Claudet I, Marcoux M-O, Karsenty C, Rittié J-L, Honorat R, Lelong-Tissier M-C
Service d'accueil des urgences pédiatriques, hôpital des Enfants, 330, avenue de Grande-Bretagne, TSA 740034, 31059 Toulouse cedex 09, France.
Ann Fr Anesth Reanim. 2012 Mar;31(3):255-8. doi: 10.1016/j.annfar.2011.12.007. Epub 2012 Feb 3.
We report a paediatric case of survival following severe hydrogen sulfide (H2S) gas intoxication. A 13-year-old boy was found submerged to the neck in a manure tank. He was hypothermic, unresponsive with bilateral mydriasis, and had poor oxygen saturation. After intubation, he was transferred to the paediatric intensive care unit of a tertiary care children's hospital. He developed acute respiratory distress syndrome (ARDS) requiring high frequency percussive ventilation. Cardiac evaluation was significant for myocardial infarction and left ventricular function impairment. He completely recovered from the respiratory and cardiac failure. Neurological examinations showed abnormal signals on MRI in the semi-oval center and in the frontal cortex. Follow-up detected partial impairment of axonal fibers of the right external popliteal sciatic nerve. Paediatric cases of survival after H2S intoxication have been rarely reported. Such exposures can evolve to severe ARDS and benefit from high frequency percussive ventilation. Hypothermia and other metabolic abnormalities are now better explained thanks to actual knowledge about endogenous H2S function. Lessons learned from paediatric accidents should result in better information about this threat for farmers and families living in houses with septic tanks, reducing the risk to their own and their children's safety.
我们报告了一例重度硫化氢（H₂S）气体中毒后存活的儿科病例。一名13岁男孩被发现颈部以下淹没在粪坑中。他体温过低，双侧瞳孔散大且无反应，血氧饱和度低。插管后，他被转至一家三级儿童医院的儿科重症监护病房。他出现了需要高频振荡通气的急性呼吸窘迫综合征（ARDS）。心脏评估显示有心肌梗死和左心室功能损害。他从呼吸和心力衰竭中完全康复。神经学检查显示在半卵圆中心和额叶皮质的MRI上有异常信号。随访发现右腘外坐骨神经轴突纤维部分受损。H₂S中毒后存活的儿科病例鲜有报道。此类暴露可发展为严重ARDS并受益于高频振荡通气。由于对内源性H₂S功能的实际了解，现在对体温过低和其他代谢异常有了更好的解释。从儿科事故中吸取的教训应能让居住在有化粪池房屋中的农民和家庭更好地了解这种威胁，降低对自身及子女安全的风险。
