急性一氧化碳中毒的诊治进展探讨
Progress in Diagnosis and Treatment of Acute Carbon Monoxide Poisoning
DOI: 10.12677/ACM.2021.111048, PDF,   
作者: 罗凯峰:延安大学附属医院,陕西 延安;冯传杰:延安大学附属医院急诊内科,陕西 延安
关键词: 急性一氧化碳中毒生理作用中毒机制诊断治疗Acute Carbon Monoxide Poisoning Physiological Function Poisoning Mechanism Diagnosis Treatment
摘要: 急性一氧化碳(CO)中毒是急诊科常见中毒死亡原因之一,短时间吸入CO超过生理浓度即可引起中毒,中毒后可造成脑、心脏、肺等多脏器损伤,其发病率和病死率均占我国职业和非职业中毒前列。因此,早期识别与有效治疗尤为重要。本文重点就CO生理作用、中毒机制、临床表现、诊断及治疗等研究现状进行综述,以期为临床治疗提供理论基础。
Abstract: Acute carbon monoxide (CO) poisoning is one of the common death causes of poisoning in emergency department. Inhaling CO over physiological concentration in a short time can cause poisoning. After poisoning, it can cause brain, heart, lung and other organ damage. Its morbidity and mortality are at the forefront of occupational and non-occupational poisoning in our country. Therefore, early identification and effective treatment are particularly important. This article focuses on the physiological function, poisoning mechanism, clinical manifestation, diagnosis and treatment of CO, in order to provide a theoretical basis for clinical treatment.
文章引用:罗凯峰, 冯传杰. 急性一氧化碳中毒的诊治进展探讨[J]. 临床医学进展, 2021, 11(1): 336-344. https://doi.org/10.12677/ACM.2021.111048

参考文献

[1] Adach, W., Błaszczyk, M. and Olas, B. (2020) Carbon Monoxide and Its Donors—Chemical and Biological Properties. Chemico-Biological Interactions, 318, Article ID: 108973.
[Google Scholar] [CrossRef] [PubMed]
[2] Rose, J.J., Wang, L., Xu, Q., et al. (2017) Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy. American Journal of Respiratory and Critical Care Medicine, 195, 596-606.
[Google Scholar] [CrossRef
[3] Mattiuzzi, C. and Lippi, G. (2020) Worldwide Epidemiology of Carbon Monoxide Poisoning. Human & Experimental Toxicology, 39, 387-392.
[Google Scholar] [CrossRef] [PubMed]
[4] Stearns, D. and Sircar, K. (2019) National Unintentional Carbon Monoxide Poisoning Estimates Using Hospitalization and Emergency Department Data. American Journal of Emergency Medicine, 37, 421-426.
[Google Scholar] [CrossRef] [PubMed]
[5] Wang, L.L., Zhang, M., Zhang, W., et al. (2019) A Retrospective Study of Poisoning Deaths from Forensic Autopsy Cases in Northeast China (Liaoning). Journal of Forensic and Legal Medicine, 63, 7-10.
[Google Scholar] [CrossRef] [PubMed]
[6] Ashcroft, J., Fraser, E., Krishnamoorthy, S., et al. (2019) Carbon Monoxide Poisoning. BMJ, 365, l2299.
[Google Scholar] [CrossRef] [PubMed]
[7] Schatzschneider, U. (2015) Novel Lead Structures and Activation Mechanisms for CO-Releasing Molecules (CORMs). British Journal of Pharmacology, 172, 1638-1650.
[Google Scholar] [CrossRef] [PubMed]
[8] Ryter, S.W., Ma, K.C. and Choi, A. (2018) Carbon Monoxide in Lung Cell Physiology and Disease. American Journal of Physiology-Cell Physiology, 314, C211-C227.
[Google Scholar] [CrossRef] [PubMed]
[9] Rosas, I.O., Goldberg, H.J., Collard, H.R., et al. (2018) A Phase II Clinical Trial of Low-Dose Inhaled Carbon Monoxide in Idiopathic Pulmonary Fibrosis. Chest, 153, 94-104.
[Google Scholar] [CrossRef] [PubMed]
[10] Lo, I.L., Boczkowski, J., Zini, R., et al. (2011) A Carbon Monoxide-Releasing Molecule (CORM-3) Uncouples Mitochondrial Respiration and Modulates the Production of Reactive Oxygen Species. Free Radical Biology and Medicine, 50, 1556-1564.
[Google Scholar] [CrossRef] [PubMed]
[11] Lee, S.J., Ryter, S.W., Xu, J.F., et al. (2011) Carbon Monoxide Activates Autophagy via Mitochondrial Reactive Oxygen Species Formation. American Journal of Respiratory Cell and Molecular Biology, 45, 867-873.
[Google Scholar] [CrossRef
[12] 胡慧军, 孙强. 从一氧化碳的生理效应看一氧化碳中毒[J]. 中华医学杂志, 2018(10): 791-793.
