的进展情况。

结果

共治疗了 32 例孕妇病例。23 例患者的 COHb 值超过 20%（最低 6.9-最高 40.2），11 例患者有晕厥史。所有患者均在 2.4ATA 压力下接受 120 分钟的 HBO 治疗。由于胎儿应激，3 例患者接受了超过 1 次 HBO 治疗；所有其他病例均接受了 1 次 HBO 治疗。早期随访中没有发生自发性流产；只有 4 名婴儿早产。由于与 CO 中毒并发症无关的原因（紫绀型心脏病、坏死性小肠结肠炎），有 2 名婴儿在出生后早期死亡。晕厥患者与无晕厥患者、COHb 值高于 20%患者与 COHb 值低于 20%患者的实验室结果比较无显著差异（p>0.05）。