【作者】 郭洵；

【导师】 张东航；

【作者基本信息】 吉林大学 ， 公共卫生， 2010， 硕士

【摘要】 急性一氧化碳中毒是我国发病人数和死亡人数最多的急性职业中毒。一氧化碳也是许多国家引起意外生活性中毒中致死人数最多的毒物。我国常见的生活性中毒的原因为烟囱阻塞,倒烟以及门窗紧闭,室内通风不良引起一氧化碳在室内聚集,而煤气管道泄露也是常见原因之一。职业性中毒常见于煤矿瓦斯爆炸。国外常见于壁炉故障,加热源通风不足,以及吸入汽车尾气,而气象灾害常造成一氧化碳中毒的流行和爆发。但是,我国目前罕有气象条件与一氧化碳中毒方面的研究资料。目前关于一氧化碳中毒的临床研究较多,而流行病学资料较少。为进一步明确我市一氧化碳中毒的发病规律,并根据相应规律做好防护措施,从而降低一氧化碳中毒的发生。目前的治疗措施主要是:一方面尽快促使中毒者体内的碳氧血红蛋白解离,恢复正常血红蛋白的携氧和供氧功能;另一方面尽快恢复因缺氧造成的器官组织功能损伤。高压氧治疗可以迅速增加血液中的血氧含量并强制解离碳氧血红蛋白,从而迅速解除急性一氧化碳中毒患者的缺氧状态,是任何其他治疗所无法代替的,因此,高压氧对急性一氧化碳中毒是一种特效治疗。而急性一氧化碳中毒患者高压氧治疗的早晚,决定了患者高压氧治疗的疗效。本研究采用回顾性调查方法,统计分析采用统计图表及R×C的卡方检验和秩和检验,统计分析软件是SPSS16.0。P<0.05为具有统计学差异。按照急性一氧化碳中毒发病的三间分布描述一氧化碳中毒的发病规律,分析影响高压氧治疗效果的相关因素,为一氧化碳中毒的预防控制对策提高依据。结果表明气象条件可能是一氧化碳中毒的决定因素,而寒冷季节室内取暖时,煤炭、燃气、木柴等含碳物质的不完全燃烧产生的一氧化碳是导致生活性一氧化碳中毒的直接原因。不同年龄段中毒程度存在差异,具体而言,中老年人中、重度中毒的比例要大。男女患者中毒程度有差别,发病构成比不同,男性患者中、重度中毒的比例要比女性高,有统计学意义。急性一氧化碳中毒患者及时行高压氧治疗可以加快一氧化碳排出,纠正机体缺氧。高压氧治疗急性一氧化碳中毒具有恢复时间短、治愈率高、病死率低的优点。急性一氧化碳中毒患者治疗越早疗效越好,治愈率越高。随着患者开始高压氧治疗时间的延长,患者的治愈率明显下降,而患者的平均治疗次数明显增多,两者有显著的统计学差异。本研究说明一氧化碳中毒的发生与气象条件、年龄、性别有关。研究易于产生一氧化碳、不利于一氧化碳扩散的气象条件,开展一氧化碳中毒气象条件预报,提高中毒伤害监测预警能力,加强气象因素与中毒伤害关系研究,开展中毒监测预警、对居民进行中毒预防健康教育、改善居住环境可以控制一氧化碳中毒的发生。发生急性一氧化碳中毒后,应尽快进行高压氧治疗,因高压氧治疗可以迅速清除体内高浓度的一氧化碳,改善机体的缺氧、组织呼吸抑制状态,从而减轻器官和组织的损伤。另外,高压氧疗效虽好,但并非能解决一切问题,而应重视综合治疗,以利取得最佳疗效。更多还原

