急性CO中毒致心肌损害及早期干预与预后的临床研究

Clinical study on myocardial damage caused by acute CO poisoning and early intervention and prognosis

目的探讨急性一氧化碳(CO)中毒致心肌损害及早期干预与预后的临床效果。方法回顾性分析2017年6月~2020年6月江西省新余市人民医院急诊科收治的90例急性CO中毒致心肌损害患者的临床资料,按治疗方式不同将其分为干预组与对照组,每组各45例。两组患者均接受常规对症支持治疗,在此基础上,干预组患者行早期高压氧治疗,对照组患者行晚期高压氧治疗,两组均连续治疗14 d。比较两组患者的临床疗效、临床指标、心肌肌钙蛋白T(cTnT)水平与心肌酶谱。结果干预组患者的治疗总有效率高于对照组,苏醒时间、住院时间短于对照组,高压氧仓治疗次数少于对照组,差异有统计学意义(P<0.05)。治疗后两组患者的cTnT、肌酸激酶(CK)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)水平均低于治疗前,差异有统计学意义(P<0.05)。治疗后干预组患者的cTnT、CK、AST、LDH、CK-MB水平低于对照组,差异有统计学意义(P<0.05)。结论早期高压氧治疗急性CO中毒致心肌损害患者能够有效改善患者病情,改善cTnT、心肌酶谱指标,减少高压氧仓治疗次数,缩短苏醒时间及住院时间,值得临床推广。

Objective To investigate the clinical effect of acute carbon monoxide(CO)poisoning on myocardial damage and early intervention and prognosis.Methods Clinical data of 90 patients with myocardial damage caused by acute CO poisoning admitted to People′s Hospital of Xinyu City,Jiangxi Province from June 2017 to June 2020 were retrospectively analyzed and divided into intervention group and control group according to different treatment methods,with 45 cases in each group.Patients of both groups received conventional symptomatic and supportive treatment.On this basis,the intervention group received early hyperbaric oxygen therapy,and the control group received late hyperbaric oxygen therapy.Both groups received continuous treatment for 14 days.The clinical efficacy,clinical indicators,cardiac troponin T(cTnT)and myocardial enzyme spectrum were compared between the two groups.Results The total effective rate of treatment in the intervention group was higher than that in the control group,the recovery time and hospitalization time were shorter than those in the control group,hyperbaric oxygen chamber treatment times was less than that of the control group,and the differences were statistically significant(P<0.05).After treatment,the levels of cTnT,creatine kinase(CK),aspartate aminotransferase(AST),lactate dehydrogenase(LDH)and creatine kinase isoenzyme(CK-MB)in the groups were lower than those before treatment,and the differences were statistically significant(P<0.05).After treatment,the levels of cTnT,CK,AST,LDH and CK-MB in the intervention group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Early hyperbaric oxygen treatment of patients with myocardial damage caused by acute CO poisoning can effectively improve the patient′s condition,improve cTnT and myocardial enzyme spectrum indicators,reduce the number of hyperbaric oxygen treatments,and shorten the recovery time and hospitalization time.It is worthy of clinical promotion.