体外膜氧合救治静脉二甲苯中毒致重度急性呼吸窘迫综合征患者一例_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

丁媛 , 包万员 , 王瑰 , 施晓婷 , 刘宁 ,  朱滨

苏州大学附属第三医院重症医学科（江苏常州 213003）;

Corresponding author：

朱滨, Email: drzhubin@126.com

Keywords：

二甲苯中毒; 静脉注射; 急性呼吸窘迫综合征; 体外膜氧合

DOI：

10.7507/1671-6205.202209058

Video：

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目的总结静脉二甲苯中毒患者的临床特点、治疗、预后和体外膜氧合（extracorporeal membrane oxygenation，ECMO）救治重症中毒患者的经验。方法回顾分析我院重症医学科收治的1例静脉注射二甲苯后出现重度急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）患者的资料。以“xylene”和“acute poisoning”以及“苯”或“二甲苯”和“中毒”为检索词分别在PubMed以及中国知网、万方数据库中检索，并复习相关文献。结果患者男，30岁，静脉注射二甲苯出现重度ARDS，在ECMO支持下经过积极治疗成功出院，预后良好。检索数据库中仅有3篇国外报道描述了苯类化合物静脉注射中毒的病例，这是国内第1例二甲苯静脉中毒的报道，也是二甲苯中毒运用ECMO治疗的首例报道。结论静脉苯类化合物中毒患者可出现严重的呼吸衰竭，且为首发症状之一，早期积极治疗，临床预后较好，ECMO为这类患者提供了一种救治手段。

Citation： 丁媛, 包万员, 王瑰, 施晓婷, 刘宁, 朱滨. 体外膜氧合救治静脉二甲苯中毒致重度急性呼吸窘迫综合征患者一例. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(1): 52-56. doi: 10.7507/1671-6205.202209058 Copy

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2.	中国心胸血管麻醉学会, 中华医学会麻醉学分会, 中国医师协会麻醉学医师分会, 等. 不同情况下成人体外膜肺氧合临床应用专家共识(2020版). 中国循环杂志, 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.	马瑞敏, 李怡华, 叶俏. 苯中毒文献计量与热点可视化分析. 中华劳动卫生职业病杂志, 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.	Ševčik P, Hep A, Pešlová 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.	曹艳梅, 蒋欣宇, 闵春燕, 等. 急性甲苯和二甲苯及乙苯中毒后遗症1例. 中华劳动卫生职业病杂志, 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.	钱颖, 谢永鹏, 沈叶菊, 等. 以机械功为导向的急性呼吸窘迫综合征机械通气新理念. 中国呼吸与危重监护杂志, 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. 中国心胸血管麻醉学会, 中华医学会麻醉学分会, 中国医师协会麻醉学医师分会, 等. 不同情况下成人体外膜肺氧合临床应用专家共识(2020版). 中国循环杂志, 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. 马瑞敏, 李怡华, 叶俏. 苯中毒文献计量与热点可视化分析. 中华劳动卫生职业病杂志, 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. Ševčik P, Hep A, Pešlová 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. 曹艳梅, 蒋欣宇, 闵春燕, 等. 急性甲苯和二甲苯及乙苯中毒后遗症1例. 中华劳动卫生职业病杂志, 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. 钱颖, 谢永鹏, 沈叶菊, 等. 以机械功为导向的急性呼吸窘迫综合征机械通气新理念. 中国呼吸与危重监护杂志, 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

体外膜氧合救治静脉二甲苯中毒致重度急性呼吸窘迫综合征患者一例

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