Hyperbaric Medicine Division, Intermountain LDS Hospital, Salt Lake City, Utah.
Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah.
Undersea Hyperb Med. 2024 Third Quarter;51(3):253-276.
Despite established exposure limits and safety standards, and the availability of carbon monoxide (CO) alarms, each year an estimated 50,000 people in the United States visit emergency departments for CO poisoning. Carbon monoxide poisoning can occur from brief exposures to high levels of CO or from longer exposures to lower levels. If the CO exposure is sufficiently high, unconsciousness and death occur quickly, and without symptoms. With non-lethal exposures to CO, common symptoms include headaches, nausea and vomiting, dizziness, general malaise, and altered mental status. Some patients may have chest pain, shortness of breath, and myocardial ischemia, and may require mechanical ventilation and treatment of shock. Individuals poisoned by CO often develop brain injury. As with brain injury from non- CO causes such as traumatic brain injury, the clinical expression of brain injury caused by CO poisoning includes the domains of cognition, affect, neurological, and somatic. Common problems are neurological: imbalance, motor weakness, neuropathies, hearing loss, tinnitus, Parkinson's-like syndrome, vestibular, gaze, auditory processing, cognitive, anxiety and depression, posttraumatic stress, personality change, persistent headaches, dizziness, sleep problems, and others. In addition, some will have cardiac or other problems. While breathing oxygen hastens the removal of carboxyhemoglobin (COHb), hyperbaric oxygen (HBO) hastens COHb elimination and favorably modulates inflammatory processes instigated by CO poisoning, an effect not observed with breathing normobaric oxygen. Hyperbaric oxygen improves mitochondrial function, inhibits lipid peroxidation transiently, impairs leukocyte adhesion to injured microvasculature, and reduces brain inflammation caused by CO-induced adduct formation of myelin basic protein. Based upon supportive randomized clinical trials in humans and considerable evidence from animal studies, HBO should be considered for all cases of acute symptomatic CO poisoning. Hyperbaric oxygen is indicated for CO poisoning complicated by cyanide poisoning, often concomitantly with smoke inhalation.
尽管有既定的暴露限值和安全标准，并且有一氧化碳 (CO) 警报器可用，但每年仍有估计 50,000 名美国人因 CO 中毒而到急诊部门就诊。CO 中毒可能是由于短时间暴露于高浓度 CO 或长时间暴露于低浓度 CO 引起的。如果 CO 暴露足够高，意识丧失和死亡会迅速发生，且没有症状。对于非致命性 CO 暴露，常见症状包括头痛、恶心和呕吐、头晕、全身不适和精神状态改变。一些患者可能有胸痛、呼吸急促和心肌缺血，可能需要机械通气和休克治疗。CO 中毒的个体常发生脑损伤。与非 CO 引起的脑损伤（如创伤性脑损伤）一样，CO 中毒引起的脑损伤的临床表达包括认知、情感、神经和躯体领域。常见的问题是神经系统：平衡失调、运动无力、神经病、听力损失、耳鸣、帕金森样综合征、前庭、凝视、听觉处理、认知、焦虑和抑郁、创伤后应激、人格改变、持续性头痛、头晕、睡眠问题等。此外，一些人还会有心脏或其他问题。虽然吸氧可以加速去除碳氧血红蛋白 (COHb)，但高压氧 (HBO) 可以加速 COHb 的消除，并有利于调节由 CO 中毒引发的炎症过程，而常压吸氧则没有这种效果。高压氧可改善线粒体功能，短暂抑制脂质过氧化，抑制白细胞黏附于受损的微血管，并减少由 CO 诱导的髓鞘碱性蛋白加合物形成引起的脑炎症。基于人类的支持性随机临床试验和大量动物研究证据，应考虑对所有急性症状性 CO 中毒病例使用 HBO。高压氧适用于伴有氰化物中毒的 CO 中毒，通常与烟雾吸入同时使用。
