急性氯气中毒危重患儿6例临床分析  

Clinical analysis of 6 critically ill children with acute chlorine poisoning

作　　者：徐文淼 高恒妙[1] 刘颖超[1] 王丽娟[1] 钱素云[1] Xu Wenmiao;Gao Hengmiao;Liu Yingchao;Wang Lijuan;Qian Suyun(Pediatric Intensive Care Unit,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院重症医学科,北京100045

出　　处：《中华儿科杂志》2022年第2期124-128,共5页Chinese Journal of Pediatrics

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.17193)。

摘　　要：目的总结急性氯气中毒危重患儿的临床特征及诊疗经验,探讨有效应对策略。方法回顾性总结2019年8月一起突发群体性氯气中毒事件中就诊于首都医科大学附属北京儿童医院重症医学科的6例危重患儿的一般情况、临床表现、诊疗经过和随访结果(截至出院后1年6个月)。结果6例危重患儿中男4例、女2例,年龄4~12岁。事发时均处于距氯气源5 m以内,均以严重呼吸困难为突出表现,中毒后3.5~7.0 h行气管插管、机械通气;病情最严重的1例患儿距氯气源最近(仅1.5 m),撤离时间最长(约5 min),常规机械通气不能纠正缺氧并出现严重休克,于中毒后10 h开始静脉-动脉体外膜肺氧合(ECMO)治疗。6例患儿全部存活。随访6例患儿生长发育均未见异常;肺功能检查除1例因既往有可疑哮喘存在小气道阻力增高外,余5例未见异常;肺部CT、脑电图、颅脑磁共振成像均未见异常。结论重度氯气中毒主要表现为呼吸衰竭,常在中毒后数小时内需机械通气。常规机械通气无效时ECMO治疗可挽救生命,救治及时预后好。Objective To analyze the clinical characteristics and treatment of critically ill children with acute chlorine poisoning and explore the risk factors and effective strategies.Methods This retrospective study collected the clinical data,including general state,clinical characteristics,treatment and follow-up(till 1 year and 6 months after discharge),of 6 critically ill children who were hospitalized in the Pediatric Intensive Care Unit of Beijing Children′s Hospital due to acute chlorine poisoning in August 2019.Results There were 6 children characterized by severe dyspnea in this accident,among whom 4 were boys and two girls,aged 4-12 years.When the accident occurred,they were within 5 m of the chlorine source.These patients underwent tracheal intubation and mechanical ventilation in 3.5-7.0 h after poisoning.The child who was the closest to the chlorine source(1.5 m)and took the longest time(5 min)to evacuate was the most severe one.He suffered hypoxia which could not be corrected by conventional mechanical ventilation and severe shock,then had veno-arterial extracorporeal membrane oxygenation(ECMO)treatment started 10 h after the accident.All the 6 children in this study survived.Following-up found no growth and developmental abnormality.The pulmonary function tests were normal except for one case with increased small airway resistance due to previous suspected asthma,and the lung CT,electhoencephalogram,and brain magnetic resonance imaging were all normal.Conclusions Severe chlorine poisoning is mainly characterized by respiratory failure.Mechanical ventilation is often required within a few hours after poisoning.When conventional mechanical ventilation is ineffective,ECMO could save live.Timely treatment could improve prognosis.

关 键 词：气体中毒 儿童 呼吸 人工 体外膜氧合作用 

分 类 号：R720.597[医药卫生—急诊医学]