笑气中毒致神经系统损害6例临床分析及康复治疗

程冰苑 王蓓 罗文鑫 周雨萍 屈妍 刘迟

摘 要 目的：分析笑气中毒导致神经系统损害的临床特点及康复治疗。方法：回顾6例笑气中毒致神经系统损害患者的诊疗过程，检索国内外文献进行分析与总结。结果：6例患者中，急性中毒者1例，表现为短暂性意识障碍合并呼吸困难，伴四肢麻木和无力；5例患者为慢性中毒，表现为四肢麻木和/或无力。血液学检查同型半胱氨酸（Hcy）升高4例，维生素B12水平下降2例。颈髓MRI及肌电图检查提示异常。停止接触笑气，补充叶酸和维生素B12，联合康复治疗，完全治愈1例，好转5例。结论：笑气中毒患者以脊髓损害和周围神经损害症状为主；Hcy升高是维生素B12缺乏的敏感指标，MRI和肌电图检查有助于诊断；停吸笑气、大量维生素B12给药联合康复治疗对这种神经病的治疗有效。

关键词 笑气 中毒 神经系统损害 康复治疗

中图分类号：R595.5 文献标志码：B 文章编号：1006-1533（2021）11-0041-04

Clinical analysis and rehabilitation therapy of 6 cases of nervous system damage induced by nitrous oxide

CHENG Bingyuan1*， WANG Bei2， LUO Wenxing3， ZHOU Yuping3， QU Yan4， LIU Chi5**

（1. Department of Rehabilitation Medicine； 2. Department of Neurology； 3. Department of General Medicine； 4. Department of Gastroenterology； 5. Department of Geriatrics Center， the Centre Hospital of Jingan District， Fudan University， Shanghai 200040， China）

ABSTRACT Objective： To investigate the clinical characteristics and rehabilitation methods of nervous system disorder caused by nitrous oxide （N2O） intoxication. Methods： The diagnosis and treatment process for 6 patients with nervous system damage caused by N2O were retrospectively reviewed， and meanwhile analyzed and summarized by retrieval of related literature. Results： One patient was acute intoxication， manifested as temporary disturbance of consciousness with dyspnea， limb numbness and weakness and the others were chronic intoxication， limb numbness and/or weakness. Homocysteine increased in 4 patients， vitamin B12 levels decreased in 2 patients. Abnormal signals were shown in cervical spinal cord MRI and electromyography. One patient was completely cured and the others were improved after exposure to N2O was stopped， vitamin B12 was supplemented and rehabilitation therapy was implemented. Conclusion： The main symptoms of N2O poisoning are spinal cord injury and peripheral nerve damage. The rise of serum homocysteine is a sensitive indicator for vitamin B12 deficiency. MRI and electromyography are helpful for diagnosis. Cessation of exposure to N2O， administration of large doses of vitamin B12 and implementation of rehabilitation therapy are effective for the treatment of such neuropathy.

KEy WORDS nitrous oxide； intoxication； nervous system damage； rehabilitation therapy

笑氣，学名一氧化二氮（nitrous oxide，N2O），是一种无色、味甜、无刺激性的气体。N2O应用广泛，临床上因其短暂麻醉作用而被应用于麻醉诱导或其他全身麻醉药的辅助用药[1]。近年来，吸食笑气因可获得精神上短暂的快感而开始逐渐在年轻人群中流行起来，但大量吸食笑气可引发贫血、神经损害，长期大量接触则可能导致窒息、瘫痪等严重症状[2]。近几年过量吸食笑气的病例增长，本研究回顾性分析上海市静安区中心医院于2016年1月—2019年12月收治的6例笑气中毒病例，分析临床特点并总结康复治疗，供临床工作者参考。……