检索历史 清除

目的 探讨早期无创正压通气联合高压氧( hyperbaric oxygen,HBO)治疗急性重度一氧化碳中毒的疗效,以提高治愈率,降低迟发性脑病的发生率.方法 178例急性重度一氧化碳中毒患者分为单纯HBO组90例和无创正压通气联合高HBO治疗组(通气+HBO组)88例,2组患者均接受常规治疗,包括脱水、降低颅内压、抗感染、对症支持等治疗.单纯高压氧组入院后1周内接受HBO治疗,2次/d,其他时间给予持续吸氧；通气+ HBO组入院后1周内,除给予每日2次的HBO治疗外,其他时间给予持续无创正压通气.比较2组治疗效果、死亡例数或迟发性脑病例数等.结果 通气+ HBO组治疗后各项指标(痊愈率:86.4％,有效率:100.0％)与单纯HBO组(痊愈率:58.9％,有效率:94.4％)比较差异均有统计学意义(P＜0.05或P＜0.01)；在以患者就诊时间为指标的分组中,就诊时间＞6h者通气+ HBO组的治疗效果更好,与单纯HBO组比较差异有统计学意义(P＜0.05).结论 对急性重度一氧化碳中毒患者,应力争早期应用无创正压通气联合HBO治疗,可提高治愈率,降低死亡率,减少迟发性脑病的发生.

Objective To explore the therapeutic effect of noninvasive positive pressure ventilation coupled with early hyperbaric oxygen (HBO) therapy on severe carbon monoxide poisoning,with aims to increase cure rate and decrease incidence of delayed encephalopathy.Methods One hundred and seventy-eight cases of severe carbon monoxide poisoning were randomly divided into 2 groups:the simple HBO therapy group consisting of 90 patients,and the non-invasive positive pressure ventilation + HBO group consisting of 88 patients.The 2 groups of patients all received routine medical treatment,such as rectification of dehydration,reduction of intracranial pressure,antibiotics,symptom-directed medical support,etc.The patients in the simple HBO therapy group received HBO therapy twice a day within 1 week of admission into the hospital.At other time without HBO therapy,they had normobaric oxygen breathing.The patients in the positive pressure ventilation + HBO group were treated with positive pressure ventilation coupled with HBO therapy twice a day within 1 week of admission,and at other time,they had continuous non - invasive positive pressure ventilation.Then,therapeutic effects,the number of dead cases and the number of delayed encephalopathy were compared between the 2 groups.Results Statistical significance could be noted,when comparisons were made between the simple HBO group and the non-invasive positive pressure ventilation + HBO group(P ＜ 0.05 or P ＜ 0.01 ).For patients with treatment time as an indicator,which was over 6 hours,the therapeutic effects of the noninvasive positive pressure ventilation + HBO group were obviously better than those of the simple HBO group,with statistical significance ( P ＜ 0.05 ).Conclusions For patients with acute severe carbon monoxide poisoning,noninvasive positive pressure ventilation and HBO therapy should be applied as early as possible,so as to increase cure rate,decrease mortality and reduce occurrence of delayed encephalopathy.