急性化学性肺水肿及迟发性肺水肿的损伤特点及临床救治（附29例报告）  

Characteristic and clinical treatment of acute chamical lung edema, induced by intoxication of nitric oxide.

作　　者：岳茂兴[1] 

机构地区：[1]解放军第306医院特种医学中心、普通外科中心,北京100101

出　　处：《世界急危重病医学杂志》2007年第6期2123-2126,共4页internationl journal of emergency and critical care medicine

基　　金：解放军总装备部卫生局重点指令性攻关课题（No.200010306）

摘　　要：目的本文探讨严重化学性肺水肿的特点及其救治对策。方法（1）迅速维持呼吸道通畅。（2）促进毒物排出和促进已吸收的毒物排出。（3）尽力维持伤员的呼吸循环机能：①保暖；②间断高流量（3～5L／min）吸氧；③解除支气管痉挛；④脱水；⑤血液巾高铁血红蛋白含量升高的处理；⑥强心药物使用；⑦对症治疗和支持疗法等。结果本组29例中有3例患者死亡，死亡率为10．35％。2例死亡者均有咳血性泡沫样痰、鼻腔流出泡沫状液体，肺通气换气功能严重损害，引起脑及心肌受损，出现呼吸循环衰竭、昏迷而死亡。结论迟发性严重急性化学性肺水肿的危害特别大．因为常初期不易引起急救医师的重视，但一旦发病，往往病情危笃，使抢救措手不及。应提醒大家初期即对该问题的严重性予以重视，预防对患者来说，尤重于治疗。Objectve To investigate the Characteristic and clinical treatment of acute chamical lung edema induced by intoxication of nitric oxide. Methods （1）Keep effective breath and circulate function. （2）Accelerate the excretion of the toxicant. （3） Sputum suction and bronchoalveolar larage fluid（BALF） by fibrobronchoscop were important in the treatment. （4）Dehydration, reduction of the ferrihemochrome and supplying of the cardiant. （5） The key point of the treatment is the combining using dexemathason and anisodamine Results 2 cases were died after the treatment. They have severe damage of the respiratory and circulation function, and finally dying from the failure of respiratory and circulation. Conclusion It is difficult to treat acute chamical lung edema induced by intoxication of nitric oxide. Preventive measurement is important before the intoxication and the multi-treatment, including combining using dexemathason and anisodamine were proved effective.

关 键 词：氮氧化物 中毒 化学性 急性 迟发性 肺水肿 

分 类 号：R541.63[医药卫生—心血管疾病]