氧气中毒
氧气中毒 Oxygen toxicity | |
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在1942-1943年,英国政府对潜水员的氧气中毒症状进行了大量的实验。该舱加压至3.7大气压力。图片中间的人正透过面罩呼吸100%浓度的氧气。[1] | |
类型 | 中毒[*] |
分类和外部资源 | |
医学专科 | 急诊医学 |
ICD-10 | T59.8 |
ICD-9-CM | 987.8 |
MeSH | D018496 |
氧气中毒(英语:Oxygen toxicity),是指吸入高浓度高压氧气的不良反应,又称氧气毒性症,氧气毒性。这种症状历史上曾称以发现及描述此病症的19世纪研究员命名,其对中枢神经系统的影响称为保罗·伯特症,对肺的影响则称为劳伦史密斯症。氧气中毒严重时会导致细胞的受损及死亡,多数症状表现在中枢神经系统、肺和眼睛。氧气中毒可能对潜水员、依赖高浓度氧气维生的人(例如早产婴儿)以及进行高压氧疗的人造成威胁。
吸入加压的氧气会导致人体组织中氧含量过高,从而形成高氧症。暴露在高压氧气中的类型不同,人体所受到的影响也不同。人体短时间内暴露在高于大气中氧气分压的氧气中会导致中枢神经系统中毒,长时间或暴露于标准气压下的氧气时则会导致肺部和眼睛中毒。症状可能包括迷失方向、呼吸困难、视力改变(例如近视)。如果更长时间地暴露于氧分压高于标准大气压的氧气中,或者短时间暴露在极高压的氧气中,则会导致细胞膜氧化应激、肺泡萎缩、视网膜脱落以及癫痫发作。氧气中毒的处置方法是减少与高压氧气的接触。有研究表明,长期来说,人体可以在氧气中毒后恢复到健康状态。
避免氧气中毒的医学指南可适用于需要呼吸气体中的氧气分压较高,大于空气中氧气分压的场合,包括使用压缩呼吸气体的潜水员、高压治疗、新生儿护理及载人航天。因为这些医学指南,因氧气中毒造成的癫痫发作越来越少,而肺部及眼睛的损伤主要局限于早产儿护理时才会出现。
近年来,氧气也会用在一些非医疗性应用中,例如氧气吧。美国食品药品监督管理局建议有心脏或肺部疾病的人不要去氧气吧。水肺潜水员会呼吸高浓度的氧气,甚至浓度会到100%,因此需针对使用这类气体进行特别的训练。
分类
[编辑]![The effects of high inspired oxygen pressure: (1) chemical toxicity, pulmonary damage, hypoxemia; (2) retinal damage, erythrocyte hemolysis, liver damage, heart damage, endocrine effects, kidney damage, destruction of any cell; (3) toxic effects on central nervous system, twitching, convulsions, death.](http://upload.wikimedia.org/wikipedia/commons/2/25/Clark1974.png)
氧气中毒可以按受影响对象分为三种主要类型:[2][3][4]
- 中枢神经系统:在高压的情况下抽搐,然后神志不清;
- 肺部:于不停增加压力时呼吸困难和胸部疼痛;
- 眼睛(视网膜病变症状):在高压的情况下眼部特征改变。
中枢神经系统氧气中毒的症状包括癫痫发作、短暂的四肢僵硬并伴有抽搐和神志不清,这对于承受超过大气压的潜水员来说是致命的。肺部氧气中毒会导致肺部受损、呼吸疼痛和呼吸困难。氧气中毒造成的眼部氧化损伤可能导致近视或部分视网膜脱落。在供氧是处置的一步时,特别是对新生儿来说,肺部和眼部的损伤最容易发生,这也是高压氧疗中的一个引人关注的问题。
人体内的任何细胞都可能发生氧化损伤,但其主要影响上述三者。红细胞也可能发生氧化损伤,从而引发溶血反应[5][6]。肝脏[7]、心肌[8]、内分泌腺(肾上腺、生殖腺和甲状腺)[9][10][11]和肾[12]的细胞也会受到氧化损伤的影响。[2][13]
在非正常的情况下,氧气中毒对组织的影响是可视的。有研究怀疑在太空飞行时,高浓度氧气会对骨骼造成损伤[14]。
症状及体征
[编辑]暴露时间(分钟) | 人数 | 症状 |
---|---|---|
96 | 1 | 严重头晕肌肉痉挛、呕吐 |
60–69 | 3 | 嘴唇抽动、不舒适恶心眩晕、手臂抽动 |
50–55 | 4 | 严重嘴唇抽动、眩晕、呓语、嗜睡 |
31–35 | 4 | 恶心眩晕、嘴唇身体抽动 |
21–30 | 6 | 身体抽动、疲劳、 严重嘴唇抽动、上腹癫痫、失忆 |
16–20 | 8 | 身体抽动、眩晕、上腹癫痫、 呼吸急促 |
11–15 | 4 | 呼吸控制、嘴唇抽动、昏迷、恶心、头脑混乱 |
6–10 | 6 | 眩晕、嘴唇抽动、痒灼感、严重恶心、打嗝 |
原因
[编辑]人体当暴露在氧气分压大于大气中的氧气分压的氧气中时,就可能引起氧气中毒。氧气中毒主要发生在以下三种情况中:潜水、高压氧疗以及提供额外氧气的时候(特别是对新生儿而言)。各情况下的危险因素都有显著的不同。
中枢神经系统毒性
[编辑]潜水员和进行高压氧疗的患者最可能暴露在超过160千帕斯卡的氧气分压(约为标准大气中氧气分压的八倍)的氧气中数分钟至数小时不等,而这常常与中枢神经系统中毒有关。因为海平面大气压通常只有约100千帕斯卡,中枢神经系统中毒可以只发生在外界压力比通常情况高的高压氧治疗的情况下。[15][16] 在60米水深下呼吸氧气的潜水员面临着氧气中毒“冲击”(癫痫发作)的危险。当潜水员在较浅的深度下吸入高氧气体等混入氧气的混合气体时,类似情况也可能发生。潜水员只有在最大工作水深下才能吸入这类混合物。[17]
