吸入硝酸气体引起的急性呼吸窘迫综合征1例报道并文献复习

Acute Respiratory Distress Syndrome Caused by Inhalation of Nitric Acid Gas: A Case Report and Literature Review

摘要: 目的：急性呼吸窘迫综合征是重症监护病房的常见疾病，病因复杂且死亡率极高，目前暂无特效的治疗方法。方法：回顾性分析1例因吸入硝酸气体致重症急性呼吸窘迫综合征患者的病史资料、临床表现、实验室检查结果及治疗转归，并进行相关文献复习。结果：患者中年男性，因“持续吸入硝酸气体1.5 h后出现胸闷憋喘33 h”入院。于当地医院给予相应对症治疗后症状未见好转且呼吸困难加重，遂行气管插管，机械通气。后转入我院。诊断方法为胸部CT和血气分析。治疗方法包括给予每日纤支镜灌洗，加强液体管理负平衡。药物上给予西维来司他钠减少肺内渗出，给予甲强龙抗炎，哌拉西林/他唑巴坦钠抗感染治疗。临床转归：患者拔出气管插管，临床症状消失，影像学完全吸收。

Abstract: Objective: Acute respiratory distress syndrome (ARDS) is a common disease in intensive care unit (ICU). The etiology is complex and with a higher mortality rate, there is no effective treatment for it. Methods: We reviewed a case of severe acute respiratory distress syndrome caused by inhalation of nitric acid gas, analyzing the medical history, clinical manifestations, laboratory findings, and treatment outcome, and carried out a literature review. Results: The patient, a middle-aged male, was admitted to the hospital due to “chest tightness and dyspnea for 33 hours after continuous in-halation of nitric acid gas for 1.5 hours”, after some symptomatic treatment in the local hospital, the symptoms did not improve and dyspnea worsened, endotracheal intubation and mechanical venti-lation were performed, and was transferred to our hospital for further treatment. The diagnostic methods were chest CT and blood gas analysis. Treatment methods involved daily fiberoptic bron-choscopy lavage therapy, strengthening negative liquid balance management. Sivelestat sodium was given to reduce pulmonary exudation, methylprednisolone to prevent inflammation, and pipe-racillin/tazobactam sodium to prevent infection. Clinical Outcome: The patient pulled out the tra-cheal intubation, clinical symptoms disappeared, and the pulmonary imaging was completely ab-sorbed.