急性吸入性金属镍中毒4例

Acute inhalational metallic nickel poisoning

目的探讨急性吸入性金属镍中毒的临床特点，并观察治疗效果。方法收集南京医科大学第一附属医院急诊医学中心近期收治的4例急性吸入性金属镍中毒患者的临床资料，分析其暴露史、临床特点、实验室及影像学检查、血清及尿镍浓度及临床治疗和转归。结果4例患者胸部CT均表现为肺部弥漫性渗出。血清及尿镍浓度均升高，与病情严重性成正比。2例重症患者予二巯丙磺钠和机械通气，4例患者均接受了糖皮质激素治疗。所有患者均病情改善出院。结论吸入性金属镍中毒少见，早期症状不典型。肺部弥漫性渗出改变为其主要特征。血、尿镍检测有助于诊断和判断病情。糖皮质激素、驱镍治疗和对症处理有效。

Objective To investigate the clinical characteristics of acute inhalational metallic nickel poisoning and its treatment effect. Methods Data including epidemiology, clinical features, laboratory tests, imaging examinations, therapy protocol as well as prognosis were collected and analyzed. Results Thoracic CT scan of all patients demonstrated as bilateral diffuse infiltration. Nickel concentration in both blood and urine were high in all patients and the concentration was positively associated with poisoning severity. All 4 patients received glucocorticoid treatment, 2 of whom with acute respiratory distress syndrome were admitted to ICU to initiate mechanical ventilation and were given sodium dimercaptopropanesulfonate. All patients survived to hospital discharge. Conclusions Acute inhalational metallic nickel poisoning is uncommon and early symptoms are inconclusive. The blood and urine nickel concentration is helpful to judge the severity of the disease. Pulmonary diffuse infiltration is the main clinical feature. Glucocorticoid, chelation therapy as well as symptomatic treatment are effective therapies to relief disease severity.