[13] Kinoshita, H., Türkan, H., Vucinic, S., et al. (2020) Carbon Monoxide Poisoning. Toxicology Reports, 7, 169-173.
[Google Scholar] [CrossRef] [PubMed]
[14] Jeon, S.B., Sohn, C.H., Seo, D.W., et al. (2018) Acute Brain Lesions on Magnetic Resonance Imaging and Delayed Neurological Sequelae in Carbon Monoxide Poisoning. JAMA Neurology, 75, 436-443.
[Google Scholar] [CrossRef] [PubMed]
[15] Kuroda, H., Fujihara, K., Kushimoto, S., et al. (2015) Novel Clinical Grading of Delayed Neurologic Sequelae after Carbon Monoxide Poisoning and Factors Associated with Outcome. Neurotoxicology, 48, 35-43.
[Google Scholar] [CrossRef] [PubMed]
[16] Ryter, S.W. (2019) Heme Oxygenase-1/Carbon Monoxide as Modulators of Autophagy and Inflammation. Archives of Biochemistry and Biophysics, 678, Article ID: 108186.
[Google Scholar] [CrossRef] [PubMed]
[17] Cronje, F.J., Carraway, M.S., Freiberger, J.J., et al. (2004) Carbon Monoxide Actuates O(2)-Limited Heme Degradation in the Rat Brain. Free Radical Biology and Medicine, 37, 1802-1812.
[Google Scholar] [CrossRef] [PubMed]
[18] Olatunde, O., Raj, V., Tambe, V., et al. (2020) Carbon Monoxide Poisoning and Its Effect on QTc Prolongation. Journal of Cardiology Cases, 22, 19-21.
[Google Scholar] [CrossRef] [PubMed]
[19] Dallas, M.L., Yang, Z., Boyle, J.P., et al. (2012) Carbon Monoxide Induces Cardiac Arrhythmia via Induction of the Late Na+ Current. American Journal of Respiratory and Critical Care Medicine, 186, 648-656.
[Google Scholar] [CrossRef
[20] Dorey, A., Scheerlinck, P., Nguyen, H., et al. (2020) Acute and Chronic Carbon Monoxide Toxicity from Tobacco Smoking. Military Medicine, 185, e61-e67.
[Google Scholar] [CrossRef] [PubMed]
[21] Weaver, L.K., Churchill, S.K., Deru, K., et al. (2013) False Positive Rate of Carbon Monoxide Saturation by Pulse Oximetry of Emergency Department Patients. Respiratory Care, 58, 232-240.
[Google Scholar] [CrossRef] [PubMed]
[22] Reumuth, G., Alharbi, Z., Houschyar, K.S., et al. (2019) Carbon Monoxide Intoxication: What We Know. Burns, 45, 526-530.
[Google Scholar] [CrossRef] [PubMed]
[23] Guo, D., Hu, H. and Pan, S. (2020) Oligodendrocyte Dysfunction and Regeneration Failure: A Novel Hypothesis of Delayed Encephalopathy after Carbon Monoxide Poisoning. Medical Hypotheses, 136, Article ID: 109522.
[Google Scholar] [CrossRef] [PubMed]
[24] Weaver, L.K., Valentine, K.J. and Hopkins, R.O. (2007) Carbon Monoxide Poisoning: Risk Factors for Cognitive Sequelae and the Role of Hyperbaric Oxygen. American Journal of Respiratory and Critical Care Medicine, 176, 491-497.
[Google Scholar] [CrossRef
[25] Lippi, G., Rastelli, G., Meschi, T., et al. (2012) Pathophysiology, Clinics, Diagnosis and Treatment of Heart Involvement in Carbon Monoxide Poisoning. Clinical Biochemistry, 45, 1278-1285.
[Google Scholar] [CrossRef] [PubMed]
[26] Sohn, C.H., Huh, J.W., Seo, D.W., et al. (2017) Aspiration Pneumonia in Carbon Monoxide Poisoning Patients with Loss of Consciousness: Prevalence, Outcomes, and Risk Factors. The American Journal of Medicine, 130, 1421-1465.
[Google Scholar] [CrossRef] [PubMed]
[27] Kim, S.J., Oh, H.S., Cha, Y.S., et al. (2020) Evaluation of Hepatic Injury in Acute Carbon Monoxide-Poisoned Patients in Emergency Department. Human & Experimental Toxicology, 39, 883-889.
[Google Scholar] [CrossRef] [PubMed]
[28] Kim, S.G., Woo, J. and Kang, G.W. (2019) A Case Report on the Acute and Late Complications Associated with Carbon Monoxide Poisoning: Acute Kidney Injury, Rhabdomyolysis, and Delayed Leukoencephalopathy. Medicine (Baltimore), 98, e15551.
