“笑气”中毒导致神经系统损害4例并文献复习

The clinical analysis of 4 cases of nitrous oxide intoxication caused nervous system impairment and review of the literature

目的探讨笑气中毒的临床表现、影像学特点、鉴别诊断及治疗。方法收集本院诊治的4例笑气中毒患者的临床资料,结合国外文献报道12例,国内文献报道1例,对共计17例患者的临床表现、影像学特点、鉴别诊断及治疗等进行分析。结果 17例患者中表现为肢体麻木14例、深感觉障碍12例、肢体无力,疲倦8例,共济失调7例。影像学上表现为类似于脊髓亚急性联合变性的倒"V"字型,伴或不伴维生素B12缺乏。经过停止接触笑气,及时肌肉注射或口服维生素B12以及甲基强的松龙静脉滴注,通常可以在数周至数月内恢复正常。结论笑气中毒导致神经系统损害的患者日益增加,临床医生要掌握其临床特点,并进行合理诊治。

Objective To investigate the clinical manifestations,radiological features,differential diagnosis and treatment of nitrous oxide intoxication.Methods Four nitrous oxide intoxication cases admitted to our department with clinical data were analyzed,the literatures were reviewed,the clinical manifestations,imaging features and differential diagnosis were analyzed.Results At present,12 cases reported abroad,1 case reported domestically,and 4 cases treated in our department,a total of 17 cases.Among the 17 patients,there were 14 cases with body numbness,there were 12 cases with proprioception impairment,there were 8 cases with weakness of limb or fatigue,and there were 7 cases with ataxia.Imaging was characterized by＂V＂type,with or without vitamin B12 deficiency,which was similar to subacute combined degeneration of spinal cord.After a cessation of contact with nitrous oxide,patient would return to normal within weeks or months,if a timely muscle injection or oral administration of vitamin B12,methylprednisolone 80 mg once daily intravenous infusion were added.Conclusion Nitrous oxide increasingly caused the addict with nervous system injury,and the clinician should master its clinical characteristics and conduct reasonably.