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[Chest最新论文]:高压氧治疗能够降低一氧化碳中毒患者病死率
2017年11月28日 时讯速递, 进展交流 暂无评论

Hyperbaric Oxygen Therapy Is Associated With Lower Short- and Long-Term Mortality in Patients With Carbon Monoxide Poisoning

Chien-Cheng Huang, Chung-Han Ho, Yi-Chen Chen

Chest 2017; 152: 943-953

DOI: http://dx.doi.org/10.1016/j.chest.2017.03.049

Background 背景

To date, there has been no consensus about the effect of hyperbaric oxygen therapy (HBOT) on the mortality of patients with carbon monoxide poisoning (COP). This retrospective nationwide population-based cohort study from Taiwan was conducted to clarify this issue.

有关高压氧疗(HBOT)对一氧化碳中毒(COP)的作用至今尚无共识。这个基于台湾人口的回顾性队列研究旨在阐明上述问题。

Methods 方法

Using the Nationwide Poisoning Database, we identified 25,737 patients with COP diagnosed between 1999 and 2012, including 7,278 patients who received HBOT and 18,459 patients who did not. The mortality risks of the two cohorts were compared, including overall mortality, and stratified analyses by age, sex, underlying comorbidities, monthly income, suicide attempt, drug poisoning, acute respiratory failure, and follow-up until 2013 were conducted. We also tried to identify independent mortality predictors and evaluated their effects.

采用全国中毒数据库,我们检索到1999年至2012年间25737名诊断为COP的患者,包括7278名接受HBOT的患者及18459名未接受HBOT的患者。我们比较了两个队列的死亡风险,包括总病死率,并根据年龄、性别、基础疾病、每月收入、自杀行为、药物中毒、急性呼吸功能衰竭和直至2013年的随访情况进行分层分析。我们还尝试鉴别死亡的独立预测因素,并评估其效果。

Results 结果

Patients who received HBOT had a lower mortality rate compared with patients who did not (adjusted hazard ratio [AHR], 0.74; 95% CI, 0.67-0.81) after adjusting for age, sex, underlying comorbidities, monthly income, and concomitant conditions, especially in patients younger than 20 years (AHR, 0.45; 95% CI, 0.26-0.80) and those with acute respiratory failure (AHR, 0.43; 95% CI, 0.35-0.53). The lower mortality rate was noted for a period of 4 years after treatment of the COP. Patients who received two or more sessions of HBOT had a lower mortality rate than did those who received HBOT only once. Older age, male sex, low monthly income, diabetes, malignancy, stroke, alcoholism, mental disorders, suicide attempts, and acute respiratory failure were also independent mortality predictors.

与未接受HBOT的患者相比,接受HBOT的患者根据年龄、性别、基础疾病、月收入和其他合并情况校正后的病死率更低(校正风险比 [AHR], 0.74; 95% CI, 0.67-0.81),尤其是20岁以下患者(AHR, 0.45; 95% CI, 0.26-0.80)和急性呼吸功能衰竭患者 (AHR, 0.43; 95% CI, 0.35-0.53)。COP治疗后4年间病死率均呈显著降低。接受两次或多次HBOT的患者病死率较仅接受一次HBOT患者更低。年龄较大、男性、月收入低,糖尿病,恶性肿瘤、卒中、酗酒、精神障碍、自杀行为和急性呼吸功能衰竭是死亡的独立预测因素。

Conclusions 结论

HBOT was associated with a lower mortality rate in patients with COP, especially in those who were younger than 20 years and those with acute respiratory failure. The results provide important references for decision-making in the treatment of COP.

HBOT伴随COP患者病死率降低,尤其是年龄20岁以下的患者和急性呼吸功能衰竭患者。这一结果对于COP的治疗决策提供了重要的参考。

 

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