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1例68岁原发性肝癌男性患者因行肝动脉导管化疗输注碘普罗胺30 ml。输注完毕后约20 min,患者突发呼吸困难,血压130/76 mm Hg(1 mm Hg=0.133 kPa),心率136次/min,脉搏血氧饱和度0.80。给予地塞米松10 mg静脉注射。动脉血气分析:pH 7.31,二氧化碳分压34 mm Hg,氧分压69 mm Hg。胸部X线检查示两肺多发斑片状阴影。考虑为碘普罗胺所致非心源性肺水肿。行无创呼吸机辅助通气,并静脉注射呋塞米20 mg。约12 h后患者呼吸困难改善,氧合指数为110。治疗后36 h,改为面罩吸氧,氧合指数上升至132。2 d后采用鼻导管吸氧,氧合指数达175;5 d后氧合指数升至260。约2周后,患者呼吸困难症状消失,动脉血气分析各项指标均正常。
A 68-year-old man with primary liver cancer underwent transcatheter hepatic arterial infusion of iopromide 30 ml. About 20 min after the infusion, the patient developed sudden dyspnea with a blood pressure of 130/76 mm Hg (1 mm Hg = 0.133 kPa), a heart rate of 136 beats / min and a pulse oximetry level of 0.80. Give dexamethasone 10 mg intravenously. Arterial blood gas analysis: pH 7.31, partial pressure of carbon dioxide 34 mm Hg, partial pressure of oxygen 69 mm Hg. Chest X-ray examination showed multiple lung patchy shadow. Consider iopromide-induced non-cardiogenic pulmonary edema. Noninvasive ventilator assisted ventilation and intravenous furosemide 20 mg. The patient’s dyspnea improved after about 12 h with an oxygenation index of 110. 36 h after treatment, the masks were changed to oxygen. After the oxygenation index rose to 132.2 days, the nasal cannula was used to absorb oxygen and the oxygenation index reached 175. The oxygenation index rose to 260 after 5 days. After about 2 weeks, the symptoms of dyspnea disappeared and all the indexes of arterial blood gas analysis were normal.