Mathieu D, Mathieu-Nolf M, Wattel F
Service d'Urgence Respiratoire, de Réanimation Médicale et de Médecine Hyperbare, Centre Anti-Poisons Nord Picardie.
Bull Acad Natl Med. 1996 May;180(5):965-71; discussion 972-3.
Carbon monoxide (CO) poisoning still represents a frequent and severe casualty in France. Aside the well-known effect of CO on hemoglobin, the role of CO binding to other hemoproteins like myoglobin and cytochrome a3 have been more recently recognized. Moreover, in addition to these hypoxic injuries, the reoxygenation phase may itself induce toxic effects by a mechanism close to the ischemia-reperfusion phenomenon. Clinical manifestations include neurologic disturbances, cardiac arrythmia, respiratory and circulatory failures which usually disappear with removal from toxic atmosphere and administration of oxygen. However, long term neurologic manifestations may occur and lead to important functional impairment and disability. Hyperbaric oxygen in actually the treatment of choice to avoid the occurrence of delayed sequelae. HBO is advocated in every patient who remains comatose on hospital admission, who had lost consciousness during toxic exposure or with persisting neurologic abnormalities. CO poisoned pregnant women should also undergo HBO. Well designed prevention programs are urgently needed in our country to decrease the incidence and the consequences of CO poisoning.
在法国，一氧化碳（CO）中毒仍然是一种常见且严重的伤亡原因。除了CO对血红蛋白的众所周知的影响外，CO与其他血红蛋白如肌红蛋白和细胞色素a3结合的作用最近也得到了更多认识。此外，除了这些缺氧损伤外，再氧合阶段本身可能通过类似于缺血-再灌注现象的机制诱导毒性作用。临床表现包括神经功能障碍、心律失常、呼吸和循环衰竭，通常在脱离有毒环境并给予氧气后消失。然而，可能会出现长期神经表现，并导致严重的功能障碍和残疾。高压氧实际上是避免延迟后遗症发生的首选治疗方法。对于入院时仍昏迷、在中毒暴露期间失去意识或有持续神经异常的每一位患者，都提倡进行高压氧治疗。CO中毒的孕妇也应接受高压氧治疗。我国迫切需要精心设计的预防方案，以降低CO中毒的发生率和后果。
