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Article(id=1240651441392645052, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240651438955754377, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202401437, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1706198400000, receivedDateStr=2024-01-26, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773723953817, onlineDateStr=2026-03-17, pubDate=1719244800000, pubDateStr=2024-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773723953817, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773723953817, creator=13701087609, updateTime=1773723953817, updator=13701087609, issue=Issue{id=1240651438955754377, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='12', pageStart='2113', pageEnd='2912', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773723953236, creator=13701087609, updateTime=1773723953236, updator=13701087609, preIssue=null, nextIssue=null, ext=null, issueFiles=null}, startPage=2169, endPage=2173, ext={EN=ArticleExt(id=1240651441606554565, articleId=1240651441392645052, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Epidemic characteristics of non-occupational carbon monoxide poisoning incidents in Jinan, 2011-2022, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the non-occupational carbon monoxide (CO) poisoning incidents in Jinan City from 2011 to 2022, to grasp their epidemiological characteristics, and propose suggestions for further reducing the morbidity and mortality of non-occupational CO poisoning.

Methods

Descriptive epidemiological method was used to analyze the data. The chi-square test was used to compare the rates.

Results

From 2011 to 2022, Jinan City reported 3 003 incidents of non-occupational CO poisoning, with 4 208 cases of poisoning. The average number of poisoning cases per year was 351, with the population over 60 years old being the high-risk group for poisoning. There was a total of 125 deaths, with a fatality rate of 2.97%. The mortality rate of critically ill patients was significantly higher than that of other groups (χ2=45.54, P<0.001). The average annual incidence of non-occupational CO poisoning was 47.48 per million, and the average annual mortality rate was 1.18 per million. The date of occurrence of non-occupational CO poisoning in Jinan City had obvious seasonal characteristics, which was consistent with the winter and spring heating seasons. Among poisoning incidents with clear causes, improper heating was a major cause of poisoning (2 554, 87.4%), followed by gas leaks (207, 7.1%), and the consumption of charcoal hot pots and other charcoal-grilled foods (113, 3.9%).

Conclusion

Although the incidence of non-occupational CO poisoning in Jinan is on a downward trend, the number of people poisoned is still high, and the causes of poisoning are diverse. Therefore it is necessary for multiple departments to jointly carry out the corresponding inspection and preventive work while strengthening the safety education for the residents.

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目的

分析2011—2022年济南市非职业性一氧化碳（carbon monoxide，CO）中毒事件，掌握其流行病学特点，为进一步降低非职业性CO中毒事件发病率和死亡率提出意见和建议。

方法

采用描述性分析方法对资料进行分析，率的比较使用χ2检验。

结果

2011—2022年济南市累计报告非职业性CO中毒事件3 003起，中毒病例4 208例，年均中毒病例351例，60岁以上人群是中毒高发人群。中毒死亡病例共125例，病死率2.97%，其中危重症患者病死率显著高于其他人群（χ2=45.54，P<0.001）。非职业性CO中毒年均发病率为47.48/100万，年均死亡率为1.18/100万。济南市非职业性CO中毒事件的发生日期具有明显的季节性特征，与冬春季取暖季节基本一致。在明确原因的中毒事件中，取暖不当是引起中毒的主要原因(2 554,87.4%)，其次是燃气、煤气泄漏(207,7.1%)和食用木炭火锅及其他炭烤食品(113,3.9%)。

结论

济南市非职业性CO中毒发病率虽整体呈现下降趋势，但中毒人数仍然较多，中毒原因多样，在对居民加强安全教育的同时，需要多部门联合开展相应检查及预防工作。

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阮师漫，E-mail:
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孔子昂（1999—），男，硕士在读，研究方向：环境与健康

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孔子昂（1999—），男，硕士在读，研究方向：环境与健康

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Outcomes of non-occupational CO poisoning critical and other patients in Jinan city from 2011 to 2022

, figureFileSmall=null, figureFileBig=null, tableContent=
组别死亡治愈合计
危重症患者44560604
其他患者813 5233 604
合计1254 0834 208
), ArticleFig(id=1240651450024522152, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240651441392645052, language=CN, label=表1, caption=

2011—2022年济南市非职业性CO中毒危重症患者和其他患者转归情况表

, figureFileSmall=null, figureFileBig=null, tableContent=
组别死亡治愈合计
危重症患者44560604
其他患者813 5233 604
合计1254 0834 208
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2011—2022年济南市非职业性一氧化碳中毒事件流行特征分析
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孔子昂 1, 2 , 李明君 2 , 单冰 2 , 崔亮亮 2 , 阮师漫 3
现代预防医学 | 环境与职业卫生 2024,51(12): 2169-2173
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现代预防医学 | 环境与职业卫生 2024, 51(12): 2169-2173
2011—2022年济南市非职业性一氧化碳中毒事件流行特征分析
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孔子昂1, 2, 李明君2, 单冰2, 崔亮亮2, 阮师漫3
作者信息
  • 1.山东大学公共卫生学院，山东 济南 250012
  • 2.山东大学附属济南市疾病预防控制中心
  • 3.济南市医疗保障局

