Grassin F, André M, Rallec B, Combes E, Vinsonneau U, Paleiron N
Service de pneumologie, hôpital d'instruction des armées, 29240 Brest Armées, France.
Rev Mal Respir. 2011 Sep;28(7):919-23. doi: 10.1016/j.rmr.2011.05.005. Epub 2011 Jul 7.
The new methods of cannabis consumption (home made water pipe or "bang") may be responsible for fatal respiratory complications. We present a case, with fatal outcome, of a man of 19 years with no previous history other than an addiction to cannabis using "bang". He was admitted to intensive care with acute dyspnoea. A CT scan showed bilateral, diffuse alveolar shadowing. He was anaemic with an Hb of 9.3g/l. Bronchoalveolar lavage revealed massive alveolar haemorrhage. Investigations for infection and immunological disorder were negative and toxicology was negative except for cannabis. Antibiotic treatment was given and favourable progress allowed early discharge. Death occurred 15 days later due to alveolar haemorrhage following a further "bang" of cannabis. Autopsy showed toxic alveolar haemorrhage. The probable mechanism is pulmonary damage due to acid anhydrides released by the incomplete combustion of cannabis in contact with plastic. These acids have a double effect on the lungs: a direct toxicity with severe inflammation of the mucosa leading to alveolar haemorrhage and subsequently the acid anhydrides may lead to the syndrome of intra-alveolar haemorrhage and anaemia described in occupational lung diseases by Herbert in Oxford in 1979. It manifests itself by haemoptysis and intravascular haemolysis. We draw attention to the extremely serious potential consequences of new methods of using cannabis, particularly the use of "bang" in homemade plastic materials.
大麻消费的新方式（自制水烟筒或“邦”）可能导致致命的呼吸并发症。我们报告一例19岁男性病例，该患者除了吸食“邦”形式的大麻成瘾外无其他既往病史，最终死亡。他因急性呼吸困难入住重症监护病房。CT扫描显示双侧弥漫性肺泡阴影。他贫血，血红蛋白为9.3g/l。支气管肺泡灌洗显示大量肺泡出血。感染和免疫紊乱检查均为阴性，毒理学检查除大麻外也为阴性。给予抗生素治疗，病情好转后提前出院。15天后，患者在再次吸食“邦”形式的大麻后因肺泡出血死亡。尸检显示中毒性肺泡出血。可能的机制是大麻与塑料接触不完全燃烧释放的酸酐对肺部造成损害。这些酸对肺部有双重作用：直接毒性导致黏膜严重炎症，进而引起肺泡出血，随后酸酐可能导致1979年牛津的赫伯特所描述的职业性肺病中的肺泡内出血和贫血综合征。其表现为咯血和血管内溶血。我们提请注意使用大麻新方式，特别是在自制塑料材料中使用“邦”形式大麻的极其严重的潜在后果。
