氧化亚氮中毒致中枢神经系统损害6例临床分析及文献复习  

Clinical analysis and literature review of 6 cases with nitrous oxide induced myeloneuropathy

作　　者：冯雪丹[1] 于莎莎 陈建华 高煜 马红梅[1] 王向波[2] FENG Xuedan;YU Shasha;CHEN Jianhua;GAO Yu;MA Hongmei;WANG Xiangbo(Department of Neurology,Beijing Youanmen Hospital,Beijing 100069,China)

机构地区：[1]北京丰台右安门医院神经内科,100069 [2]首都医科大学宣武医院神经内科,100053

出　　处：《疑难病杂志》2018年第11期1276-1279,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨氧化亚氮(N_2O)中毒致中枢神经系统损害的临床特点。方法回顾性分析2017年1月—2018年4月北京丰台右安门医院神经内科诊治的6例氧化亚氮中毒致神经系统损害患者的临床资料,并检索国内外文献进行总结。结果 6例患者主要临床表现为四肢麻木无力6例,共济失调5例,认知功能减低2例。血清同型半胱氨酸(Hcy)升高5例。6例颈髓MR检查均有异常信号。肌电图提示神经源性损害,以运动神经为主,脱髓鞘伴或不伴轴索损害。停止接触氧化亚氮,补充B族维生素、康复锻炼及高压氧联合治疗,完全治愈2例,好转3例,失访1例。结论氧化亚氮中毒患者以脊髓损害和周围神经损害为主;高同型半胱氨酸血症是维生素B_(12)缺乏的敏感指标,MR和肌电图检查有助于诊断;维生素B_(12)联合康复治疗有效。Objective To investigate the clinical characteristics of nervous system disorder caused by N2O intoxication.Methods A retrospectives analysis of clinical data of 6 patients with nitrous oxide intoxication in the department of neurology,Beijing Youanmen Hospital from January 2017 to April 2018.Related literatures were reviewed and summarized.Results The main clinical manifestations were limb numbness and weakness in all of the 6 patients,ataxia in 5 patients,cognitive impairment in 2 patients,sphincter dysfunction in 2 patients,transient consciousness disorders in 2 patients,and psychosis in 1 patients.Markedly elevated plasma homocysteine levels in 5 cases.All patients show abnormal signal in MR cervical spinal cord.Electromyography(EMG)indicates neurogenic damage,mainly motor,demyelination or without axonal injury.The first step of treatment is to stop contact with Nitrous Oxide.The symptoms of patients improved after vitamin B12 supplementation,rehabilitation therapy and hyperbaric oxygen combined therapy.Conclusion The most predominant characteristic of N 2O intoxication presented with polyneuropathy and myelopathy.The increase of homocysteine is a more valuable indicator for the absence(insufficient activity)of vitamin B12.MR and Electrophysiological examination play important role in the diagnosis of N2O intoxication.Vitamin B12 supplementation combined with nerve rehabilitation therapy is effective.

关 键 词：氧化亚氮 中毒 周围神经 脊髓病变 

分 类 号：R595.1[医药卫生—内科学]