董莘哲

【摘要】  2023年8月24日日照市人民医院收治的2例急性溴甲烷中毒患者，虽辅助检查无特异性，但有明确的溴甲烷接触史，诊断较明确。1例患者症状较重，病情迅速恶化，救治2月后死亡；另1例神志模糊、频发肢体抽搐，给予抗癫痫等治疗。急性溴甲烷中毒主要损害呼吸系统及神经系统，可能遗留严重后遗症甚至死亡。其致病机制尚不明确，尚无特效药治疗。目前以对症支持治疗为主，尽早脱离中毒环境是治疗的关键。

【关键词】  急性溴甲烷中毒；临床表现；辅助检查；治疗；预后

中图分类号  R595   文献标识码  A    文章编号  1671-0223（2024）13--03

Two case studies with clinical treatments for acute methyl bromide intoxication Dong Shenzhe. Nerve Electrophysiology Room， Rizhao People's Hospital， Rizhao 276800， China

【Abstract】   To review the clinical characteristics， treatment and prognosis of 2 patients with acute methyl bromide intoxication treated in our hospital on August 24，2023. Although there were no specificity in the examinations， 2 patients had a clear history of exposure to methyl bromide， and the diagnosis was definite.One patient had severe symptoms， his condition deteriorated rapidly， and died 2 months later.The other case had blurred consciousness and frequent limb convulsions， we give him treatment to control epilepsy.Acute methyl bromide intoxication often destroy humans respiratory system and neurological system，and may leave serious sequelae and even death.The mechanism of acute methyl bromide intoxication has not been elucidated and there is no targeted medicine.At present， the main treatment is symptomatic support， and getting out of toxic environment as early as possible is the key to treatment.

【Key words】  Acute methyl bromide intoxication; Clinical characteristics; Accessory examination; Therapy; Prognosis

溴甲烷又名溴代甲烷或甲基溴，是一种无色、略带甜味的液体，极易挥发，渗透力及扩散力强，其蒸汽较空气重。主要用作熏蒸消毒剂、化工原料等。溴甲烷中毒在国内外报道均不多见，近年来，由于技术的改善，人们预防观念的提高，溴甲烷中毒病例报道更是明显减少。国内缺乏对此类疾病的文献报道或相关研究，对治疗效果及预后的了解匮乏。现将日照市人民医院收治的2例急性溴甲烷中毒患者的临床资料及诊治情况报告如下，提高对急性溴甲烷中毒的认识。

1  病历报告

1.1  病例1

患者男，47岁，于2023-8-24 8：40左右进入密闭船舱后昏迷倒地，9：30送至医院，期间出现3次心脏骤停。入院时无自主呼吸，予气管插管接呼吸机辅助通气，收入重症监护室。

1.1.1  入院查体  神志昏迷，双侧瞳孔直径7mm，对光反射消失，颈软，四肢软瘫，深浅反射消失。双肺呼吸音粗，心音弱。

1.1.2  辅助检查  血常规：C-反应蛋白（CRP）314.35mg/L，血红蛋白（Hb）52g/L，白细胞（WBC）91.89x109/L，中性细胞87.93x109/L。……