![Pulmonary toxicity tolerance curves. Refer to caption.](http://upload.wikimedia.org/wikipedia/commons/thumb/0/04/Pulmonary_toxicity_tolerance_curves.svg/400px-Pulmonary_toxicity_tolerance_curves.svg.png)
参见
[编辑]参考资料
[编辑]- ^ 1.0 1.1 Donald, Part I 1947.
- ^ 2.0 2.1 Clark & Thom 2003,第358–360页.
- ^ Acott, Chris. Oxygen toxicity: A brief history of oxygen in diving. South Pacific Underwater Medicine Society Journal. 1999, 29 (3): 150–5 [2008-04-29]. ISSN 0813-1988. OCLC 16986801. (原始内容存档于2010-12-25).
- ^ Beehler, CC. Oxygen and the eye. Survey of Ophthalmology. 1964, 45: 549–60. PMID 14232720.
- ^ Goldstein, JR; Mengel, CE. Hemolysis in mice exposed to varying levels of hyperoxia. Aerospace Medicine. 1969, 40 (1): 12–13. PMID 5782651.
- ^ Larkin, EC; Adams, JD; Williams, WT; Duncan, DM. Hematologic responses to hypobaric hyperoxia. American Journal of Physiology. 1972, 223 (2): 431–7. PMID 4403030.
- ^
Schaffner, Fenton; Felig, Philip. CHANGES IN HEPATIC STRUCTURE IN RATS PRODUCED BY BREATHING PURE OXYGEN (PDF). Journal of Cell Biology. 1965, 27 (3): 505–17. PMC 2106769
. PMID 5885427. doi:10.1083/jcb.27.3.505.
- ^ Caulfield, JB; Shelton, RW; Burke, JF. Cytotoxic effects of oxygen on striated muscle. Archives of Pathology. 1972, 94 (2): 127–32. PMID 5046798.
- ^ Bean, JW; Johnson, PC. Adrenocortical response to single and repeated exposure to oxygen at high pressure. American Journal of Physiology. 1954, 179 (3): 410–4. PMID 13228600.
- ^ Edstrom, JE; Rockert, H. The effect of oxygen at high pressure on the histology of the central nervous system and sympathetic and endocrine cells. Acta Physiologica Scandinavica. 1962, 55 (2–3): 255–63. PMID 13889254. doi:10.1111/j.1748-1716.1962.tb02438.x.
- ^ Gersh, I; Wagner, CE. Metabolic factors in oxygen poisoning. American Journal of Physiology. 1945, 144 (2): 270–7.
- ^ Hess, RT; Menzel, DB. Effect of dietary antioxidant level and oxygen exposure on the fine structure of the proximal convoluted tubules. Aerospace Medicine. 1971, 42 (6): 646–9. PMID 5155150.
- ^ Clark, John M. The toxicity of oxygen. American Review of Respiratory Disease. 1974, 110 (6 Pt 2): 40–50 [2017-05-17]. PMID 4613232. (原始内容存档于2021-02-26). (subscription required)
- ^ Patel, Dharmeshkumar N; Goel, Ashish; Agarwal, SB; Garg, Praveenkumar; Lakhani, Krishna K. Oxygen toxicity (PDF). Journal, Indian Academy of Clinical Medicine. 2003, 4 (3): 234–237 [2008-09-28]. (原始内容 (PDF)存档于2015-09-22).
