一氧化二氮中毒致神经系统损伤四例报道并文献复习

Nervous System Damage Caused by Nitrous Oxide Poisoning:Four Cases Report and Literature Review

一氧化二氮(N_(2)O)是一种无色、有甜味的气体,因吸食后可使人丧失痛觉、产生欣快感而在娱乐场所被滥用,长期大量吸食会引起神经系统损伤。本文回顾了2020年3—7月就诊于陕西省人民医院的4例N_(2)O中毒致神经系统损伤患者的临床资料,并总结了其临床特点:N_(2)O中毒致神经系统损伤临床上可表现为脊髓亚急性联合变性,也可表现为肢体麻木等周围神经病变、认知功能减退及情绪障碍等;肌电图多表现为长度依赖性多发性周围神经病变、髓鞘脱失及轴索损伤等;脊髓MRI常表现为脊髓后索倒“V”字形异常信号改变;伴或不伴维生素B_(12)缺乏。早期停止接触N_(2)O并及时给予维生素B_(12)治疗,大部分神经损伤可逐渐恢复。长期滥用N_(2)O导致神经系统损伤的程度不同,患者临床表现各异,临床上如年轻患者出现上述症状,需仔细询问病史,如有N_(2)O吸入史,应结合影像学、实验室检查等考虑N_(2)O中毒,以便早发现、早治疗。

Nitrous oxide(N_(2)O)is a colorless,sweet gas.It is abused in entertainment venues because it can make people lose the pain and produce euphoric sensation after smoking.Long-term heavy smoking will cause nervous system damage.This paper reviewed the clinical data of 4 patients with nervous system damage caused by N_(2)O poisoning who were admitted to Shaanxi Provincial People's Hospital from March to July 2020,and summarized their clinical characteristics:the nervous system damage caused by N_(2)O poisoning may be clinically manifested as subacute combined degeneration of the spinal cord,or peripheral neuropathy such as limb numbness,cognitive dicline,and emotional disorder,etc;EMG was mainly manifested as length-dependent multiple peripheral neuropathy,demyelination and axonal damage,etc;MRI of the spinal cord often expressed as"V"shape abnormal signal changes in the posterior funiculus;with or without vitamin B_(12) deficiency.Early cessation of N_(2)O exposure and timely administration of vitamin B_(12) can result in the gradual recovery of most nerve injuries.It is pointed out that long-term abuse of N_(2)O leads to different levels of nervous system damage,and the clinical manifestations of patients are different.In clinical practice,if the above symptoms occur in young patients,the medical history should be asked carefully.If there is a history of N_(2)O inhalation,N_(2)O poisoning should be considered in combination with imaging and laboratory examination,so as to early detect and treat.