氮氧化物致急性化学中毒性肺水肿的临床救治研究

Clinical research on the chemical and toxic pulmonary edema induced by nitrogen tetroxide

目的 探索对氮氧化物致急性化学中毒性肺水肿临床救治的新途径。方法 ①间断高流量吸氧 ,同时湿化吸入 5 0 %的酒精抗泡 ;②肺部体征明显者雾化吸入二甲基硅油 ;③根据病人紫绀情况分别给予美兰或维生素C静推 ;④心率快者用半量西地兰静推 ;⑤用速尿 10～ 2 0mg静推 ;⑥关键性治疗为莨菪碱联用地塞米松冲击疗法 ,遇呼衰、低氧血症者 ,同时使用呼吸机等。结果 6 4例患者中有 19例发生急性化学中毒性肺水肿 ,死亡 3例 ,16例得救 ,急性化学中毒性肺水肿患者的死亡率为 15 78%。结论 氮氧化物所致的化学中毒性肺水肿较临床其它原因的急性肺水肿病情发展迅猛 ,救治极为困难 ,死亡率极高。综合治疗是至关重要的 ,莨菪碱类药物联用地塞米松有良好的效果。

Objective To investigate the clinical method of the chemical and toxic pulmonary edema induced by nitrogen oxide.Methods ①Intermittent and high flux inhalation of oxygen humidified by 50% alcohol; ②Aerosol inhalation of silicon oil to the patient with significant symptom of lung; ③Intro venous injection of Methylene blue and (or) Vitamine C according to the cyanosis; ④Intro venous injection of half dosage cedilanid to the patient with high heart rate; ⑤10～20 milligram furosemide intro venous injection;⑥The key point is combine and high dosage using hyoscyamine and dexamethason during the treatment and to apply respirator to the patient those who have respiratory failure or hypoxemia.Results There are 19 chemical and toxic pulmonary edema cases among 64 cases intoxication of nitrogen tetroxide 3 were dead and 16 was saved of the 19 cases.Conclusion Chemical and toxic pulmonary edema induced by nitrogen oxide was more severe than other type and was difficult to cure.Multiple treatment is the most important: cardio-pulmonary resuscitation,antifoam agent,ultrasonic aerosol inhalation,antianaphylatic and antalkali treatment,avoid methemoglobinemia and electrolyte disturbance,properly posture and high flux inhalation of oxygen.Combine using hyoscyamine and dexamethason was effective in the treatment.