Resolution of Acute Priapism in Two Children With Sickle Cell Disease Who Received Nitrous Oxide.
Resolution of Acute Priapism in Two Children With Sickle Cell Disease Who Received Nitrous Oxide.
复制标题
两名接受一氧化二氮治疗的镰状细胞病儿童的急性阴茎勃起得到解决。
DOI：
10.1111/acem.13822
复制
发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Morris,ClaudiaR
中科院分区：
文献类型：
--
作者：
Greenwald,MichaelH;Gutman,ColleenK;Morris,ClaudiaR
背景一氧化二氮（N O）是一种吸入性药物，具有抗焦虑、健忘、强效扩张性和轻至中度镇痛特性，常用于急诊科（ED）。N2O起效快（<5分钟），恢复快（<5分钟），无需静脉注射即可快速滴定。它几乎没有副作用，不需要肾脏或肝脏代谢排泄，也没有过敏反应的报道。阴茎勃起障碍是镰状细胞病（SCD）的严重并发症，影响约35%的男性，对生活质量产生不利影响。治疗选择有限且无证据依据，包括水合、碱化、镇痛、氧合以防止进一步镰状细胞坏死和换血。4小时内无反应的患者通常需要进行痛苦的侵入性手术，包括从海绵体抽血和注射苯肾上腺素。病例报告描述了口服伪麻黄碱、西地那非和静脉注射精氨酸的治疗效果，但缺乏对照临床试验。虽然在法国，通常使用50:50的氧化亚氮/氧气混合物来增强对静脉注射吗啡没有充分反应的SCD和血管闭合性疼痛事件（VOE）患者的镇痛作用，但没有使用它来治疗阴茎勃起的报道。我们描述了N2O对儿童ED中SCD相关的急性阴茎勃起功能障碍的治疗效果。方法：这是一个由两名患有Hb - SS的青春期男孩组成的病例系列，他们在3个不同的场合向ED提出急性阴茎勃起功能障碍，口服治疗（伪麻黄碱和阿片类药物）失败。N2O气体用于帮助静脉置管。结果在每次出现时（患者1为8岁和10岁，患者2为15岁），患者在接受N2O治疗后4 - 15分钟内阴茎勃起完全消退（最多60%）。患者在每次出现后都从急诊科出院，在随后的一周内没有复发。结论痉挛是SCD的一种具有挑战性的并发症，与长期发病率和治疗方案的缺乏有关。阿片类药物是常用的。考虑到目前推荐的治疗方法的风险和不一致的结果，N2O可能是一种潜在的阿片类药物节约治疗ED勃起障碍的选择，值得进一步研究。虽然坊间传闻，但在治疗急诊科医生可能没有其他选择时，吸入一氧化二氮是一种可以考虑的干预措施。
BackgroundNitrous oxide (N O) is an inhalational medication that has anxiolytic, amnestic, potent venodilatory and mild‐to‐moderate analgesic properties commonly used in the emergency department (ED) setting. N2O has a rapid onset of action (<5 minutes) and recovery (<5 minutes) and can be quickly titrated to effect without the need for IV access. It has few side effects, does not require renal or hepatic metabolism for excretion and has no reports of allergic reaction. Priapism is a serious complication of sickle cell disease (SCD) affecting approximately 35% of males, with an adverse impact on quality of life. