體外膜氧合救治靜脈二甲苯中毒致重度急性呼吸窘迫綜合征患者一例_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

丁媛 , 包萬員 , 王瑰 , 施曉婷 , 劉寧 ,  朱濱

蘇州大學附屬第三醫院重癥醫學科（江蘇常州 213003）;

Corresponding?author：

朱濱, Email: drzhubin@126.com

Keywords：

二甲苯中毒; 靜脈注射; 急性呼吸窘迫綜合征; 體外膜氧合

DOI：

10.7507/1671-6205.202209058

Video：

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目的總結靜脈二甲苯中毒患者的臨床特點、治療、預后和體外膜氧合（extracorporeal membrane oxygenation，ECMO）救治重癥中毒患者的經驗。方法回顧分析我院重癥醫學科收治的1例靜脈注射二甲苯后出現重度急性呼吸窘迫綜合征（acute respiratory distress syndrome，ARDS）患者的資料。以“xylene”和“acute poisoning”以及“苯”或“二甲苯”和“中毒”為檢索詞分別在PubMed以及中國知網、萬方數據庫中檢索，并復習相關文獻。結果患者男，30歲，靜脈注射二甲苯出現重度ARDS，在ECMO支持下經過積極治療成功出院，預后良好。檢索數據庫中僅有3篇國外報道描述了苯類化合物靜脈注射中毒的病例，這是國內第1例二甲苯靜脈中毒的報道，也是二甲苯中毒運用ECMO治療的首例報道。結論靜脈苯類化合物中毒患者可出現嚴重的呼吸衰竭，且為首發癥狀之一，早期積極治療，臨床預后較好，ECMO為這類患者提供了一種救治手段。

Citation： 丁媛, 包萬員, 王瑰, 施曉婷, 劉寧, 朱濱. 體外膜氧合救治靜脈二甲苯中毒致重度急性呼吸窘迫綜合征患者一例. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(1): 52-56. doi: 10.7507/1671-6205.202209058 Copy

1.	Tonna JE, Abrams D, Brodie D, et al. Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO): Guideline from the Extracorporeal Life Support Organization (ELSO). ASAIO J, 2021, 67(6): 601-610.
2.	中國心胸血管麻醉學會, 中華醫學會麻醉學分會, 中國醫師協會麻醉學醫師分會, 等. 不同情況下成人體外膜肺氧合臨床應用專家共識(2020版). 中國循環雜志, 2020, 35(11): 1052-1063.
3.	Choi CY, Cho N, Park SY, et al. Urine methyl hippuric acid levels in acute pesticide poisoning: estimation of ingested xylene volume and association with clinical outcome parameters. J Korean Med Sci, 2017, 32(12): 2051-2057.
4.	馬瑞敏, 李怡華, 葉俏. 苯中毒文獻計量與熱點可視化分析. 中華勞動衛生職業病雜志, 2021, 39(12): 933-937.
5.	Belkoniene M, Socquet J, Njemba-Freiburghaus D, et al. Near fatal intoxication by nicotine and propylene glycol injection: a case report of an e-liquid poisoning. BMC Pharmacol Toxicol, 2019, 20(1): 28.
6.	Argo A, Bongiorno D, Bonifacio A, et al. A fatal case of a paint thinner ingestion: comparison between toxicological and histological findings. Am J Forensic Med Pathol, 2010, 31(2): 186-191.
7.	Zimmerman JL. Cocaine intoxication. Crit Care Clin, 2012, 28(4): 517-526.
8.	Recordati C, De Maglie M, Bianchessi S, et al. Tissue distribution and acute toxicity of silver after single intravenous administration in mice: nano-specific and size-dependent effects. Part Fibre Toxicol, 2016, 13: 12.
9.	?ev?ik P, Hep A, Pe?lová M. Intravenous xylene poisoning. Intensive Care Med, 1992, 18(6): 377-378.
10.	Gursoy S, Kunt N, Kaygusuz K, et al. Intravenous amitraz poisoning. Clin Toxicol (Phila), 2005, 43(2): 113-116.
11.	Kulkarni RR, Hemanth Kumar RG, Kulkarni PR, et al. Psychological autopsy and necropsy of an unusual case of suicide by intravenous toluene. Indian J Psychol Med, 2015, 37(2): 233-235.
12.	Win-Shwe TT, Fujimaki H. Neurotoxicity of toluene. Toxicol Lett, 2010, 198(2): 93-99.
13.	曹艷梅, 蔣欣宇, 閔春燕, 等. 急性甲苯和二甲苯及乙苯中毒后遺癥1例. 中華勞動衛生職業病雜志, 2022, 40(7): 532-534.
14.	Sandikci M, Seyrek K, Aksit H, et al. Inhalation of formaldehyde and xylene induces apoptotic cell death in the lung tissue. Toxicol Ind Health, 2009, 25(7): 455-461.
15.	Méausoone C, Landkocz Y, Cazier F, et al. Toxicological responses of BEAS-2B cells to repeated exposures to benzene, toluene, m-xylene, and mesitylene using air-liquid interface method. J Appl Toxicol, 2021, 41(8): 1262-1274.
16.	Papi L, Chericoni S, Bresci F, et al. Fatal acute poisoning from massive inhalation of gasoline vapors: case report and comparison with similar cases. J Forensic Sci, 2013, 58(2): 552-555.
17.	Zhao Q, Li YJ, Chai XL, et al. Interaction of inhalable volatile organic compounds and pulmonary surfactant: potential hazards of VOCs exposure to lung. J Hazard Mater, 2019, 369: 512-520.
18.	Gummin DD, Mowry JB, Spyker DA, et al. 2017 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 35th Annual Report. Clin Toxicol (Phila), 2018, 56(12): 1213-1415.
19.	Mycyk MB. Extracorporeal membrane oxygenation shows promise for treatment of poisoning some of the time: the challenge to do better by aiming higher. Crit Care Med, 2020, 48(8): 1235-1237.
20.	Lorusso R, Shekar K, MacLaren G, et al. ELSO Interim Guidelines for Venoarterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients. ASAIO J, 2021, 67(8): 827-844.
21.	錢穎, 謝永鵬, 沈葉菊, 等. 以機械功為導向的急性呼吸窘迫綜合征機械通氣新理念. 中國呼吸與危重監護雜志, 2020, 19(4): 418-421.
22.	Camporota L, Caricola EV, Bartolomeo N, et al. Lung recruitability in severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Crit Care Med, 2019, 47(9): 1177-1183.
23.	Villar J, Ferrando C, Martínez D, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med, 2020, 8(3): 267-276.

