急性光气中毒致皮下及-或纵隔气肿治疗

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1、急性光气中毒致皮下及/或纵隔气肿治疗【摘要】目的探讨急性光气中毒所致纵膈、皮下气肿的临床特点及救治策略。方法本研究中的81例患者均来自一起群体性光气中毒事件，排除既往有心肺等基础性疾病的患者。共有5例患者出现皮下和/或纵膈气肿，收集患者年龄、性别、动脉血气和呼吸机参数等临床资料，计量资料通过t检验进行统计学分析。结果在5例并发皮下和/或纵膈气肿的患者中，男性3例，女性2例，平均年龄为(23.20±5.17)岁，气肿发生率0.06%o经对症治疗后4例痊愈，1例因并发ARDS导致的顽固性低氧血症而死亡。同时，在出现气肿后，患者的动脉血气结果变化差异无统计学意义(P>0.

2、05)o结论急性光气中毒重症患者出现皮下和/或纵膈气肿，与光气导致的肺损伤和治疗过程中呼吸机参数设置有关，在治疗过程中注意采用尽可能低的呼吸机支持条件是非常重要的。【关键词】光气；皮下和/或纵膈气肿；治疗Therapeuticstrategiesfordealingwithcutaneousemphysemaofchestwalland/orpneumomediastinumcausedbyseveretriphosgenepoisoningZHANGLin-lin,ZHOUShu-sheng,SUNZi~min,YANGTian-jun,ZHUShou-jun,F

3、ANHua,LIUBao.省略[Abstract】ObjectiveToanalyzetheclinicalfeaturesandtheeffectoftherapyoncutaneousemphysemaofchestwalland/orpneumomediastinumcomplicatedinsevereacutetriphosgenepoisoningpatients.MethodsAmong81triphosgenepoisoningpatients,5complicatedwithcutaneousemphysemaofchestwalland/orpn

4、eumomediastinumwereanalyzedinrespectoftheclinicaldataincludingage,gender,arterialbloodgas(ABG),modesofmechanicalventilationsupportandsoon.ResultsFivepatientsconsistingof3malesand2females,aged(23・20±5・17)years,werecomplicatedwithcutaneousemphysemaofchestwalland/orpneumomediastiumwithapr

5、evalencerateof0.06%.Ofthem,4werealleviatedcompletelyand1diedofacuterespiratorydistresssyndrome(ARDS).Therewasnosignificantdifferenceinarterialbloodgasanalysis(ABG)betweenpatientswithcutaneousemphysemaand/orpneumomediastinumandpatientswithout(P>0.05).ConelusionsTriphosgene-inducedacutel

6、unginjurytreatedwithmechanicalventilationsupportwithhighPEEPishighlysuggestedashighriskfactorfortheformationofcutaneousemphysemaofchestwalland/orpneumomediastinuminsevereacuteTriphosgenepoisoningpatients.ItisveryimportarittosetthePEEPlevelofmechanicalventilationsupportaslowaspossiblefo

7、ravoidanceofalveolarrupture.[Keywords]Triphosgene；Cutaneousemphysemaofchestwalland(or)pneumomediastinum；Therapy光气化学名称为碳酰氯，是由三光气在生产过程中因温度较高或加入有机溶剂后释放出的毒性极高气体。三光气又称固体光气，化学名称为双(三氯甲基)碳酸酯，简称BTC,外观为白色固体，不溶于水，易溶于氯苯、甲苯、二氯甲烷、氯仿等有机溶剂，目前国内外尚未见有固体光气本身对人体毒性作用的报道[1-2],故在工业上作一般毒性物质处理。而光气毒性是氯气的10倍[3