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目的总结硫酸气雾吸入中毒性肺水肿患者的临床特点、救治方法及转归。方法对4例硫酸气雾吸入中毒性肺水肿患者的临床表现、胸部CT表现、抢救措施及转归进行回顾性分析。结果 4例硫酸气雾吸入中毒性肺水肿患者中重度中毒2例,中度中毒2例。患者均有咳嗽、咳痰、胸闷、呼吸困难、咽痛、流涕、结膜充血,双肺听诊呼吸音粗糙,其中2例闻及干、湿啰音。心率53~103次/min,未闻及明显病理性杂音。2例患者动脉血氧分压(PaO 2)<60 mm Hg,氧合指数<200 mm Hg。胸部CT检查示双肺弥漫性磨玻璃影2例,双肺散在絮状密度增高影及小结节影2例。2例行肺功能检查者中1例肺功能下降,1例肺功能基本正常。1例患者谷丙转氨酶、谷草转氨酶增高。入院后均给予雾化吸入、支气管舒张剂、氧疗、适当控制液体入量及糖皮质激素等综合治疗,其中2例重度中毒患者气道分泌物较多,予以反复拍背、气道雾化及支气管舒张剂。治疗后患者症状均改善,行PaO 2、肝功能、胸部CT、肺功能检查均未见异常后出院。结论硫酸气雾吸入中毒性肺水肿患者均有咳嗽、咳痰、胸闷、呼吸困难、咽痛、流涕、结膜充血,双肺呼吸音粗糙。胸部CT检查可有弥漫性磨玻璃影或散在絮状密度增高影及小结节影。中度中毒者肺功能可基本正常。重度中毒者谷丙转氨酶、谷草转氨酶可增高。给予保持呼吸道通畅、合理氧疗、糖皮质激素、雾化吸入等综合治疗措施后预后良好。
Objective To summarize the clinical characteristics, treatment and outcome of patients with toxic pulmonary edema induced by sulfuric acid vapor inhalation. Methods The clinical manifestations, thoracic CT findings, rescue measures and prognosis of 4 patients with poisoning pulmonary pulmonary edema induced by sulfuric acid aerosol were retrospectively analyzed. Results In 4 patients with severe poisoning caused by inhalation of sulfuric acid mist in toxic pulmonary edema, 2 cases were moderately poisoned and 2 cases were moderately poisoned. Patients had cough, sputum, chest tightness, difficulty breathing, sore throat, runny nose, conjunctival hyperemia, lung auscultation respiratory sounds rough, of which 2 cases of dry and wet rales. Heart rate 53 ~ 103 times / min, no obvious and pathological murmur. Two patients had PaO 2 <60 mm Hg, and oxygenation index <200 mm Hg. CT chest CT showed diffuse ground glass in 2 cases, double lung scattered in the density of flocculus and small nodules in 2 cases. One of 2 routine pulmonary function tests showed decreased pulmonary function and 1 case of normal pulmonary function. 1 case of alanine aminotransferase, aspartate aminotransferase increased. After admission were given nebulization, bronchodilator, oxygen therapy, appropriate control of fluid intake and glucocorticoid and other comprehensive treatment, including two cases of severe poisoning patients with more airway secretions, to be shot back and airway aerosol And bronchodilator. After treatment, the symptoms of the patients were improved. PaO 2, liver function, chest CT and pulmonary function tests were all discharged without any abnormalities. Conclusion Sulfuric acid inhalation inhalation toxic pulmonary edema in patients with cough, sputum, chest tightness, difficulty breathing, sore throat, runny nose, conjunctival congestion, lung breath sounds rough. Chest CT examination may have diffuse ground glass or loose floc density increases the shadow and nodules. Moderate poisoning may be normal lung function. Severe poisoning alanine aminotransferase, aspartate aminotransferase can be increased. Given to maintain airway patency, reasonable oxygen therapy, glucocorticoid, nebulized inhalation and other comprehensive treatment measures with good prognosis.