背景:亚硝酸钠中毒的常见原因已从以前因接触或摄入受污染的水和食物而导致的意外中毒转变为最近令人震惊的故意中毒,这是一种自杀/退出的方法。高铁血红蛋白(MetHb)的后续形成限制了体内氧气的运输和利用,导致组织水平的功能性缺氧。在临床实践中,紫蓝色外观和氧分压的不匹配通常有助于鉴定高铁血红蛋白血症。及时识别特征不匹配和准确诊断亚硝酸钠中毒是实施规范化系统干预措施的前提。
方法:1名孕妇入院前2h因意识障碍和嗜睡进入哈尔滨医科大学附属第一医院重症医学科。随后,她出现呕吐和紫红色皮肤。那个女人接受了气管插管,有创机械通气(IMV),并纠正ICU内环境紊乱。她的早产儿出生时的MetHb水平高于正常水平,为3.3%,接受了亚甲蓝和维生素C的解毒,补充维生素K1,输注新鲜冷冻血浆,以及通过气管插管和IMV的呼吸支持。入院后第3天,产妇恢复了意识,疏散了IMV,并恢复肠内营养。24小时后,她被转移到产科病房。入院后第7天,该名女子康复并出院,没有任何后遗症。
结论:MetHb可以穿过胎盘屏障。MetHb水平既反映了亚硝酸钠中毒的严重程度,又可作为治疗效果的反馈。
BACKGROUND: The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of suicide/exit. The subsequent formation of methemoglobin (MetHb) restricts oxygen transport and utilization in the body, resulting in functional hypoxia at the tissue level. In clinical practice, a mismatch of cyanotic appearance and oxygen partial pressure usually contributes to the identification of
methemoglobinemia. Prompt recognition of characteristic mismatch and accurate diagnosis of sodium nitrite poisoning are prerequisites for the implementation of standardized systemic interventions.
METHODS: A pregnant woman was admitted to the Department of Critical Care Medicine at the First Affiliated Hospital of Harbin Medical University due to consciousness disorders and drowsiness 2 h before admission. Subsequently, she developed vomiting and cyanotic skin. The woman underwent orotracheal intubation, invasive mechanical ventilation (IMV), and correction of internal environment disturbance in the ICU. Her premature infant was born with a higher-than-normal MetHb level of 3.3%, and received detoxification with methylene blue and vitamin C, supplemental vitamin K1, an infusion of fresh frozen plasma, as well as respiratory support via orotracheal intubation and IMV. On day 3 after admission, the puerpera regained consciousness, evacuated the IMV, and resumed enteral nutrition. She was then transferred to the maternity ward 24 h later. On day 7 after admission, the woman recovered and was discharged without any sequelae.
CONCLUSIONS: MetHb can cross through the placental barrier. Level of MetHb both reflects severity of the sodium nitrite poisoning and serves as feedback on therapeutic effectiveness.