    • 孔子昂（1999—），男，硕士在读，研究方向：环境与健康

通讯作者:

阮师漫，E-mail:
Epidemic characteristics of non-occupational carbon monoxide poisoning incidents in Jinan, 2011-2022
Zi-ang KONG1, 2, Ming-jun LI2, Bing SHAN2, Liang-liang CUI2, Shi-man RUAN3
Affiliations
  • School of Public Health, Shandong University, Jinan, Shandong 250012, China
出版时间: 2024-06-25 doi: 10.20043/j.cnki.MPM.202401437
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摘要
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目的

分析2011—2022年济南市非职业性一氧化碳（carbon monoxide，CO）中毒事件，掌握其流行病学特点，为进一步降低非职业性CO中毒事件发病率和死亡率提出意见和建议。

方法

采用描述性分析方法对资料进行分析，率的比较使用χ2检验。

结果

2011—2022年济南市累计报告非职业性CO中毒事件3 003起，中毒病例4 208例，年均中毒病例351例，60岁以上人群是中毒高发人群。中毒死亡病例共125例，病死率2.97%，其中危重症患者病死率显著高于其他人群（χ2=45.54，P<0.001）。非职业性CO中毒年均发病率为47.48/100万，年均死亡率为1.18/100万。济南市非职业性CO中毒事件的发生日期具有明显的季节性特征，与冬春季取暖季节基本一致。在明确原因的中毒事件中，取暖不当是引起中毒的主要原因(2 554,87.4%)，其次是燃气、煤气泄漏(207,7.1%)和食用木炭火锅及其他炭烤食品(113,3.9%)。

结论

济南市非职业性CO中毒发病率虽整体呈现下降趋势，但中毒人数仍然较多，中毒原因多样，在对居民加强安全教育的同时，需要多部门联合开展相应检查及预防工作。

非职业性一氧化碳中毒  /  流行病学特征  /  中毒原因
Objective

To analyze the non-occupational carbon monoxide (CO) poisoning incidents in Jinan City from 2011 to 2022, to grasp their epidemiological characteristics, and propose suggestions for further reducing the morbidity and mortality of non-occupational CO poisoning.

Methods

Descriptive epidemiological method was used to analyze the data. The chi-square test was used to compare the rates.

Results

From 2011 to 2022, Jinan City reported 3 003 incidents of non-occupational CO poisoning, with 4 208 cases of poisoning. The average number of poisoning cases per year was 351, with the population over 60 years old being the high-risk group for poisoning. There was a total of 125 deaths, with a fatality rate of 2.97%. The mortality rate of critically ill patients was significantly higher than that of other groups (χ2=45.54, P<0.001). The average annual incidence of non-occupational CO poisoning was 47.48 per million, and the average annual mortality rate was 1.18 per million. The date of occurrence of non-occupational CO poisoning in Jinan City had obvious seasonal characteristics, which was consistent with the winter and spring heating seasons. Among poisoning incidents with clear causes, improper heating was a major cause of poisoning (2 554, 87.4%), followed by gas leaks (207, 7.1%), and the consumption of charcoal hot pots and other charcoal-grilled foods (113, 3.9%).

Conclusion

Although the incidence of non-occupational CO poisoning in Jinan is on a downward trend, the number of people poisoned is still high, and the causes of poisoning are diverse. Therefore it is necessary for multiple departments to jointly carry out the corresponding inspection and preventive work while strengthening the safety education for the residents.

