Hyperbaric oxygen for paroxysmal sympathetic hyperactivity syndrome after acute carbon monoxide poisoning

Yang, Lu; Nan, Ding; Liu, Xuehua; Zhang, Jing; Zhang, Yi; Liang, Fang; Zhu, Wanqiu; Yang, Jing*

Author Information

Department of Hyperbaric Oxygen, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

*Correspondence to: Yang Jing, PhD, Yangjingbjcyhbo@163.com.

Funding:This study was supported by the Multidisciplinary Clinical Research Innovation Team Project of Beijing Chaoyang Hospital, Capital Medical University (No. CYDXK202208).

Abstract

Paroxysmal sympathetic hyperactivity syndrome (PSH) is common in patients with severe craniocerebral injuries. Carbon monoxide poisoning (ACOP) may lead to secondary PSH, and hyperbaric oxygen (HBO) is an important treatment method for ACOP that can promote the dissociation of carboxyhemoglobin and reduce the long-term sequelae of ACOP. To explore the risk factors and clinical characteristics of PSH secondary to acute ACOP and to investigate the efficacy of HBO treatment, a retrospective analysis was performed on patients with moderate to severe ACOP admitted to the Hyperbaric Oxygen Department of Beijing Chaoyang Hospital, Capital Medical University, from January 1, 2018 to December 31, 2024. Three patients developed PSH during hospitalization and were classified into the PSH group, while the remaining 50 patients were in the non-PSH group. Univariate Fisher’s exact test indicated that a coma duration of more than 72 hours was related to the occurrence of PSH after ACOP, and irregular HBO treatment after onset might be associated with the occurrence of PSH after ACOP. All three PSH patients developed paroxysmal postural or dystonic disorders after onset, accompanied by sympathetic excitation manifestations such as increased heart rate, respiratory rate, elevated blood pressure, and fever. Antiepileptic drugs had poor effects, and the attacks were effectively controlled after HBO treatment combined with adjusted drug therapy. The results indicate that for patients with severe carbon monoxide poisoning, especially those with a long coma duration or irregular HBO treatment after onset, if epileptic seizures occur during the disease course and are accompanied by sympathetic excitation manifestations, the possibility of PSH should be considered. Regular HBO treatment is of great significance for controlling the onset of symptoms.

摘要

阵发性交感神经过度兴奋综合征（PSH）常见于重型颅脑损伤患者。急性一氧化碳中毒（ACOP）可继发PSH，而高压氧（HBO）是治疗ACOP的重要方法，能促进碳氧血红蛋白解离并减少ACOP远期后遗症。为探讨急性ACOP继发PSH的危险因素与临床特征，并评估HBO治疗效果，本研究对2018年1月1日至2024年12月31日期间首都医科大学附属北京朝阳医院高压氧科收治的中重度ACOP患者进行回顾性分析。其中3例住院期间发生PSH的患者被纳入PSH组，其余50例患者为非PSH组。单因素Fisher精确检验显示，昏迷时间超过72小时与ACOP后PSH的发生相关，发病后未接受规律HBO治疗可能与ACOP后PSH的发生存在关联。3例PSH患者发病后均出现阵发性姿势异常或肌张力障碍，伴随心率增快、呼吸急促、血压升高及发热等交感神经兴奋表现。抗癫痫药物治疗效果欠佳，经HBO联合调整药物治疗后发作得到有效控制。研究结果表明，对于重度一氧化碳中毒患者，特别是昏迷时间长或发病后未接受规律HBO治疗者，若病程中出现癫痫样发作并伴有交感神经兴奋表现，应考虑PSH可能。规律HBO治疗对控制症状发作具有重要意义。