硫芥末(SM)是一种起泡的化学战剂,在第一次世界大战和伊拉克-伊朗冲突中使用。本文的目的是根据我们的临床和研究经验,讨论并批判性地回顾已发表的治疗SM中毒的实验结果。受害者必须立即离开污染区域。净化的最佳解决方案是大量的水,使用中性肥皂和0.5%的次氯酸钠。严重中毒的患者应根据先进的生命支持方案和呼吸系统疾病和化学烧伤的重症监护治疗进行治疗。硫代硫酸钠输注(100-500mg/kg/min)应在SM暴露后60分钟开始。然而,推荐使用N-乙酰半胱氨酸(NAC),它们都不是特异性或有效的解毒剂。SM引起的肺损伤的重要保护性和保守治疗包括湿化氧气,支气管扩张剂,NAC作为粘液,补液,机械通气,根据临床指示适当的抗生素和呼吸物理治疗。急性SM眼部病变的治疗从局部抗生素开始;最好是舒法西胺滴眼液,继续使用润滑剂,和人造眼泪。皮肤损伤的治疗包括:湿敷料;最好用磺胺嘧啶银乳膏,镇痛药,止痒,物理清创,清创酶,激光清创术,然后根据临床指示进行皮肤自体分裂厚度治疗。新建议的药物和治疗方法包括:抗炎药,烟酰胺,西利宾,钙调蛋白拮抗剂,氯倍他索,全层皮肤移植治疗皮肤损伤;强力霉素;贝伐单抗,和秋水仙碱用于眼外伤。基于动物研究的推荐化合物包括烟酰胺,抑肽酶,去天冬氨酸-血管紧张素-I,γ-谷氨酰转移酶,维生素E,和维生素D。体外研究表明,二甲基硫脲,L-硝基精氨酸,甲酯,丙酮酸钠,丁基羟基茴香醚,乙丙炔酸,大环内酯类抗生素是有效的。然而,没有一个,除大环内酯类抗生素已被临床证实。建议避免不适当的多重用药。
Sulfur mustard (SM) is a blistering chemical warfare agent that was used during the World War I and in the Iraq-Iran conflict. The aim of this paper is to discuss and critically
review the published results of experiments on the treatment of SM poisoning based on our clinical and research experience. The victims must remove from the contaminated zone immediately. The best solution for decontamination is large amounts of water, using neutral soap and 0.5% sodium hypochlorite. Severely intoxicated patients should be treated according to advanced life support protocols and intensive care therapy for respiratory disorders and the chemical burn. Sodium thiosulfate infusion (100-500 mg/kg/min) should be started up to 60 min after SM exposure. However, N-acetyle cysteine (NAC) is recommended, none of them acts as specific or effective antidote. The important protective and conservative treatment of SM-induced pulmonary injuries include humidified oxygen, bronchodilators, NAC as muculytic, rehydration, mechanical ventilation, appropriate antibiotics and respiratory physiotherapy as clinically indicated. Treatment of acute SM ocular lesions start with topical antibiotics; preferably sulfacetamide eye drop, continue with lubricants, and artificial tears. Treatment for cutaneous injuries include: moist dressing; preferably with silver sulfadiazine cream, analgesic, anti-pruritic, physically debridement, debridase, Laser debridement, followed by skin autologous split-thickness therapy as clinically indicated. The new suggested medications and therapeutic approaches include: anti-inflammatory agents, Niacinamide, Silibinin, Calmodulin antagonists, Clobetasol, full-thickness skin grafting for skin injuries; Doxycycline; Bevacizumab, and Colchicine for ocular injuries. Recommended compounds based on animal studies include Niacinamide, Aprotinin, des-aspartate-angiotensin-I, Gamma-glutamyltransferase, vitamin E, and vitamin D. In vitro studies revealed that Dimethylthiourea, L-nitroarginine, Methyl-ester, Sodium pyruvate, Butylated hydroxyanisole, ethacrynic acid, and macrolide antibiotics are effective. However, none of them, except macrolide antibiotics have been proved clinically. Avoidance of inappropriate polypharmacy is advisable.