Non-occupational carbon monoxide poisoning  /  Epidemiological characteristics  /  Poisoning reason
孔子昂, 李明君, 单冰, 崔亮亮, 阮师漫. 2011—2022年济南市非职业性一氧化碳中毒事件流行特征分析. 现代预防医学, 2024 , 51 (12) : 2169 -2173 . DOI: 10.20043/j.cnki.MPM.202401437
Zi-ang KONG, Ming-jun LI, Bing SHAN, Liang-liang CUI, Shi-man RUAN. Epidemic characteristics of non-occupational carbon monoxide poisoning incidents in Jinan, 2011-2022[J]. Modern Preventive Medicine, 2024 , 51 (12) : 2169 -2173 . DOI: 10.20043/j.cnki.MPM.202401437
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非职业性一氧化碳（carbon monoxide，CO）中毒泛指在日常生活中发生的CO中毒事件，是非药物性中毒死亡的主要原因。全球疾病负担评估显示，2021年因意外CO中毒导致的死亡率为3.66/100万，共造成28 900例死亡，生命损失年118万人年[1]。2018—2022年间，我国各级疾控共上报非职业性CO中毒事件25 775起，其中山东省报告数连年居第一位，在此期间共报告11 155起[2-4]，是非职业性CO中毒事件的高发省份。济南市作为山东省的省会城市，长期开展非职业性CO中毒监测工作，也是山东省内的重点报告城市。既往济南市非职业性CO中毒研究多集中在燃煤取暖所致中毒[5]，但在初步整理中显示，由其他原因导致的中毒也不容忽视，且近年来济南市非职业性CO中毒的研究较少。为更好了解济南市非职业性CO中毒事件的特征与变化趋势，本文系统分析了2011—2022年济南市非职业性CO中毒病例的临床特征、发生原因以及流行特征。希望为今后开展非职业性CO中毒监测预警和政府民生工作提供依据和参考。
1　资料与方法
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1.1　数据来源
数据来源于中国疾病预防控制信息系统中的突发公共卫生事件报告管理信息系统。收集了2011—2022年济南市CO中毒的流行病学调查和临床诊疗数据，包括：事件发生时间、地点、原因、中毒人数和死亡人数等，报告事件均经疾病预防控制部门调查核实，并确认结案。人口学信息来源于济南市统计年鉴。
1.2　研究方法
采用描述性分析的方法对非职业性CO中毒病例的人口统计学特征、中毒发生时间、地点和原因进行汇总分析。进一步采用集中度法计算研究期间中毒病例发生的离散程度，分析其季节分布及变化趋势等流行病学特征[6]。集中度M是衡量发病时间季节性强弱的指标，计算公式为：
式中，M表示集中度，ri表示疾病某月发病数与全年发病总数之比，i表示月份，Rx表示x轴方向的离散度，Ry表示y轴方向的离散度。M值说明疾病的发生在一年内的集中程度（季节性）[7]，M取值范围为0~1，当M>0.9，说明疾病有严格季节性；0.7<M≤0.9，说明疾病有很强季节性；0.5<M≤0.7，说明疾病有明显的季节性；0.3<M≤0.5，说明疾病有一定季节性；M≤0.3，说明疾病季节性不明显。
1.3　统计分析
使用Excel 2021和SPSS 25.0进行资料整理和分析，组间比较使用χ2检验，检验水准α=0.05。
2　结果
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2.1　基本情况
2011—2022年济南市累计报告非职业性CO中毒事件3 003起，中毒病例4 208例，年均中毒病例351例。死亡病例共125例，病死率2.97%。年均非职业性CO中毒发病率为47.48/100万，年均死亡率为1.18/100万。
2.2　临床特征
中毒患者大多临床特征表现为头晕（63.5%）、恶心（58.8%）、头痛（37.2%）等，少部分患者出现了昏迷（15.1%）、大小便失禁（3.1%）等危重症状。见表1。出现这些症状的患者，病死率显著高于其他患者（χ2=45.54，P<0.001）。临床救治措施包括：吸氧（62.9%）、高压氧舱（28.4%）、营养脑神经（16.6%）、药物治疗（10.2%）、输液（5.9%），以及其他对症治疗手段。
2.3　时间分布
2.3.1　年份分布
研究期间济南市非职业CO中毒报告事件数、病例数、死亡数呈现出波浪式下降趋势，在部分年份也出现了较之前年份中毒增多的情况，中毒人数和死亡人数变化趋势基本保持一致，在中毒人数增多的年份，死亡人数也有所上升，如2015、2016、2018以及2021年。2012年事件报告数（415起）和中毒人数（573例）均为最多，在此后出现了大幅下降。见图1。
2.3.2　月份分布
应用集中度法分析2011—2022年济南市非职业性CO中毒发病的季节性分布，结果显示：Rx=-0.03，Ry=0.73，M=0.73，提示研究期间济南市非职业性CO中毒病例发生具有很强的季节性，中毒主要集中发生在冬春季（十一月份到次年三月份），其他月份中毒事件发生较少。见图2。
2.3.3　时段分布