1. Tonna JE, Abrams D, Brodie D, et al. Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO): Guideline from the Extracorporeal Life Support Organization (ELSO). ASAIO J, 2021, 67(6): 601-610.
2. 中國心胸血管麻醉學會, 中華醫學會麻醉學分會, 中國醫師協會麻醉學醫師分會, 等. 不同情況下成人體外膜肺氧合臨床應用專家共識(2020版). 中國循環雜志, 2020, 35(11): 1052-1063.
3. Choi CY, Cho N, Park SY, et al. Urine methyl hippuric acid levels in acute pesticide poisoning: estimation of ingested xylene volume and association with clinical outcome parameters. J Korean Med Sci, 2017, 32(12): 2051-2057.
4. 馬瑞敏, 李怡華, 葉俏. 苯中毒文獻計量與熱點可視化分析. 中華勞動衛生職業病雜志, 2021, 39(12): 933-937.
5. Belkoniene M, Socquet J, Njemba-Freiburghaus D, et al. Near fatal intoxication by nicotine and propylene glycol injection: a case report of an e-liquid poisoning. BMC Pharmacol Toxicol, 2019, 20(1): 28.
6. Argo A, Bongiorno D, Bonifacio A, et al. A fatal case of a paint thinner ingestion: comparison between toxicological and histological findings. Am J Forensic Med Pathol, 2010, 31(2): 186-191.
7. Zimmerman JL. Cocaine intoxication. Crit Care Clin, 2012, 28(4): 517-526.
8. Recordati C, De Maglie M, Bianchessi S, et al. Tissue distribution and acute toxicity of silver after single intravenous administration in mice: nano-specific and size-dependent effects. Part Fibre Toxicol, 2016, 13: 12.
9. ?ev?ik P, Hep A, Pe?lová M. Intravenous xylene poisoning. Intensive Care Med, 1992, 18(6): 377-378.
10. Gursoy S, Kunt N, Kaygusuz K, et al. Intravenous amitraz poisoning. Clin Toxicol (Phila), 2005, 43(2): 113-116.
11. Kulkarni RR, Hemanth Kumar RG, Kulkarni PR, et al. Psychological autopsy and necropsy of an unusual case of suicide by intravenous toluene. Indian J Psychol Med, 2015, 37(2): 233-235.
12. Win-Shwe TT, Fujimaki H. Neurotoxicity of toluene. Toxicol Lett, 2010, 198(2): 93-99.
13. 曹艷梅, 蔣欣宇, 閔春燕, 等. 急性甲苯和二甲苯及乙苯中毒后遺癥1例. 中華勞動衛生職業病雜志, 2022, 40(7): 532-534.
14. Sandikci M, Seyrek K, Aksit H, et al. Inhalation of formaldehyde and xylene induces apoptotic cell death in the lung tissue. Toxicol Ind Health, 2009, 25(7): 455-461.
15. Méausoone C, Landkocz Y, Cazier F, et al. Toxicological responses of BEAS-2B cells to repeated exposures to benzene, toluene, m-xylene, and mesitylene using air-liquid interface method. J Appl Toxicol, 2021, 41(8): 1262-1274.
16. Papi L, Chericoni S, Bresci F, et al. Fatal acute poisoning from massive inhalation of gasoline vapors: case report and comparison with similar cases. J Forensic Sci, 2013, 58(2): 552-555.
17. Zhao Q, Li YJ, Chai XL, et al. Interaction of inhalable volatile organic compounds and pulmonary surfactant: potential hazards of VOCs exposure to lung. J Hazard Mater, 2019, 369: 512-520.
18. Gummin DD, Mowry JB, Spyker DA, et al. 2017 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 35th Annual Report. Clin Toxicol (Phila), 2018, 56(12): 1213-1415.
19. Mycyk MB. Extracorporeal membrane oxygenation shows promise for treatment of poisoning some of the time: the challenge to do better by aiming higher. Crit Care Med, 2020, 48(8): 1235-1237.
20. Lorusso R, Shekar K, MacLaren G, et al. ELSO Interim Guidelines for Venoarterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients. ASAIO J, 2021, 67(8): 827-844.
21. 錢穎, 謝永鵬, 沈葉菊, 等. 以機械功為導向的急性呼吸窘迫綜合征機械通氣新理念. 中國呼吸與危重監護雜志, 2020, 19(4): 418-421.
22. Camporota L, Caricola EV, Bartolomeo N, et al. Lung recruitability in severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation. Crit Care Med, 2019, 47(9): 1177-1183.
23. Villar J, Ferrando C, Martínez D, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med, 2020, 8(3): 267-276.

Chinese Journal of Respiratory and Critical Care Medicine

體外膜氧合救治靜脈二甲苯中毒致重度急性呼吸窘迫綜合征患者一例

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