- ^ Smerz, RW. Incidence of oxygen toxicity during the treatment of dysbarism. Undersea and Hyperbaric Medicine. 2004, 31 (2): 199–202 [2008-04-30]. PMID 15485081. (原始内容存档于2011-05-13).
- ^ Hampson, Neal B; Simonson, Steven G; Kramer, CC; Piantadosi, Claude A. Central nervous system oxygen toxicity during hyperbaric treatment of patients with carbon monoxide poisoning. Undersea and Hyperbaric Medicine. 1996, 23 (4): 215–9 [2008-04-29]. PMID 8989851. (原始内容存档于2011-05-14).
- ^ Lang 2001,第7页.
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[编辑]- Clark, James M; Thom, Stephen R. Oxygen under pressure. Brubakk, Alf O; Neuman, Tom S (编). Bennett and Elliott's physiology and medicine of diving 5th. United States: Saunders. 2003: 358–418. ISBN 978-0-7020-2571-6. OCLC 51607923.
- Clark, John M; Lambertsen, Christian J. Pulmonary oxygen tolerance in man and derivation of pulmonary oxygen tolerance curves. IFEM Report No. 1-70 (Philadelphia, PA: Environmental Biomedical Stress Data Center, Institute for Environmental Medicine, University of Pennsylvania Medical Center). 1970 [2008-04-29]. (原始内容存档于2008-10-07).
- Donald, Kenneth W. Oxygen Poisoning in Man: Part I. British Medical Journal. 1947, 1 (4506): 667–672. PMC 2053251
. PMID 20248086. doi:10.1136/bmj.1.4506.667.
- Donald, Kenneth W. Oxygen Poisoning in Man: Part II. British Medical Journal. 1947, 1 (4507): 712–717. PMC 2053400
. PMID 20248096. doi:10.1136/bmj.1.4507.712.
- Revised version of Donald's articles also available as:
- Donald, Kenneth W. Oxygen and the diver. UK: Harley Swan, 237 pages. 1992. ISBN 1-85421-176-5. OCLC 26894235.
- Hamilton, Robert W; Thalmann, Edward D. Decompression practice. Brubakk, Alf O; Neuman, Tom S (编). Bennett and Elliott's physiology and medicine of diving 5th. United States: Saunders. 2003: 475–479. ISBN 978-0-7020-2571-6. OCLC 51607923.
- Lang, Michael A (编). DAN nitrox workshop proceedings. Durham, NC: Divers Alert Network, 197 pages. 2001 [2008-09-20]. (原始内容存档于2008-10-24).
- Regillo, Carl D; Brown, Gary C; Flynn, Harry W. Vitreoretinal Disease: The Essentials. New York: Thieme, 693 pages. 1998. ISBN 978-0-86577-761-3. OCLC 39170393.
- U.S. Navy Supervisor of Diving. U.S. Navy Diving Manual (PDF). SS521-AG-PRO-010 0910-LP-106-0957, revision 6 with Change A entered. U.S. Naval Sea Systems Command. 2011 [2015-01-29]. (原始内容 (PDF)存档于2014-12-10).
拓展阅读
[编辑]- Lamb, John S. The Practice of Oxygen Measurement for Divers. Flagstaff: Best Publishing, 120 pages. 1999. ISBN 0-941332-68-3. OCLC 44018369.
- Lippmann, John; Bugg, Stan. The Diving Emergency Handbook. Teddington, UK: Underwater World Publications. 1993. ISBN 0-946020-18-3. OCLC 52056845.
- Lippmann, John; Mitchell, Simon. Oxygen. Deeper into Diving 2nd. Victoria, Australia: J.L. Publications. 2005: 121–4. ISBN 0-9752290-1-X. OCLC 66524750.
外部链接
[编辑]General
The following external site is a compendium of resources:
- Rubicon Research Repository. – Online collection of the oxygen toxicity research
Specialised
The following external sites contain resources specific to particular topics:
- 2008 Divers Alert Network Technical Diving Conference (页面存档备份,存于互联网档案馆). – Video of "Oxygen Toxicity" lecture by Dr. Richard Vann (free download, mp4, 86MB).
- MCG生理学 4/4ch7/s4ch7_7. – Wide and detailed discussion of the effects of breathing oxygen on the respiratory system.
- Rajiah, Prabhakar. Bronchopulmonary Dysplasia. eMedicine. 2009-03-11 [2009-06-29]. (原始内容存档于2009-06-14). – Concise clinical overview with extensive references.
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