Sekijima Y, Morita H, Shindo M, Okudera H, Shibata T
Department of Medicine, Shinshu University School of Medicine. Japan.
Rinsho Shinkeigaku. 1995 Nov;35(11):1241-5.
A patient severely poisoned with sarin in the Sarin Attack in Matsumoto is described. A 19-year-old man was exposed to sarin at 23:00 on 27 June, 1994. At 1:00 of the following day, a rescue team found and brought him to the hospital. His blood pressure was 150-80mmHg and the heart rate was 120/min with frequent premature ventricular contractions (PVC). His respiration was shallow and copious salivation and excretion from the respiratory tract were observed. Consciousness disturbance, generalized convulsion, severe miosis and fasciculation of tongue, facial muscle and extremities were also marked. Serum cholinesterase was 21 U/l (normal 109-249) and acetylcholinesterase in erythrocyte (E-AchE) was 0.1U/l (normal 1.2-2.0). Electroencephalogram (EEG) 30 hours after exposure showed polispike and wave complexes. Ventilatory assistance, forced urination and injection of diazepam and atropin improved his general condition and he was discharged 18 days after exposure. Three months after exposure, E-AchE was normalized and there was no complaint. But one year after exposure, EEG showed epilecpic discharges during sleep, and Holter electrocardiogram showed frequent PVC. As no clinical cases of severe sarin poisoning like this patient was reported, a longterm follow-up of this patient is very important.
本文描述了一名在松本沙林毒气袭击事件中严重中毒的患者。一名19岁男性于1994年6月27日23:00接触到沙林毒气。次日1:00，一支救援队伍找到并将他送往医院。他的血压为150 - 80mmHg，心率为120次/分钟，伴有频发室性早搏（PVC）。他呼吸浅促，伴有大量流涎和呼吸道分泌物。意识障碍、全身抽搐、严重瞳孔缩小以及舌、面部肌肉和四肢的肌束震颤也很明显。血清胆碱酯酶为21U/L（正常范围109 - 249），红细胞乙酰胆碱酯酶（E - AchE）为0.1U/L（正常范围1.2 - 2.0）。接触沙林毒气30小时后的脑电图（EEG）显示多棘慢复合波。通过通气辅助、强制排尿以及注射地西泮和阿托品，他的总体状况得到改善，并在接触毒气18天后出院。接触毒气三个月后，E - AchE恢复正常，患者无不适主诉。但接触毒气一年后，脑电图显示睡眠期间有癫痫样放电，动态心电图显示频发PVC。由于此前未报道过像该患者这样严重的沙林中毒临床病例，因此对该患者进行长期随访非常重要。
