纳洛酮抢救重度一氧化碳中毒患儿的临床应用
作者：徐心坦，单继平，牛峰海，王瑜。
［摘要］ 目的：探讨纳洛酮抢救重度一氧化碳中毒患儿的临床疗效。方法：采用随机、对照实验，将重度一氧化碳中毒患儿入院后随机分成纳洛酮治疗组和对照组，观察患儿昏迷时间、后遗症及死亡情况。结果：治疗组平均昏迷时间(3.93±1.85)h,明显短于对照组(5.97±3.24)h,（P0.01），两组后遗症及死亡情况无明显差异（P0.05）。结论：纳洛酮能够加快重度一氧化碳中毒患儿苏醒，缩短昏迷时间。
Clinical effect of naloxone on children severely poisoned with carbon monoxide。
［Abstract］ Objective:To study the clinical effect of naloxone on children severely poisoned with carbon monoxide. Methods: 60 children of severe carbon monoxide poisoning were randomly divided into a control group (30 cases) and a naloxone treatment group (30 cases). There was no significant difference between the two groups in the components of gender, age and the coma degree. And they were assessed for the time of coma, sequela and death. Results: There was significant difference in the time of coma between the two groups (the coma time was respectively 3.93±1.85 hours and 5.97±3.24 hours). There was no significant difference in the sequela and death. Conclusions: The treatment of naloxone could improve the level of consciousness and shorten the time of coma in severe carbon monoxide poisoning.
［Key words］ Poisoning; Carbon monoxide; Coma; Naloxone 一氧化碳中毒伴深度昏迷是急诊常见危重症之一,并发症及后遗症多，病死率高,在治疗中颇为棘手。我科于1998年2月～2005年10月应用纳洛酮抢救重度一氧化碳中毒儿童，取得较好疗效，现报道如下。
1 资料与方法。
1.1 一般资料所有病例均符合重度一氧化碳中毒的诊断标准［1］：（1）有煤炉取暖排烟不畅或煤气管道漏气等接触中毒；（2）口唇呈樱红色，出现昏迷、惊厥，极重者出现呼吸循环中枢麻痹；（3）血中碳氧血红蛋白测定呈阳性。60例患儿随机分为治疗组和对照组各30例。两组患儿在性别、年龄、就诊时间及昏迷程度方面比较差异无统计学意义，具有可比性，见表1。
1.2 治疗方法对照组在用高压氧治疗、吸氧、使用呼吸兴奋剂的同时，并用20%甘露醇0.5～1.0 g/(kg・次) 静脉滴注，6～12 h/次，脑水肿重者加地塞米松0.2～0.3 mg/(kg・d)静脉滴注，大剂量维生素C、维生素B6、三磷酸腺苷、辅酶A、细胞色素C及胞二磷胆碱等静脉滴注。根据患儿有无高热、出血、抽搐、休克、水电解质紊乱症状及呼吸情况，采用相应的措施，并用抗生素预防肺部和泌尿系统感染。治疗组在对照组治疗基础上加用纳洛酮0.01～0.03 mg/(kg・次)加入生理盐水5～10 mL静脉注射，1～2 h给药1次，意识清醒后按0.03～0.05 mg/(kg・h)持续静脉滴注3～5 h，1次/d，7～10 d为一疗程。
表1 两组病例一般情况的比较 略。