急性重度一氧化碳中毒肺水肿13例临床救治体会  

Clinical experience in urgent care of 13 cases of pulmonary edema following acute severe carbon monoxide poisoning

作　　者：范丹峰[1] 肖宏[1] 潘树义[1] 

机构地区：[1]海军总医院高压氧科,北京100048

出　　处：《中华航海医学与高气压医学杂志》2017年第1期65-68,共4页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的 总结急性重度一氧化碳中毒肺水肿的临床特点和治疗经验。方法 对2011年至2016年4月首诊我院的13例急性一氧化碳中毒性肺水肿临床资料进行回顾性分析。结果 12例患者在接受综合治疗后48 h呼吸指标逐渐平稳，呼吸频率[（治疗后（20.67±2.53）次/min，治疗前（35.92±4.27）次/min，P〈0.05]、碳氧血红蛋白含量[治疗后（2.58±1.56）%，治疗前（29.75±11.29）%，P〈0.05]显著下降，动脉氧分压显著升高[治疗后（94.08±14.47） mmHg，治疗前（55.50±5.66） mmHg，P〈0.05]（1 mmHg＝0.133 kPa）。9例气管插管，呼吸机辅助呼吸的患者，8例成功拔管，1例死亡。中毒后第3～5天复查肺CT，10例患者肺叶水肿影像学表现基本消失；2例患者影像学表现遗留高密度影。结论 急性重度一氧化碳中毒患者肺部损伤的最主要表现为肺水肿，同时可能合并吸入性肺炎，需要严密观察症状和体征，及时对症处理，保证患者生命安全。Objective To summarize clinical characteristics and experience in urgent care of the patients with pulmonary edema after acute severe carbon monoxide （CO） poisoning.Methods Retrospective analyses were made on the clinical data of 13 cases of pulmonary edema after acute severe CO poisoning from Jan. 2011 to Apr. 2016.Results Forty-eight hours after comprehensive therapy, respiratory indexes of the 12 patients gradually became stable. Respiratory rate after treatment was significantly lower than that before treatment [（20.67±2.53） post treatment vs. （35.92±4.27） bpm before treatment] （P〈0.05）. The level of carboxyhemoglobin was significantly decreased [（2.58±1.56）% post treatment vs. （29.75±11.29）% before treatment] （P〈0.05）, and the level of arterial oxygen tension was significantly increased, as compared with that before treatment [（94.08±14.47） mmHg post treatment vs. （55.50±5.66） mmHg before treatment] （P〈0.05）（1 mmHg=0.133 kPa）. Of the 9 patients who had endotracheal intubation and mechanical ventilation, 8 were extubated and one died. Reexamination of pulmonary CT 3-5 days after CO poisoning revealed that pulmonary edema almost disappeared in 10 cases, and high density shadow was still present in 2 patients.Conclusions The main manifestation of lung injury in patients with acute severe CO poisoning was pulmonary edema, which might be accompanied with aspiration pneumonia. Close observation should be made on the signs and symptoms of the patients and timely symptomatic treatment should be given, so as to ensure the safety of patients.

关 键 词：一氧化碳中毒 肺水肿 吸入性肺炎 治疗 

分 类 号：R563[医药卫生—呼吸系统] R595.1[医药卫生—内科学]