一氧化二氮滥用致肺栓塞的临床分析  

Clinical analysis of pulmonary embolism caused by nitrous oxide abuse

作　　者：王丽 李悦 赵雪梅 安树昌 铁常乐 王倩 汪仁斌[4] 张瑾[5] 王天祎 段晓慧[4] 董明睿[4] 刘芳[1] WANG Li;LI Yue;ZHAO Xue-mei(Department of Neurology,The First Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]清华大学第一附属医院神经内科,北京100016 [2]清华大学第一附属医院放射诊断科,北京100016 [3]清华大学第一附属医院呼吸科,北京100016 [4]中日友好医院神经科,北京100029 [5]中日友好医院胸外科,北京100029 [6]中日友好医院检验科,北京100029

出　　处：《中日友好医院学报》2021年第5期268-272,F0002,共6页Journal of China-Japan Friendship Hospital

基　　金：清华大学第一附属医院领航基金(LH-02)。

摘　　要：目的:分析一氧化二氮滥用导致肺栓塞患者的临床和影像学特点,探讨可能的发病机制。方法:对2019年1月~2020年12月在中日友好医院和清华大学第一附属医院神经内科就诊的4例一氧化二氮滥用致神经系统损害病程中合并肺栓塞患者的临床特点、实验室检测、影像学检查结果等进行回顾性分析。结果:4例患者均为男性,平均年龄24.75±3.50岁,平均一氧化二氮接触时间13.50±9.04个月。患者先后出现神经系统及呼吸道症状,伴有下肢肿胀,存在血同型半胱氨酸、D-二聚体升高,肺动脉CTA均发现双侧肺动脉栓塞。其中3例患者颈胸椎磁共振脊髓后索可见"倒V"征。结论:长期滥用一氧化二氮可能会增加肺栓塞的风险,血浆D-二聚体升高、呼吸道症状或下肢肿胀可作为此类患者的预警指标之一,必要时尽快完善肺动脉CTA,减少误诊。Objective:To investigate the clinical and imaging characteristics of patients with pulmonary embolism caused by nitrous oxide abuse, and to explore its mechanism.Methods:Retrospective analysis was performed on 4 patients with pulmonary embolism in the course of neurological damage caused by nitrous oxide abuse from January 2019 to December 2020.Results:All 4 patients were male.The average age was 24.75 ±3.50 years,and the average exposure time to nitrous oxide was 13.50 ±9.04 months.The symptoms of nervous system and respiratory tract appeared successively accompanied with swelling of lower limbs.The levels of homocysteine and D-dimer increased.Bilateral pulmonary embolism was found in all patients by CTA. "Inverted V-type" sign was found in 3 cases by spinal MRI.Conclusion:Long term abuse of nitrous oxide may increase the risk of pulmonary embolism.Elevated plasma D-dimer,respiratory symptoms or swelling of lower limbs can be used as one of the early warning indicators.If necessary,CTA should be improved as soon as possible to reduce misdiagnosis.

关 键 词：一氧化二氮 肺栓塞 同型半胱氨酸 MTHFRC677T基因 脊髓病变 

分 类 号：R744.9[医药卫生—神经病学与精神病学]