水烟与非水烟一氧化碳中毒：患者特征、临床表现及结局的比较

Abdul-Nabi Sarah S, Tamim Hani, Hitti Eveline

Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.

Am J Emerg Med. 2024 May;79:70-74. doi: 10.1016/j.ajem.2024.02.012. Epub 2024 Feb 10.

OBJECTIVE

The aim of this study is to describe the difference between carboxyhemoglobin (CO-Hb) acute poisoning caused by waterpipe vs non-waterpipe exposures as they relate to demographics, clinical presentations and outcome of patients.

DESIGN

Retrospective cohort study conducted in the Emergency Department (ED) at the Lebanon.

PATIENTS

All adult patients presenting with a CO-Hb level ≥ 10 between January 2019 and August 2023 with exposure types stratified as waterpipe or non-waterpipe.

MEASUREMENTS AND MAIN RESULTS

111 ED visits were identified. Among these, 73.9% were attributed to waterpipe exposure, while 26.1% were non-waterpipe sources. These included cigarette smoking (17.2%), burning coal (24.1%), fire incidents (3.6%), gas leaks (6.9%), heating device use (10.3%), and undocumented sources (37.9%). Patients with waterpipe-related carbon monoxide exposure were younger (41 vs 50 years, p = 0.015) women (63.4 vs 41.4%, p = 0.039) with less comorbidities compared to non-waterpipe exposures (22.2 vs 41.4%, p = 0.047). Waterpipe smokers were more likely to present during the summer (42.7 vs 13.8%, p = 0.002) and have shorter ED length of stays (3.9 vs 4.5 h, p = 0.03). A higher percentage of waterpipe smokers presented with syncope (52.4 vs 17.2%, p = 0.001) whereas cough/dyspnea were more common in non-waterpipe exposures (31 vs 9.8%, p = 0.006). The initial CO-Hb level was found to be significantly higher in waterpipe exposure as compared to non-waterpipe (19.7 vs 13.7, p = 0.004). Non-waterpipe exposures were more likely to be admitted to the hospital (24.1 vs 4.9%, p = 0.015). Waterpipe smokers had significantly higher odds of experiencing syncope, with a 5.74-fold increase in risk compared to those exposed to non-waterpipe sources (p = 0.004) irrespective of their CO-Hb level. Furthermore, males had significantly lower odds of syncope as compared to females, following carbon monoxide exposure (aOR 0.31, 95% CI 0.13-0.74).

CONCLUSION

CO-Hb poisoning related to waterpipe smoking has distinctive features. Syncope is a commonly associated presentation that should solicit a focused social history in communities where waterpipe smoking is common. Furthermore, CO-Hb poisoning should remain on the differential in patients presenting with headache, syncope, dizziness, vomiting or shortness of breath, even outside of the non-waterpipe exposure peaks of winter season.

目的

本研究旨在描述水烟与非水烟暴露所致碳氧血红蛋白（CO-Hb）急性中毒在人口统计学、临床表现及患者预后方面的差异。

设计

在黎巴嫩急诊科进行的回顾性队列研究。

患者

2019年1月至2023年8月期间所有CO-Hb水平≥10%的成年患者，暴露类型分为水烟或非水烟。

测量指标及主要结果

共确定了111次急诊就诊病例。其中，73.9%归因于水烟暴露，26.1%为非水烟来源。这些非水烟来源包括吸烟（17.2%）、烧煤（24.1%）、火灾事故（3.6%）、煤气泄漏（6.9%）、使用加热设备（10.3%）以及来源不明（37.9%）。与非水烟暴露患者相比，水烟相关一氧化碳暴露患者更年轻（41岁对50岁，p = 0.015），女性比例更高（63.4%对41.4%，p = 0.039），合并症更少（22.2%对41.4%，p = 0.047）。水烟吸食者更可能在夏季就诊（42.7%对13.8%，p = 0.002），且急诊留观时间更短（3.9小时对4.5小时，p = 0.03）。更高比例的水烟吸食者出现晕厥（52.4%对17.2%，p = 0.001），而非水烟暴露者中咳嗽/呼吸困难更为常见（31%对9.8%，p = 0.006）。发现水烟暴露患者的初始CO-Hb水平显著高于非水烟暴露患者（19.7对13.7，p = 0.004）。非水烟暴露者更可能入院（24.1%对4.9%，p = 0.015）。无论CO-Hb水平如何，水烟吸食者发生晕厥的几率显著更高，与非水烟暴露者相比风险增加5.74倍（p = 0.004）。此外，一氧化碳暴露后男性发生晕厥的几率显著低于女性（校正比值比0.31，95%可信区间0.13 - 0.74）。