济南市非职业性CO中毒的发生在一天中的时间分布有着明显差异。根据患者前往就诊时间，中毒事件24小时时间分布显示，中毒事件发生次数最多的时段是上午6点至9点，共发生744起，占全部事件的21.9%，中午12点至晚9点中毒事件发生较少。见图3。
2.4　人群分布
4 208例非职业性CO中毒患者中，有3 402例（80.8%）报告了年龄、性别信息，其中男性1 480例（43.5%），平均年龄53.0岁，女性1 922例（56.5%），平均年龄49.6岁。≥60岁人群是中毒的高发人群（1 383例，40.7%），其次是18~<45岁（953例，28.0%）和45~<60岁（766例，22.5%）人群，0~18岁人群中毒风险最小（300例，8.8%）。见图4。
2.5　中毒原因
2 921起非职业性CO中毒事件发生报告了明确原因。其中，取暖不当是导致中毒的主要原因（2 554起，87.4%），其次是燃气和煤气泄漏（207起，7.1%），排在第三位的是食用木炭火锅及其他炭烤食品所致（113起，3.9%），此外导致CO中毒的原因还有燃气热水器使用不当、火灾、自杀等。对单次中毒人数超过5人的聚集型中毒事件进行筛选分析，共筛选出31起事件，累及195例中毒病例。其中26起中毒事件发生在公共场所，102例是由于炭烤饮食导致的。
3　讨论
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济南市2011—2022年非职业性CO中毒事件发生次数和中毒人数总体呈下降趋势，但在2015、2018和2021年出现了较为明显的回升，这一情况可能与济南市在这三年间遇到的低温寒潮和不利气象条件有关。有关于济南市的研究表明，随着低温阈值的降低和寒潮持续时间的增加，寒潮与CO中毒的关联也相应增加，寒潮与CO中毒风险之间存在显著相关性[8]。
济南市非职业性CO中毒事件的发生具有明显的季节性，每年十一月份到次年三月份为事件的高发月份，在四月份后，随着气温上升，居民取暖需求减少，中毒事件数量明显回落，根据监测系统结案报告显示，此后主要的中毒原因是燃气泄漏和食用炭烤饮食不当等。
济南市CO中毒事件的发生还表现出明显的时段集中分布特征，上午6点至9点是中毒事件报告发生的高发时间段。一项关于济南市燃煤CO中毒的病例对照研究显示，中毒多发生在夜间，患者中未安装烟囱、将采暖炉放置在卧室、睡前不封炉子等行为常见[9]。在通风状况不良的夜晚，由于取暖不当造成室内CO浓度上升，患者在睡梦中中毒或在感到不适时已无法离开现场，在早晨由他人发现异常并送往就医[10]，造成延误就诊，使得部分报告发生时间延后。
济南市非职业性CO中毒病例中，60岁以上老年人是CO中毒高发人群，这一点与上海市的情况不同，上海市CO中毒人员大多属于青壮年[11]，可能与城市人口年龄结构不同以及老年人自身身体状况、经济状况等方面处于劣势有关[12]，要着重关注弱势老年人群体，减少中毒事件的发生，一旦确诊，要尽快使用高压氧等针对性措施，保护危重症患者，挽救患者生命，减少患者发生中毒后遗症的风险[13]。
燃气、煤气泄漏作为济南市非职业性CO中毒的第二大病因，期间共造成293人中毒，其中发生在中心城区（槐荫区、市中区、历下区、历城区、天桥区）的共计241人，占82.3%。值得注意的是中心城区非职业性CO中毒发生较为集中，多发生在城中村、老旧小区以及区交界处，受管理缺失、设施老化以及人口老龄化的多重影响，CO中毒成为了这些地区需要重点关注的公共卫生问题。2022年8月槐荫区政府召开全区燃气安全专题会议，开展了针对经营场所、老旧小区的燃气检查和烟感报警器的安装[14]，在此之后，槐荫区只报告了1起此类中毒事件，说明通过政府协调干预，可有效减少老城区因燃气泄漏导致的CO中毒。厨房燃气检查已经进入常态化，CO报警器的安装也比较普及，但目前针对老旧热水器的检查较少，洗浴导致的CO中毒多是由于燃气热水器使用不当，发生排气不畅或废气倒灌，CO气体在室内蓄积，造成人员中毒[15]。随着使用年限的增加，燃气热水器的安全隐患也在上升，使用人员要提高使用安全意识，定期检查维护，尽早更换新型热水器，避免此类中毒事件的发生。
非职业性CO中毒仍然是济南市需要引起重点关注的一类环境因素突发公共卫生事件，特别是供暖季开始后数量出现显著升高。采取集中供暖、提高居民防范意识是避免发生中毒的有效措施。为此，建议在中毒高发季节和不良气象条件来临时，对中毒高发地区和场所开展安全检查与健康教育工作，减轻居民因CO中毒造成的健康损失和医疗经济负担。
基金
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  • 2022年济南市卫生健康委员会大数据科技计划项目(2022-BD-05)
文献
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2024年第51卷第12期
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doi: 10.20043/j.cnki.MPM.202401437
  • 接收时间：2024-01-26
  • 首发时间：2026-03-17
  • 出版时间：2024-06-25
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  • 收稿日期：2024-01-26
基金
2022年济南市卫生健康委员会大数据科技计划项目(2022-BD-05)
作者信息
    1.山东大学公共卫生学院，山东 济南 250012
    2.山东大学附属济南市疾病预防控制中心
    3.济南市医疗保障局

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