亚甲蓝治疗急性亚硝酸盐中毒的疗效观察

Observation of the effect of methylene blue on nitrite poisoning

目的总结急性亚硝酸盐中毒的临床特点及诊治方法。方法复习22例急性亚硝酸盐中毒患者的临床资料及有关文献，22例患者治愈后均证实为接触亚硝酸盐所致中毒，就诊当时仅1例有明确口服亚硝酸盐病史，临床症状以恶心、呕吐、胸闷、心悸、头晕、乏力常见，严重者有意识丧失、呼吸困难甚至昏迷、呼吸衰竭，体征均有皮肤黏膜紫绀，口唇、甲床紫绀为主，特效解毒剂亚甲蓝的用量根据紫绀情况调整。结果22例患者均治愈，其中16例患者静脉推注稀释的亚甲蓝20mg后紫绀及胸闷症状改善，观察24h离院，5例患者在30min内先后应用亚甲蓝40mg后好转，1例口服30g亚硝酸盐自杀的13岁男性，体质量40kg，在30min内急用亚甲蓝共60mg并行机械通气、洗胃、抑酸等对症治疗，3d后出院，所有患者随访均无后遗症。结论急性亚硝酸盐中毒元特异表现，有紫绀体征者试用亚甲蓝是安全的，治疗效果可靠，适量应用能明显缩短病程。

Objective To summarize the clinical features, diagnosis and treatment of acute nitrite poisoning by analysis of clinical cases. Methods Twenty-two cases of acute nitrite poisoning were reported. The chnical manifestations and therapeutic effect of methylene blue were analyzed. Twenty-two cases were confirmed as nitrite poisoning caused after curing. Only 1 case had a history of definite oral nitrite at emergency time. The common clinical symptoms were nausea, vomiting, chest tightness, palpitations, dizziness and fatigue. Serious cases had loss of consciousness, breathing difficulties and even coma, respiratory failure. All of the 22 cases had signs of skin and mucous membrane cyanosis. Lips and nail bed was the main and common part of cyanosis. Specific antidote methylene blue was adjusted dosage according to the cyanosis. Results All of the 22 cases were cured without complications. Sixteen cases were intravenous push methylene blue 20 mg, and the symptoms of cyanosis and chest tightness released, after observation for 24 h, and to be away from hospital. Five cases were given methylene blue 40 mg within 30 min, and released. One case who want to commit suicide , 13 years old, body weight 40 kg, was given methylene blue 60 mg within 30 min and was given mechanical ventilation, gastric lavage, after 3 d and to be away from hospital. All patients had no sequel. Conclusions The clinical symptoms of nitrite poisoning patients are nonspecific. The patients with cyanosis signs is safe and effective treating with methylene blue. Appropriate application of methylene blue can obviously shorten the course of acute nitrite poisoning.