一氧化碳中毒病人其死亡因子分析-以某中部醫學中心為例

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Title:	一氧化碳中毒病人其死亡因子分析-以某中部醫學中心為例 Predictive Factors of Mortality in Carbon Monoxide Intoxication Patients–Experience of a Medical Center in Central Taiwan
Authors:	蕭琬云;Wan-Yun Hsiao
Contributors:	醫務管理學系碩士在職專班
Keywords:	一氧化碳中毒;高壓氧治療;心跳停止;死亡率;Carbon monoxide poisoning;hyperbaric oxygen therapy;cardiac arrest;outcome;mortality
Date:	2015-07-15
Issue Date:	2015-11-04 17:04:41 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	目的: 一氧化碳中毒會引起多種後遺症，但是針對一氧化碳中毒病人死亡之原因缺乏探討與預測分析。研究方法:採回溯性研究，收集2001年7月至2010年12月於中部某醫學中心加護病房所有一氧化碳中毒病人的治療紀錄，臨床診斷ICD-9-CM代碼986(一氧化碳中毒)。查閱每個病人病歷收集所有的臨床數據。結果:共有787位病人納入研究，其中，140位病人住進加護病房，647位病人於一般病房治療，有15位病人於急診時因為心跳停止經由心肺復甦術後仍死亡，死亡率2.23%。140位病人轉入加護病房治療後有20位病人死亡，死亡率14.29%。分析所有一氧化碳中毒死亡的病人，高一氧化碳血紅數值、低昏迷指數、代謝性酸中毒，心臟的損傷為主要原因。加護病房一氧化碳中毒病人，代謝性酸中毒和昏迷指數3分者，死亡率有意義的增高。急性生理與慢性健康評估評分大於25分是加護病房一氧化碳中毒病人死亡的一個指標。而高壓氧治療可以降低加護病房一氧化碳中毒病人的死亡率。結論: 到院前救護缺乏疾病預測的評估是導致死亡最大的原因。急性生理與慢性健康評估評分大於25分，有高死亡率。高壓氧治療可以降低加護病房一氧化碳中毒病人死亡率。 Background:Acute carbon monoxide (CO) poisoning is a very important clinical entity of great interest to public health and remains a leading cause of morbidity and mortality from intoxication. Carbon monoxide (CO) toxicity results from a combination of tissue hypoxia and direct carbon monoxide-mediated damage at the cellular level. Reports have focused on CO poisoning related cognitive sequelae and the role of hyperbaric oxygen (HBO2) in patients with CO poisoning. We collect these patient’s clinical data to predict or understand which will affect their outcome in CO intoxication patient’s who admitted to the intensive care unit (ICU). Specific Aims:To understand the prognostic factors for mortality in CO poisoned patients admitted to intensive care unit (ICU). Methods:A retrospective study of all patients who received a diagnosis of CO poisoning and were admitted to the medical ICU of China Medical University Hospital (CMUH), a regional referral center of hyperbaric oxygen (HBO2) therapy for CO poisoning, were potentially eligible for inclusion in this investigation. The data were compiled and analyzed by using commercial statistical software (SPSS for Windows, version 10.0, Chicago, IL, USA). All continuous variables are reported as mean ± standard deviation (SD) and compared using a 2-tailed Student’s t test. Measurements and Main Results:Data for the surviving and non-surviving groups were compared; univariate and multivariate logistic regression analyses were performed. A multivariate logistical regression model was applied using variables that were significantly associated (p < 0.001) with survival in univariate analysis. Univariate analysis indicated that non-surviving CO poisoning patients were more likely to have had no HBO therapy (P<0.001), initial COHb level over 30 % (P=0.026), shock (P<0.001), endotracheal intubation(P=0.04), APACHE II score(P<0.001), GCS score(P<0.01), acute renal failure(P=0.024) and pH level of blood(P=0.001). Multivariate logistical regression analysis identified HBO intervention (P=0.021) and APACHE II score (P=0.005)had significant effect over mortality of CO poisoning in ICU (p = 0.04). Conclusion:In conclusion, we observed that APACHE II score over 25 on ED admission was associated with a significant mortality risk in patients with CO poisoning admitted to the ICU. Moreover, HBO intervention could reduce mortality in patients with CO poisoning admitted to the ICU.
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