体外膜氧合成功救治重度有机氟中毒4例报道

Successful treatment of 4 patients with severe acute organic fluorine poisoning using extracorporeal membrane oxygenation

目的总结应用体外膜氧合(ECMO)救治急性重度有机氟气体中毒患者的临床经验。方法2021年1月浙江衢州发生一起急性群体有机氟气体中毒事件,回顾本院应用ECMO救治其中4例重症患者的临床资料,分析患者中毒的流行病学特点,临床症状、体征、化验与检查的变化,治疗方法,ECMO治疗的模式、支持时间和并发症发生情况,以及患者的转归等。结果4例患者均为男性,年龄(52±9)岁,均在吸入气体后6 h因为胸闷、咳嗽、咽部不适等来院急诊。患者病情进展快速,以严重的急性呼吸衰竭和循环衰竭为突出表现,中毒后(13.0±4.8)h进行气管插管和机械通气,(15.5±5.3)h接受ECMO治疗。其中VV-ECMO(1例8h后转VA)、VA-ECMO各2例;ECMO治疗持续(8.8±3.6)d后均成功撤机,呼吸机治疗(23.0±28.7)d,ICU住院时间(42.0±55.4)d。其中1例VA-ECMO治疗后发生下肢坏死而截肢,后转康复医院治疗,余3例痊愈出院。结论ECMO在急性有机氟气体中毒患者的救治中具有不可替代的价值,应作为区域应对突发公共事件的能力和技术的储备。

Objective To summarize the clinical experience of treating patients with severe acute organic fluorine poisoning using extracorporeal membrane oxygenation(ECMO).Methods In January 2021,an acute mass organic fluorine gas poisoning incident occurred in Quzhou,Zhejiang Province.The clinical data of 4 severe patients with acute poisoning of organic fluorine treated by ECMO in our hospital were retrospectively analyzed,and the epidemiological characteristics,clinical symptoms,signs,the abnormal laboratory studies/examinations,and treatments of this kind poisoning patients,especially,the treatment pattern,support time,complications,and outcomes of ECMO were collected and analyzed.Results All the 4 patients were male,with an average age of(52±9)years,and all of them came to the emergency department complaining chest tightness,cough and pharyngeal discomfort 6 h after exposure by inhalation.The patient’s condition progressed rapidly with severe acute respiratory failure and circulatory failure as the prominent manifestations.The mechanical ventilations were performed(13.0±4.8)h after poisoning,and ECMO treatment was performed(15.5±5.3)h after poisoning.Among them,2 patients were treated using venoarterial(VA)ECMO,and 2 patients using venovenous(VV)ECMO,but 1 patient was converted to VA-ECMO 8 h later.The duration of ECMO support for the patients was(8.8±3.6)d.The duration of mechanical ventilation was(23.0±28.7)d and stay in intensive care unit was(42.0±55.4)d.Among them,one patient was transferred to a specialized rehabilitation hospital after the amputation surgery due to lower limb necrosis after VA-ECMO support,and the remaining 3 patients were discharged after recovery.Conclusions ECMO support might have the irreplaceable value in the treatment of patients with severe acute organic fluorine poisoning,and should be considered as one of the reserves of regional health care system in dealing with public health emergencies.