娱乐性笑气滥用致神经系统损伤的临床及预后分析  

Clinical and prognostic analysis of neurological damage caused by recreational nitrous oxide abuse

作　　者：程忱[1] 俞文恪 戚乐[4] 张文明[2] 卢晓东[1] CHENG Chen;YU Wenke;QI Le;ZHANG Wenming;LU Xiaodong(Department of Neurology,The Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China;Department of Radiology,Sir Run Run Shaw Hospital Zhejiang University School of Medicine,Hangzhou 310016,China;Department of Radiology,The Second Affiliated Hospital Zhejiang University School of Medicine,Hangzhou 310008,China;Department of Radiology,The Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)

机构地区：[1]杭州师范大学附属医院神经内科,浙江杭州310015 [2]浙江大学医学院附属邵逸夫医院放射科,浙江杭州310016 [3]浙江大学医学院附属第二医院放射科,浙江杭州310008 [4]杭州师范大学附属医院放射科,浙江杭州310015

出　　处：《健康研究》2023年第2期237-240,F0003,共5页Health Research

摘　　要：目的分析娱乐性笑气滥用致神经系统损伤的临床特点及预后,为临床诊治提供依据。方法回顾因笑气滥用而导致神经系统损伤的患者病历资料,整理患者一般资料、临床表现和体征、治疗和预后情况。结果收集到27例患者,平均年龄为(22.48±4.39)岁,接触笑气的时间为12(6,24)个月。就诊时常见的主诉为肢体麻木(70.37%)、步态不稳(40.74%)、肢体无力(37.03%),最常见的临床类型为亚急性联合变性(81.48%)和周围神经病变(18.52%)。脊髓MRI提示:脊髓病灶的出现率为59.26%,矢状位上病变多位于颈髓(93.75%),轴位上病灶多位于后索(81.25%),倒“V”征的出现率为56.25%;头颅MRI显示2例(14.29%)出现明显的皮层萎缩。主要的实验室检查异常指标为高同型半胱氨酸血症(92.59%)。停止吸食及补充维生素B12治疗后,大多数患者预后良好。结论笑气滥用导致的神经系统损伤多表现为亚急性联合变性及周围神经病,脊髓磁共振扫描病变多位于脊髓后索,如及时终止笑气吸食,大多数患者预后良好。Objective To analyze the clinical characteristics and prognosis of neurological damage caused by recreational nitrous oxide abuse and provide a basis for clinical diagnosis and treatment.Methods The medical records of patients with neurological damage caused by nitrous oxide abuse were reviewed.The general information,clinical manifestations and signs,treatment and prognosis of the patients were summarized.Results A total of 27 patients were included in the study with a mean age of(22.48±4.39)years and an average duration of nitrous oxide use of 12(6,24)months.The common symptoms were limb numbness(70.37%),gait instability(40.74%),and limb weakness(37.03%).The most common diagnosis were subacute combined degeneration(81.48%)and peripheral neuropathy(18.52%).The incidence of spinal cord lesions detected by MRI was 59.26%,with sagittal lesions mainly located in the cervical cord(93.75%)and axial lesions mainly located in the posterior column(81.25%).The inverted"V"sign was present in 56.25% of cases.Cortical atrophy was observed in two cases(14.29%)on brain MRI.The main abnormal lab exam was elevated homocysteine(92.59%).Most patients had a good prognosis after discontinuing nitrous oxide use and receiving vitamin B12 supplementation.Conclusions Neurological damage caused by nitrous oxide abuse is mainly manifested as subacute combined degeneration and peripheral neuropathy.Spinal cord lesions are mainly located in the posterior column on MRI.Most patients have a good prognosis if nitrous oxide use is discontinued in a timely manner.

关 键 词：物质滥用 一氧化二氮 维生素B12 神经系统损伤 临床特点 

分 类 号：R745.4[医药卫生—神经病学与精神病学]