高壓氧治療與急性一氧化碳中毒

Hyperbaric Oxygen Therapy and Acute Carbon Monoxide Poisoning

10.6224/JN.201808_65(4).03

郭淑珍(Shu-Chen KUO)；徐千剛(Chien-Kang HSU)；蔡建宗(Chien-Tsung TSAI)；解旻容(Min-Jung CHIEH)

急診照護 ； 一氧化碳中毒 ； 高壓氧治療 ； emergency care ； carbon monoxide poisoning ； hyperbaric oxygen therapy

護理雜誌

65卷4期（2018 / 08 / 01）

11 - 17

繁體中文

一氧化碳中毒是急診室最常見的中毒類型急症，因一氧化碳與血紅素具有高親和力與複雜的生物學特性，導致一氧化碳中毒會造成心臟、神經、肌肉、腎臟等組織病變，嚴重者數分鐘內失去知覺或死亡。近年來，高壓氧廣泛應用在急重症病人（如一氧化碳中毒、腦組織缺氧），因為高壓氧可以加速一氧化碳結合血紅素的分解，故這類病人送達急診室，若能盡早接受高壓氧治療，可以改善或降低認知障礙及延遲神經心理學後遺症。急診護理是影響一氧化碳中毒病人能否獲救的關鍵。本文探討高壓氧對一氧化碳中毒的實證分析，提出高壓氧的使用通則；繼而由護理人員角度闡述急性一氧化碳中毒的處置與照護，及高壓氧治療的護理，期能提供給急診照護團隊參考，在救護的黃金時刻給予正確有效的醫護措施，使病人得到完善的護理照顧，減低對病人的傷害，及提高存活率。

Carbon monoxide poisoning is the most commonly seen cause of poisoning in the emergency room (ER). The high affinity between carbon monoxide and hemoglobin and their complex biological characteristics greatly increase the risks of cardiac, nervous, muscular, and kidney diseases. In severe cases, patients may lose consciousness or die in just a few minutes. In recent years, hyperbaric oxygen therapy has been applied extensively in patients with severe conditions such as carbon monoxide poisoning and cerebral hypoxia. Hyperbaric oxygen accelerates the decomposition of carbon monoxide in hemoprotein. Therefore, treating patients with similar conditions in the ER with hyperbaric oxygen as soon as possible will improve their cognitive disorder and postpone their neuropsychological sequelae. ER nurses typically play a decisive role in saving patients with carbon monoxide poisoning. This research scrutinizes a case analysis of using hyperbaric oxygen to treat carbon monoxide poisoning and offers general rules for the use of hyperbaric oxygen. Further, the research elaborates from the perspective of ER nursing staffs the management and care of acute carbon monoxide poisoning and hyperbaric oxygen therapy nursing care. The aim of this research is to offer references for members of the ER nursing team and to enable this team to provide accurate and effective medical measures to patients during the ＂golden hours＂ of nursing care. Achieving this will help ensure that patients receive comprehensive nursing and care, thus reducing the harm suffered by patients and increasing the rate of survival.

