一氧化碳中毒

这是关键的诊断检验。正常水平约为 1% - 3% 而吸烟者可高达 10%。[18]Beppu T. The role of MR imaging in assessment of brain damage from carbon monoxide poisoning: a review of the literature. AJNR Am J Neuroradiol. 2014;35:625-631.http://www.ajnr.org/content/early/2013/04/18/ajnr.A3489.full.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/23598831?tool=bestpractice.com

应使用一氧化碳血氧测量法来检测碳氧血红蛋白 (CO-Hb) 水平。非侵入性脉搏一氧化碳血氧测量法对临床结局的影响尚待确定，目前并不推荐它。[15]Hampson NB. Noninvasive pulse CO-oximetry expedites evaluation and management of patients with carbon monoxide poisoning. Am J Emerg Med. 2012;30:2021-2024.http://www.ncbi.nlm.nih.gov/pubmed/22626815?tool=bestpractice.com[16]Wolf SJ, Maloney GE, Shih RD, et al; American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Carbon Monoxide Poisoning. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute carbon monoxide poisoning. Ann Emerg Med. 2017;69:98-107.http://www.annemergmed.com/article/S0196-0644(16)31345-2/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/27993310?tool=bestpractice.com

由于静脉和动脉取样之间的结果差异性不大，没有必要进行动脉取样。

碳氧血红蛋白水平可能随着时间和治疗而下降，因此可能无法反应中毒的真实严重程度。[8]Kao LW, Nanagas KA. Toxicity associated with carbon monoxide. Clin Lab Med. 2006;26:99-125.http://www.ncbi.nlm.nih.gov/pubmed/16567227?tool=bestpractice.com[9]Tomaszewski C. Carbon monoxide. In: Ford MD, Delaney KA, Ling LJ, et al., eds. Clinical toxicology. Philadelphia, PA: WB Saunders; 2001;657-667.

15% - 20% 时出现毒性作用，达到 25% 时表示重度中毒

心脏扩大、肺纹理增加、并且肺泡增大。

非心源性肺水肿体征

普遍出现非特异性心脏异常特征。

心动过速、心律失常、心肌缺血特征

非特异性心律异常，是一种普遍的体征。

心动过速、心律失常

高血糖症患者在 CO 中毒后神经系统的预后较差。[17]White SR, Penney DG. Initial study: effects of insulin and glucose treatment on neurologic outcome after CO poisoning. Ann Emerg Med. 1994;23:606-607.

可能升高

中毒程度与乳酸盐水平呈正比。

重度中毒时可能升高

升高的肌钙蛋白-I 水平可能提示心肌病并预示不良结局。[16]Wolf SJ, Maloney GE, Shih RD, et al; American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Carbon Monoxide Poisoning. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute carbon monoxide poisoning. Ann Emerg Med. 2017;69:98-107.http://www.annemergmed.com/article/S0196-0644(16)31345-2/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/27993310?tool=bestpractice.com[20]Cha YS, Cha KC, Kim OH, et al. Features and predictors of myocardial injury in carbon monoxide poisoned patients. Emerg Med J. 2014;31:210-215.http://www.ncbi.nlm.nih.gov/pubmed/23349356?tool=bestpractice.com

可能会升高

这项检测用于判断是否存在骨骼肌损伤。

可能会升高

用于评估患者在病症发作期和随访期间认知功能。

可能异常

当患者表现出诸如意识错乱、头痛、视物模糊、癫痫发作和/或昏迷等急性神经症状时，进行治疗的医生应决定是否有必要对患者进行 CT 检查。

可能看到局部性病灶和/或脑水肿

新的影像学检查方法，如磁共振，可显示出 CO 中毒后遗症，应在与神经放射学医生讨论后进行。[18]Beppu T. The role of MR imaging in assessment of brain damage from carbon monoxide poisoning: a review of the literature. AJNR Am J Neuroradiol. 2014;35:625-631.http://www.ajnr.org/content/early/2013/04/18/ajnr.A3489.full.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/23598831?tool=bestpractice.com[19]American College of Radiology. ACR-ASNR-SPR Practice parameter for the performance and interpretation of magnetic resonance spectroscopy of the central nervous system. 2014. http://www.acr.org/ (last accessed 17 February 2017).http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/MR_Spectroscopy.pdf

可能异常