中、重度一氧化碳中毒后的心肌损伤与远期死亡率

作     者：Henry C. R. Satran D. Lindgren B. T.D. Henry 杜媛(译) 马超(校) 

作者机构：不详 Minneapolis Heart Institute Foundation 920 E 28th St Minneapolis MN 55407 United States 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第6期

页      面：4-5页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：一氧化碳(CO)中毒 重度CO中毒 远期死亡率 心肌损伤 中毒后 前瞻性队列研究 高压氧治疗 成年患者 院内死亡率 远期结果 

摘      要：Context: Carbon monoxide(CO) poisoning is a common cause of toxicological morbidity and mortality. Myocardial injury is a frequent consequence of moderate to severe CO poisoning. While the in- hospital mortality for these patients is low, the long- term outcome of myocardial injury in this setting is unknown. Objective: To determine the association between myocardial injury and long- term mortality in patients following moderate to severe CO poisoning. Design, Setting, and Participants: Prospective cohort study of 230 consecutive adult patients treated for moderate to severe CO poisoning with hyperbaric oxygen and admitted to the Hennepin County Medical Center, a regional center for treatment of CO poisoning, between January 1, 1994, and January 1, 2002. Follow- up was through November 11, 2005. Main Outcome Measure: All- cause mortality. Results: Myocardial injury(cardiac troponin I level ≥ 0.7 ng/mL or creatine kinase- MB level ≥ 5.0 ng/mL and/or diagnostic electrocardiogram changes) occurred in 85(37% ) of 230 patients. At a median follow- up of 7.6 years(range: in- hospital only to 11.8 years), there were 54 deaths(24% ). Twelve of those deaths(5% ) occurred in the hospital as a result of a combination of burn injury and anoxic brain injury(n=8) or cardiac arrest and anoxic brain injury(n=4). Among the 85 patients who sustained myocardial injury from CO poisoning, 32(38% ) eventually died compared with 22(15% ) of 145 patients who did not sustain myocardial injury(adjusted hazard ratio, 2.1; 95% confidence interval, 1.2- 3.7; P=.009). Conclusion: Myocardial injury occurs frequently in patients hospitalized for moderate to severe CO poisoning and is a significant predictor of mortality.