1. Annane, D.,Chadda, K.,Gajdos, P.,Jars-Guincestre, M.-C.,Chevret, S.,Raphael, J. C.(2011).Hyperbaric oxygen therapy for acute domestic carbon monoxide poisoning: Two randomized controlled trials.Intensive Care Medicine,37(3),486-492.
2. Buckley, N. A.,Juurlink, D. N.,Isbister, G.,Bennett, M. H.,Lavonas, E. J.(2011).Hyperbaric oxygen for carbon monoxide poisoning.Cochrane Database of Systematic Reviews,4,Art. No.: CD002041.
3. Centers for Disease Control and Prevention. (2018, March 21). Carbon monoxide poisoning. Retrieved from https://www.cdc.gov/co/faqs.htm
4. Deniz, T.,Kandis, H.,Eroglu, O.,Gunes, H.,Saygun, M.,Kara, I. H.(2017).Carbon monoxide poisoning cases presenting with non-specific symptoms.Toxicology and Industrial Health,33(1),53-60.
5. Hampson, N. B.(2016).U.S. mortality due to carbon monoxide poisoning, 1999-2014. Accidental and intentional deaths.Annals of the American Thoracic Society,13(10),1768-1774.
6. Hormova, R.,Polat, G.(2017).Efficiency of hyperbaric oxygen therapy in the treatment of carbon monoxide toxicity.The Eurasian Journal of Medicine,49(3),226-227.
7. Huang, C. C.,Ho, C. H.,Chen, Y. C.,Lin, H. J.,Hsu, C. C.,Wang, J. J.,Guo, H. R.(2017).Hyperbaric oxygen therapy is associated with lower short- and long-term mortality in patients with carbon monoxide poisoning.Chest,152(5),943-953.
8. Jain, K. K.(2017).Textbook of hyperbaric medicine.Basel, Switzerland:Springer.
9. Ku, C. H.,Hung, H. M.,Leong, W. C.,Chen, H. H.,Lin, J. L.,Yen, T. H.(2015).Outcome of patients with carbon monoxide poisoning at a Far-East poison center.PLoS One,10(3),e0118995.
10. Leung, J. K. S.,Lam, R. P. K.(2018).Hyperbaric oxygen therapy: Its use in medical emergencies and its development in Hong Kong.Hong Kong Medical Journal,24(2),191-199.
11. Liu, K. S.,Huang, P.,Chen, M. T.(2000).Treatment of carbomonoxide intoxication with hyperbaric oxygen-A case report.The Journal of Plastic Surgical Association R.O.C.,9(3),195-199.
12. Mathieu, D.,Wattel, F.,Mathieu-Nolf, M.,Durak, C.,Tempe, J. P.,Bouachour, G.,Sainty, J. M.(1996).Randomized prospective study comparing the effect of HBO versus 12 hours NBO in non-comatose CO poisoned patients: Results of the preliminary analysis.Undersea Hyperbaric Medicine,23,7-8.
13. Moon, J. M.,Chun, B. J.,Baek, B. H.,Hong, Y. J.(2018).Initial diffusion weighted MRI and long-term neurologic outcomes in charcoal-burning carbon monoxide poisoning.Clinical Toxicology,56(3),161-169.
14. Mutluoglu, M.,Metin, S.,Arziman, I.,Uzun, G.,Yildiz, S.(2016).The use of hyperbaric oxygen therapy for carbon monoxide poisoning in Europe.Undersea & Hyperbaric Medicine,43(1),49-56.
15. Pardo, D. L.,Amedola, D.,Senatore, G.,Damiano, A.,Pezzuti, G.,Pugliese, N.,Vitola, N. M.(2016).Delayed neuropsychiatric syndrome after carbon monoxide poisoning: Inclusion of hyperbaric oxygen therapy in the recovery protocol.Emergency Care Journal,12(1),28-30.
16. Pepe, G.,Castelli, M.,Nazerian, P.,Vanni, S.,Del Panta, M.,Gambassi, F.,Grifoni, S.(2011).Delayed neuropsychological sequelae after carbon monoxide poisoning: Predictive risk factors in the emergency department. A retrospective study.Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine,9,article 16.
17. Raphael, J.-C.,Elkharrat, D.,Jars-Guincestre, M.-C.,Chastang, C.,Vercken, J.-B.,Chasles, V.,Gajdos, P.(1989).Trial of normobaric and hyperbaric oxygen for acute carbon monoxide intoxication.The Lancet,334(8660),414-419.
18. Rose, J. J.,Wang, L.,Xu, Q.,McTiernan, C. F.,Shiva, S.,Tejero, J.,Gladwin, M. T.(2017).Carbon monoxide poisoning: Pathogenesis, management, and future directions of therapy.American Journal of Respiratory and Critical Care Medicine,195(5),596-606.
19. Safewise. (2018). Carbon monoxide (CO) detector buyers guide. Retrieved from https://www.safewise.com/resources/carbon-monoxide-detectors-guide
20. Scheinkestel, C. D.,Bailey, M.,Myles, P. S.,Jones, K.,Cooper, D. J.,Millar, I. L.,Tuxen, D. V.(1999).Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: A randomised controlled clinical trial.The Medical Journal of Australia,170(6),203-210.
21. Thom, S. R.,Taber, R. L.,Mendiguren, I. I.,Clark, J. M.,Hardy, K. R.,Fisher, A. B.(1995).Delayed neuropsychologic sequelae after carbon monoxide poisoning: Prevention by treatment with hyperbaric oxygen.Annals of Emergency Medicine,25(4),474-480.
22. Weaver, L. K.(Ed.)(2014).Hyperbaric oxygen therapy indications.North Palm Beach, FL:Best.
23. Weaver, L. K.,Hopkins, R. O.,Chan, K. J.,Churchill, S.,Elliott, C. G.,Clemmer, T. P.,Morris, A. H.(2002).Hyperbaric oxygen for acute carbon monoxide poisoning.The New England Journal of Medicine,347(14),1057-1067.
24. Wolf, S. J.,Maloney, G. E.,Shih, R. D.,Shy, B. D.,Brown, M. D.(2017).Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute carbon monoxide poisoning.Annals of Emergency Medicine,69(1),98-107.e6.
25. Yeh, Z. T.,Tsai, C. F.,Yip, P. K.,Lo, C. Y.,Peng, S. M.,Chen, S. Y.,Kung, L. Y.(2014).Neuropsychological performance in patients with carbon monoxide poisoning.Applied Neuropsychology: Adult,21(4),278-287.
26. 李惠傑、康柏皇（2012）．醫用高壓艙：設備與安全．取自http://www.hbo.org.tw/download/test-33.pdf [Lee, H. C., & Kang, B. H. (2012). Medical hyperbaric chambers: Equipment and safety. Retrieved from http://www.hbo.org.tw/download/test-33.pdf]
27. 李惠傑、康柏皇（2013）．高壓氧治療之禁忌症． 取自http://www.hbo.org.tw/download/test-35.pdf [Lee, H. C., & Kang, B. H. (2013). Contraindications to hyperbaric oxygen therapy. Retrieved from http://www.hbo.org.tw/download/test-35.pdf]
28. 陳淑君、雷琦瑋(2003)。高壓氧治療重症病患之護理。護理雜誌，50(4)，87-92。
29. 謝忠岳、黃立言、蔡宗能、李柏群(2016)。一氧化碳中毒對心臟功能的影響。內科學誌，27(5)，223-232。

1. 張品元(Pin-Yuan Chang);郭芳里(Fang-Li Kuo)(2024)。照護一位燒炭自殺一氧化碳中毒個案之急診護理經驗。高雄護理雜誌。41(1)。170-181。