[Google Scholar] [CrossRef
[29] Porter, S.S., Hopkins, R.O., Weaver, L.K., et al. (2002) Corpus Callosum Atrophy and Neuropsychological Outcome Following Carbon Monoxide poisoning. Archives of Clinical Neuropsychology, 17, 195-204.
[Google Scholar] [CrossRef] [PubMed]
[30] Mimura, K., Harada, M., Sumiyoshi, S., et al. (1999) Long-Term Follow-Up Study on Sequelae of Carbon Monoxide Poisoning; Serial Investigation 33 Years after Poisoning. Seishin Shinkeigaku Zasshi, 101, 592-618.
[31] Kuo, S.C., Hsu, C.K., Tsai, C.T., et al. (2018) Hyperbaric Oxygen Therapy and Acute Carbon Monoxide Poisoning. The Journal of Nursing, 65, 11-17.
[32] Hampson, N.B., Piantadosi, C.A., Thom, S.R., et al. (2012) Practice Recommendations in the Diagnosis, Management, and Prevention of Carbon Monoxide Poisoning. American Journal of Respiratory and Critical Care Medicine, 186, 1095-1101.
[Google Scholar] [CrossRef
[33] Wolf, S.J., Maloney, G.E., Shih, R., et al. (2017) Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Acute Carbon Monoxide Poisoning. Annals of Emergency Medicine, 69, 98-107.
[Google Scholar] [CrossRef
[34] Weaver, L.K. (2020) Carbon Monoxide Poisoning. Undersea and Hyperbaric Medicine, 47, 151-169.
[Google Scholar] [CrossRef] [PubMed]
[35] Hu, H.-J. and Fan, D.-F. (2017) Should Hyperbaric Oxygen Be Used in Acute Carbon Monoxide Poisoning? American Journal of Emergency Medicine, 35, 1030.
[Google Scholar] [CrossRef] [PubMed]
[36] Zazzeron, L., Liu, C., Franco, W., et al. (2017) Pulmonary Phototherapy to Treat Carbon Monoxide Poisoning in Rats. Shock, 47, 735-742.
[Google Scholar] [CrossRef
[37] Sein, A.J., Schetz, D., Waldman, W., et al. (2017) Hyperventilation with Maintenance of Isocapnia. An “Old New” Method in Carbon Monoxide Intoxication. PLoS ONE, 12, e170621.
[Google Scholar] [CrossRef] [PubMed]
[38] Kreck, T.C., Shade, E.D., Lamm, W.J., et al. (2001) Isocapnic Hyperventilation Increases Carbon Monoxide Elimination and Oxygen Delivery. American Journal of Respiratory and Critical Care Medicine, 163, 458-462.
[Google Scholar] [CrossRef] [PubMed]
[39] Teerapuncharoen, K., Sharma, N.S., Barker, A.B., et al. (2015) Successful Treatment of Severe Carbon Monoxide Poisoning and Refractory Shock Using Extracorporeal Membrane Oxygenation. Respiratory Care, 60, e155-e160.
[Google Scholar] [CrossRef] [PubMed]
[40] Simonsen, C., Magnusdottir, S.O., Andreasen, J.J., et al. (2018) ECMO Improves Survival Following Cardiogenic Shock Due to Carbon Monoxide Poisoning—An Experimental Porcine Model. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26, 103.
[Google Scholar] [CrossRef] [PubMed]
[41] Shen, M., Fan, D., Zang, Y., et al. (2016) Neuroprotective Effects of Methane-Rich Saline on Experimental Acute Carbon Monoxide Toxicity. Journal of the Neurological Sciences, 369, 361-367.
[Google Scholar] [CrossRef] [PubMed]
[42] Shen, M., Zheng, Y., Zhu, K., et al. (2020) Hydrogen Gas Protects against Delayed Encephalopathy after Acute Carbon Monoxide Poisoning in a Rat Model. Neurological Research, 42, 22-30.
[Google Scholar] [CrossRef] [PubMed]
[43] 王静, 汪青松, 黄海丽, 等. 依达拉奉联合高压氧对CO中毒迟发性脑病小鼠血清MDA水平、SOD活性及海马神经元凋亡的影响[J]. 安徽医科大学学报, 2012, 47(4): 383-387.
[44] Tejero, J., Sparacino-Watkins, C.E., Ragireddy, V., et al. (2015) Exploring the Mechanisms of the Reductase Activity of Neuroglobin by Site-Directed Mutagenesis of the Heme Distal Pocket. Biochemistry, 54, 722-733.
[Google Scholar] [CrossRef] [PubMed]
[45] Azarov, I., Wang, L., Rose, J.J., et al. (2016) Five-Coordinate H64Q Neuroglobin as a Ligand-Trap Antidote for Carbon Monoxide Poisoning. Science Translational Medicine, 8, 173r-368r.
[Google Scholar] [CrossRef] [PubMed]