CAJ | 학술논문

目的：通过对患者家庭室内一氧化碳(CO)浓度的及时监测，探讨室内 CO 浓度与慢性疾病的相关性。方法收集2011年7月至2014年1月接诊的非外伤患者80例(包括非主诉和主诉 CO 中毒)，根据是否监测室内 CO 浓度分为两组，计算CO 中毒的确诊率、误诊率；通过回顾性分析研究室内 CO 浓度与血中碳氧血红蛋白(COHB)、以急性生理及慢性健康状况评分Ⅱ(APACHEⅡ)评分的关系；同时，对于 CO 中毒确诊的充血性心力衰竭患者，对比治疗前后的肌红蛋白、肌钙蛋白 I(CTNI)、肌酸激酶同工酶(CK-MB)、N-端脑利钠肽(BNP)的变化；慢性阻塞性肺疾病(COPD)评估测试(CAT)评分的变化；脑梗死患者的美国国立卫生院脑卒中量表(NIHSS)评分变化。结果血液中的 COHB、入院时 APACHEⅡ评分与室内 CO 浓度均呈正相关。对照组确诊率55.00%，误诊率81.80%；观察组确诊率80.00%，误诊率6.25%。确诊 CO 中毒患者共54例，治疗前后 COPD 的 CAT评分、脑血管病 NIHSS 评分、心衰指标(肌红蛋白、CTNI、CK-M、BNP)的差异有统计学意义(P <0.01)。结论室内 CO 浓度测定能够提示病情严重程度，提高临床 CO 中毒确诊率，降低误诊率，有助于改善慢性疾病患者的临床症状。
목적：통과대환자가정실내일양화탄(CO)농도적급시감측，탐토실내 CO 농도여만성질병적상관성。방법수집2011년7월지2014년1월접진적비외상환자80례(포괄비주소화주소 CO 중독)，근거시부감측실내 CO 농도분위량조，계산CO 중독적학진솔、오진솔；통과회고성분석연구실내 CO 농도여혈중탄양혈홍단백(COHB)、이급성생리급만성건강상황평분Ⅱ(APACHEⅡ)평분적관계；동시，대우 CO 중독학진적충혈성심력쇠갈환자，대비치료전후적기홍단백、기개단백 I(CTNI)、기산격매동공매(CK-MB)、N-단뇌리납태(BNP)적변화；만성조새성폐질병(COPD)평고측시(CAT)평분적변화；뇌경사환자적미국국립위생원뇌졸중량표(NIHSS)평분변화。결과혈액중적 COHB、입원시 APACHEⅡ평분여실내 CO 농도균정정상관。대조조학진솔55.00%，오진솔81.80%；관찰조학진솔80.00%，오진솔6.25%。학진 CO 중독환자공54례，치료전후 COPD 적 CAT평분、뇌혈관병 NIHSS 평분、심쇠지표(기홍단백、CTNI、CK-M、BNP)적차이유통계학의의(P <0.01)。결론실내 CO 농도측정능구제시병정엄중정도，제고림상 CO 중독학진솔，강저오진솔，유조우개선만성질병환자적림상증상。
Objective To explore the correlation of the indoor carbon monoxide concentration and chronic diseases by monitoring the indoor carbon monoxide concentration timely.Methods Collected the data of non-traumatic patients(n=80)from July 201 1 to January 2014,and assigned them into the experiment group with carbon monoxide concentration measured and the control group without measured.All the subjects were further divided into one group with complaint of carbon monoxide poisoning and the other one without.For patients exposed to high concentration of carbon monoxide,carboxyhemoglobin was also measured and APACHEⅡ was scaled,and the relationship between them was analyzed.The confirmation and misdiagnosis rate of carbon monoxide poison-ing were calculated.For the patients with acute exacerbation of chronic diseases like chronic cardiac failure,chronic obstructive pul-monary disease,cerebral infarction induced by carbon monoxide poisoning,BNP,CAT and NIHSS were documented on admission and during follow-up with removal of carbon monoxide exposure and compared respectively.Results The relationship between blood carboxyhemoglobin,APACHEⅡ scores on admission and indoor carbon monoxide concentration was linear,and obviously positive.Between the experiment group(n=40)and the control group(n=40),there was significant difference(P <0.05)in confirma-tion rate and misdiagnosis rate with 80.00% vs.55.00% and 6.25% vs.81.80% respectively.For the 54 patients with carbon monoxide poisoning diagnosed,the changes between before and after removal of carbon monoxide exposure of the CAT scores of chronic obstructive pulmonary disease and NIHSS score of CI disease and myoglobin,troponin I,creatine kinase isoenzyme,BNP for chronic cardiac failure were significantly different(P <0.01).Conclusion The indoor carbon monoxide concentration may indicate the severity of carbon monoxide poi-soning,which could increase the confirmation rate of carbon monoxide poisoning,and reduce the misdiagnosis rate.It is helpful to identify carbon monoxide exposure,the common inducing factor,so as to improve the patients′clinical symptoms.