体外肺辅助循环治疗重度一氧化碳中毒

Treatment of Critical Carbon Monoxide Poisoning by Cardiopulmonary Bypass

目的：报告体外肺辅助循环治疗重度一氧化碳中毒的体会。方法：入院时本组５例碳氧血红蛋白的比率均超过７５％。病人血压１３～８／１１～４ｋＰａ（９７～６０／８２～３０ｍｍＨｇ），呼吸不规则，深浅不一、呼吸道分泌物多。因不能立即进入高压氧舱治疗，而采用体外肺辅助循环治疗（静脉─静脉转流）。结果：血液中一氧化碳半排出期为１５分钟，转流３０～４０分钟后完全清醒；６０分钟后碳氧血红蛋白含量在１０％以下。体外肺辅助循环时间的延长与血液中血红蛋白含量的下降呈明显相关性（ｒ＝－０．８３，Ｐ＜０．０５）。全组病人无死亡及后遗症发生。结论：体外肺辅助循环技术可作为治疗重度一氧化碳中毒的另一途径，尤其对不能立即进入高压氧舱者。

Objective: To study the effects of cardiopulmonary bypass (CPB) treatment on critical carbon monoxide (CO) poisoning patients Methods: Five patients of critical carbon monoxide poisoning with blood CO-hemoglobin (COHb) at admission over 75% (more than 80 seconds) could not be treated immediately in the hyperbaric chamber due to unstable blood pressure (13-8/11-4 kPa), irregular breath and deep coma. They were treated by partial cardiopulmonary bypass (vein-vein).Results: All of the patients treated by CPB, the half-time of decreasing blood CO concentration was 15 minutes which was significantly lower than 25 minutes in 3 atmcopheres; the recovery of conseiousness was within 30-40 minutes and the blood CO concentration was lower than 10% after 60 minutes and the effects significantly correlated with the time of CPB(r=-0. 83, P<0. 05).There was no immediate mortality and complications.Conclusion: Patients with critical carbon monoxide poisoning can not be treated immediately by hyperbaric oxygen, can be saved by partial cardiopulmonary bypass.