复方利多卡因乳膏致儿童高铁血红蛋白血症1例并文献复习

Childhood methemoglobinemia caused by compound lidocaine cream:a case report and literature review

目的分析复方利多卡因乳膏致儿童高铁血红蛋白血症的临床特点和转归。方法总结1例复方利多卡因乳膏致儿童高铁血红蛋白血症患儿的临床资料,并复习相关文献。结果患儿,女,3岁1个月。因烫伤增生性瘢痕欲行激光治疗于2021年8月23日至深圳市儿童医院就诊,外用复方利多卡因乳膏局麻后,出现局部皮肤潮红并频繁抽搐。考虑复方利多卡因乳膏致高铁血红蛋白血症。给予止惊、供氧、亚甲蓝静滴治疗后患儿发绀逐渐缓解,观察1 h后精神反应可,复查高铁血红蛋白2.1%,予离院。查阅中文文献仅有4例儿童病例报道,均为皮肤科外用复方利多卡因乳膏所致,导致抽搐及高铁血红蛋白血症,其中心跳骤停1例、肺出血1例、心动过速1例,治疗时间最长8 d,最短3 d,预后良好,无死亡病例。查阅英文文献共13例病例报道,年龄最小为2 d,均导致高铁血红蛋白血症,表现为发绀,其中5例合并抽搐,1例合并心跳停止,1例合并头痛伴行走不稳,预后良好,无死亡病例。结论复方利多卡因乳膏致儿童高铁血红蛋白血症发病率低,起病急,提高认识,早发现,及时予亚甲蓝及对症支持治疗,预后良好。

Objective To analyze the clinical features and outcomes of children with methemoglobinemia caused by compound lidocaine cream.Methods The clinical data of a child with methemoglobinemia caused by compound lidocaine cream were summarized,and the relevant literatures were reviewed.Results The child was female,3 years and 1 month old.She wanted to be treated with laser for hyperplastic scar due to scald on August 23,2021 in Shenzhen Children's Hospital.She occurred flushing skin and convulsions after local anesthesia with compound lidocaine cream,considered as methemoglobinemia induced by compound lidocaine cream.The child's cyanosis gradually relieved after anticonvulsant,oxygen supply,and methylene blue intravenous drip treatment,observed for 1 hour,her mental response was good and the rechecked methemoglobin was 2.1%,and she was discharged from the hospital.There were only 4 children cases reported in the Chinese literatures,all of whom were caused by local application of compound lidocaine cream in department of dermatology,leading to convulsions and methemoglobinemia,including 1 case of cardiac arrest,1 case of pulmonary hemorrhage,and 1 case of tachycardia;the treatment time was from 3 to 8 days,and the prognosis was good without deaths.There were only 13 children cases reported in the English literatures,the youngest child was 2 days old,all resulted in methemoglobinemia,manifested as cyanosis,of whom 5 cases were complicated by convulsions,1 case was complicated by cardiac arrest,and 1 case was complicated by headache and unstable walking,the prognosis was good without deaths.Conclusions The incidence of methemoglobinemia induced by compound lidocaine cream is low in children,with rapid onset,and the prognosis is good with awareness raising,early detection,timely administration of methylene blue,and symptomatic supportive treatment.