窒息性氣體(張波)(編輯修改稿)
2024-11-12 20:17 本頁(yè)面
【文章內(nèi)容簡(jiǎn)介】 任何一項(xiàng)表現(xiàn)者 :a)腦水腫 。 b)休克或嚴(yán)重的心肌損害 。c)肺水腫 。d)呼吸衰竭 。 e)上消化道出血 。f)腦局灶損害如錐體系或錐體外系損害體征。 碳氧血紅蛋白濃度可 高于 50%。 急性 CO中毒遲發(fā)腦病 (神經(jīng)精神后發(fā)癥 ) 急性一氧化碳中毒意識(shí)障礙恢復(fù)后，經(jīng)約 260天的 “ 假愈期 ” ，又出現(xiàn)下列臨床表現(xiàn)之一者 : a)精神及意識(shí)障礙呈癡呆狀態(tài)，譫妄狀態(tài)或去大腦皮層狀態(tài) 。 b)錐體外系神經(jīng)障礙出現(xiàn)帕金森氏綜合征的表現(xiàn) 。 c)錐體系神經(jīng)損害 (如偏癱、病理反射陽(yáng)性或小便失禁等 ) d)大腦皮層局灶性功能障礙如失語(yǔ)、失明等，或出現(xiàn)繼發(fā)性癲癇。 頭部 CT檢查可發(fā)現(xiàn)腦部有病理性密度減低區(qū) 。腦電圖檢查可發(fā)現(xiàn)中度及高度異常。 [防治原則 ] ● 積極糾正腦缺氧： ● 治療腦水腫 ● 改善腦微循環(huán)障礙 ● 促進(jìn)腦代謝的藥物 ● 對(duì)癥治療 注意 ：對(duì)于重度中毒者一般均合并嚴(yán)重的代謝性酸中毒 ， 故應(yīng)用堿性藥物 。 糾正酸中毒應(yīng)作為急性一氧化碳中毒的常規(guī)治療措施 。 【 預(yù)防 】 ● 加強(qiáng)自然通風(fēng) ， 防止漏氣 ● 設(shè)立 CO報(bào)警器 ● 加強(qiáng)個(gè)體防護(hù) ， 普及自救 、 互救知識(shí) ● 進(jìn)入危險(xiǎn)區(qū)工作時(shí) ， 應(yīng)戴防毒面具 Background Patients with acute carbon monoxide poisoning monly have cognitive sequelae. We conducted a doubleblind,randomized trial to evaluate the effect of hyperbaric oxygen treatment on such cognitive sequelae. Methods We randomly assigned patients with symptomatic acute carbon monoxide poisoning in equal proportions to three chamber sessions within a 24hour period, consisting of either three hyperbaricoxygen treatments or one normobaricoxygen treatment plus two sessions of exposure to normobaric room air. Neuropsychological tests were administered immediately after chamber sessions 1 and 3, and 2 weeks, 6 weeks, 6 months, and 12 months after enrollment. The primary oute was cognitive sequelae six weeks after carbon monoxide poisoning. Results The trial was stopped after the third of four scheduled interim analyses, at which point there were 76 patients in each group. Cognitive sequelae at six weeks were less frequent in the hyperbaric oxygen group (19 of 76 [ percent]) than in the normobaricoxygen group (35 of 76 [ percent], P=), even after adjustment for cerebellar dysfunction and for stratification variables (adjusted odds ratio, [95 percent confidence interval, to ]。 P=). The presence of cerebellar dysfunction before treatment was associated with the occurrence of cognitive sequelae (odds ratio, [95 percent confidence interval, to ]。 P=) and was more frequent in the normobaricoxygen group (15 percent vs. 4 percent, P=). Cognitive sequelae were less frequent in the hyperbaricoxygen group at 12 months, according to the intentiontotreat analysis (P=). Conclusions Three hyperbaricoxygen treatments within a 24hour period appeared to reduce the risk of cognitive sequelae 6 weeks and 12 months after acute carbon monoxide poisoning. (N Engl J Med 2021。 347:105767.) 氰 化 氫 （ hydrogen cyanide, HCN） [理化特性 ] 常溫常壓下為無(wú)色透明液體 ， 易蒸發(fā)
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