【Abstract】 Background: The incidence and the number of deaths of acute carbon monoxide poisoning are the most among acute occupational poisoning. Carbon monoxide is also the toxicant which cause the most deaths in the accidents of life in many countries. The life of our common cause of poisoning is blocking the chimney, and doors and windows closed down smoke, carbon monoxide caused by poor indoor ventilation in the room together, and gas leaks are also common reasons. Occupational poisoning is common in coal mine gas explosion. Foreign common in the firepla1ce failure, inadequate ventilation, heat source, and the inhalation of vehicle exhaust, and carbon monoxide poisoning caused by meteorological disasters often popular and outbreaks. Present clinical study on the more carbon monoxide poisoning, and epidemiological data less. To further define the incidence of carbon monoxide poisoning laws of the city and do a good job under the corresponding law of protective measures to reduce the incidence of carbon monoxide poisoning. Current treatment is mainly: on the one hand the body as soon as possible to promote poisoning carboxyhemoglobin dissociation and restore normal oxygen-carrying hemoglobin and oxygen function; the other hand, due to lack of oxygen to restore function of organ and tissue damage. Hyperbaric oxygen therapy can rapidly increase the blood oxygen content and dissociation of carboxyhemoglobin forced to quickly relieve patients with acute carbon monoxide poisoning, hypoxia, and no other treatment can not be replaced, therefore, hyperbaric oxygen on acute carbon monoxide poisoning a specific treatment. Of acute carbon monoxide poisoning treated with hyperbaric oxygen in patients with early or late, determines the efficacy of hyperbaric oxygen therapy patients.Objective: To further define the incidence of poisoning CO city laws and in accordance with the appropriate protective measures to do law, thereby reducing the incidence of CO poisoning, the epidemiology of the disease on this study to make a comprehensive analysis of the description, further analysis of high-pressure oxygen treatment related factors, prevention and control of carbon monoxide poisoning as measures to improve the basis of prevention of such poisoning control measures.Methods: A retrospective survey methods, statistical analysis using charts and R×C chi-square test and rank sum test, statistical analysis software is SPSS16.0. P <0.05 as statistically different. In accordance with the incidence of acute carbon monoxide poisoning distribution of the three rules described the incidence of carbon monoxide poisoning, hyperbaric oxygen treatment analysis of the relevant factors.Results: The results showed that weather conditions may be determinants of carbon monoxide poisoning, and cold season, when indoor heating, coal, gas, wood and other carbonaceous materials produced by the incomplete combustion of carbon monoxide is the leading life, the direct cause of carbon monoxide poisoning. Different ages are different degrees of poisoning, in particular, the elderly, the proportion of severe poisoning is bigger. Differences between male and female patients the degree of intoxication, the incidence of different composition than the male patients, the proportion of severe poisoning than females, was statistically significant. Time-line in patients with acute carbon monoxide poisoning treated with hyperbaric oxygen can speed up the discharge of carbon monoxide to correct hypoxia. Hyperbaric oxygen for acute carbon monoxide poisoning with recovery time is short, high cure rate, low mortality advantages. Patients with acute carbon monoxide poisoning effect sooner the better, the cure rate is higher. Start with hyperbaric oxygen therapy in patients with time, the cure rate of patients decreased, while the average number of treatment of patients increased significantly, both statistically significant difference.Conclusion: This study shows the incidence of carbon monoxide poisoning and meteorological conditions, age and gender. Research prone to carbon monoxide, carbon monoxide is not conducive to the spread of weather conditions, forecast weather conditions to carry out carbon monoxide poisoning and improve monitoring and early warning capacity poisoning injuries, poisoning, injury to strengthen relations between meteorological factors and research, carry out monitoring and early warning poisoning, poisoning the residents carry out preventive health education, improving living environment can control the occurrence of carbon monoxide poisoning. After acute carbon monoxide poisoning, hyperbaric oxygen treatment should be as soon as possible, due to hyperbaric oxygen therapy can be quickly rid the body of a high concentration of carbon monoxide, improve the body’s oxygen, tissue respiratory depression status, so as to reduce damage to organs and tissues. In addition, the efficacy of hyperbaric oxygen is good, but can not solve every problem, but should pay attention to comprehensive treatment, to facilitate the best results.更多还原