CAJ | 학술논문

目的探讨重度光气中毒所致急性呼吸窘迫综合征(ARDS)患者的临床特点及救治策略.方法 17例重度光气中毒患者采用个体化综合治疗;治疗前后进行血常规、电解质、动脉血气分析、肝肾功能和心肌酶学等检测.结果治疗后,17例重度中毒患者的一般体征、水和电解质及酸碱平衡紊乱改善,与治疗前比较,白细胞计数(WBC,×109/L:12.18±4.76比21.93±6.21)、中性粒细胞比例(0.87±0.05比0.92±0.03)、血红蛋白(Hb,g/L:128.12±25.65比173.71±23.53)、血小板计数(PLT,×109/L:165.12±31.70比254.47±70.80)、丙氨酸转氨酶(ALT,U/L:70.71±46.70比212.71±141.34)、天冬氨酸转氨酶(AST,U/L:52.47±34.68比82.41±34.60)、血尿素氮(BUN,mmol/L:5.83±4.09比7.89±5.96)、血肌酐(SCr,μmol/L:48.13±14.97比67.25±24.29)、乳酸脱氢酶(LDH,U/L:280.10±81.77比586.35±186.71)、肌酸激酶(CK,U/L:199.12±106.75比683.00±323.31)、肌酸激酶同工酶(CK-MB,U/L:26.94±9.13比45.59±11.21)、血Na+(mmol/L:140.61±6.69比134.06±4.80)、血Cl-(mmol/L:95.88±6.06比102.29±7.28)、呼吸频率(RR,次/min:20.88±4.30比30.06±5.78)、心率(HR,次/min:82.76±17.16比113.35±16.90)、pH值(7.34±0.44比7.39±0.03)、血氧分压(PO2,mm Hg,1 mm Hg=0.133 kPa:84.41±30.58比59.88±15.19)、脉搏血氧饱和度(SPO2:0.91±0.08比0.78±0.15)差异均有统计学意义(P＜0.05或P＜0.01).17例重度中毒患者中16例完全康复,1例死亡,治愈率94.12％.结论光气中毒的临床表现主要为呼吸系统损害,并发ARDS,在治疗上应早期采用皮质激素及呼吸支持等综合治疗措施.
목적 탐토중도광기중독소치급성호흡군박종합정(ARDS)환자적림상특점급구치책략.방법 17례중도광기중독환자채용개체화종합치료;치료전후진행혈상규、전해질、동맥혈기분석、간신공능화심기매학등검측.결과 치료후,17례중도중독환자적일반체정、수화전해질급산감평형문란개선,여치료전비교,백세포계수(WBC,×109/L:12.18±4.76비21.93±6.21)、중성립세포비례(0.87±0.05비0.92±0.03)、혈홍단백(Hb,g/L:128.12±25.65비173.71±23.53)、혈소판계수(PLT,×109/L:165.12±31.70비254.47±70.80)、병안산전안매(ALT,U/L:70.71±46.70비212.71±141.34)、천동안산전안매(AST,U/L:52.47±34.68비82.41±34.60)、혈뇨소담(BUN,mmol/L:5.83±4.09비7.89±5.96)、혈기항(SCr,μmol/L:48.13±14.97비67.25±24.29)、유산탈경매(LDH,U/L:280.10±81.77비586.35±186.71)、기산격매(CK,U/L:199.12±106.75비683.00±323.31)、기산격매동공매(CK-MB,U/L:26.94±9.13비45.59±11.21)、혈Na+(mmol/L:140.61±6.69비134.06±4.80)、혈Cl-(mmol/L:95.88±6.06비102.29±7.28)、호흡빈솔(RR,차/min:20.88±4.30비30.06±5.78)、심솔(HR,차/min:82.76±17.16비113.35±16.90)、pH치(7.34±0.44비7.39±0.03)、혈양분압(PO2,mm Hg,1 mm Hg=0.133 kPa:84.41±30.58비59.88±15.19)、맥박혈양포화도(SPO2:0.91±0.08비0.78±0.15)차이균유통계학의의(P＜0.05혹P＜0.01).17례중도중독환자중16례완전강복,1례사망,치유솔94.12％.결론 광기중독적림상표현주요위호흡계통손해,병발ARDS,재치료상응조기채용피질격소급호흡지지등종합치료조시.
Objective To investigate the clinical features and treatment strategy for acute respiratory distress syndrome (ARDS) caused by phosgene.Methods Individualized therapy was carried out in 17 cases of severe phosgene poison patients.Blood routine,electrolytes,blood gas analysis,hepatic and renal function tests and cardiac enzymes were examined before and after treatment.Results Vital signs,fluid,electrolytes and acid-base disturbances were improved after treatment.As compared to that of pre-treatment period,white blood cells (WBC,× 109/L:12.18 ±4.76 vs.21.93 ± 6.21 ),neutrophil percentage (0.87 ± 0.05 vs.0.92 ± 0.03 ),hemoglobin (Hb,g/L:128.12 ± 25.65vs.173.71 ± 23.53),blood platelet count (PLT,× 109 /L:165.12 ± 31.70 vs.254.47 ± 70.80),alanine transaminase (ALT,U/L:70.71 ±46.70 vs.212.71 ± 141.34),aspartate aminotransferase (AST,U/L:52.47 ± 34.68 vs.82.41 ±34.60),blood urea nitrogen (BUN,mmol/L:5.83 ± 4.09 vs.7.89 ± 5.96),serum creatinine (SCr,μmol/L:48.13 ±14.97 vs.67.25 ± 24.29),lactate dehydrogenase (LDH,U/L:280.10 ± 81.77 vs.586.35 ± 186.71 ),creatine kinase (CK,U/L:199.12 ± 106.75 vs.683.00 ± 323.21 ),MB isoenzyme ofcreatine kinase (CK-MB,U/L:26.94 ± 9.13 vs.45.59 ± 11.21),serum chlorine anion (Cl-,mmol/L:95.88 ± 6.06 vs.102.29 ±7.28),respiratory rate (RR,beats/min:20.88 ±4.30 vs.30.06 ±5.78),heart rate (HR,beats/min:82.76 ± 17.16 vs.113.35 ± 16.90),blood pH value (7.34 ± 0.44 vs.7.39 ± 0.03 ) were all decreased (P＜0.05 or P＜0.01 ).Serum sodium ion (Na+,mmol/L:140.61 ± 6.69 vs.134.06 ± 4.80),arterial partial pressure of oxygen (PO2,mm Hg,1 mm Hg=0.133 kPa:84.41 ± 30.58 vs.59.88 ± 15.19) and pulse oxygen saturation (SpO2:0.91 ± 0.08 vs.0.78 ± 0.15 ) were increased (P＜0.05 or P＜0.01 ).Sixteen patients totally recovered,1 patient died,and the cure rate was 94.12％.Conclusions Respiratory system could be mainly injured as the result of exposure to phosgene and leading to ARDS.Early initial combination therapies with corticosteroids and respiratory support should be addressed.