Gerasimon Gregg, Bennett Steven, Musser Jeffrey, Rinard John
Major, Medical Corps, U.S. Army, Internal Medicine, Womack Army Medical Center, Fort Bragg, North Carolina 28310, USA.
Clin Toxicol (Phila). 2007 May;45(4):420-3. doi: 10.1080/15563650601118010.
INTRODUCTION. Hydrogen sulfide is a lipid-soluble gas produced in occupational settings and from decaying organic matter. We present a 36-year-old man who developed acute respiratory arrest from hydrogen sulfide poisoning while performing work as a dairy farmer.
The subject entered a poorly ventilated tank containing degrading eggs and, within seconds, collapsed. Coworkers were able to extract him within minutes but he was apneic. He was intubated by emergency medical services and subsequently managed with supportive care in the intensive care unit. Upon admission, a powerful rotten egg scent was noted and a hydrogen sulfide poisoning was suspected. Serum analysis for the presence of thiosulfate confirmed the diagnosis. Nitrite therapy was not administered as the subject arrived outside of the therapeutic window of effectiveness and showed evidence of excellent oxygenation. His examinations following arrival were consistent with an anoxic brain injury which slowly improved several months after the incident with intensive neuro-rehabilitation.
Hydrogen sulfide is a mitochondrial toxin and inhibits cytochrome-aa(3) and prevents cellular aerobic metabolism. Therapies for toxic exposures include removal from the contaminated environment, ventilation with 100% oxygen, and nitrite therapy if administered immediately after exposure. Hyperbaric oxygen (HBO) therapy has anecdotal support and remains controversial.
Hydrogen sulfide is a significant occupational health hazard. Education, personal protective equipment, and early treatment are important in improving outcomes.
引言。硫化氢是一种脂溶性气体，在职业环境以及腐烂的有机物中产生。我们报告一名36岁男性，他在从事奶农工作时因硫化氢中毒发生急性呼吸骤停。
该患者进入一个通风不良、装有正在腐烂鸡蛋的罐体，数秒内即倒地。同事们在数分钟内将他救出，但他已无呼吸。紧急医疗服务人员为他进行了插管，随后在重症监护病房进行支持治疗。入院时，闻到一股强烈的臭鸡蛋气味，怀疑为硫化氢中毒。血清硫代硫酸盐分析证实了诊断。由于患者到达时已超出有效治疗窗口且氧合良好，未给予亚硝酸盐治疗。他入院后的检查结果与缺氧性脑损伤相符，经过强化神经康复治疗，数月后病情逐渐好转。
硫化氢是一种线粒体毒素，可抑制细胞色素aa3并阻止细胞有氧代谢。中毒暴露的治疗方法包括脱离污染环境、用100%氧气通气，以及暴露后立即给予亚硝酸盐治疗。高压氧（HBO）治疗有一些传闻支持，但仍存在争议。
硫化氢是一种重大的职业健康危害。教育、个人防护设备和早期治疗对改善预后很重要。
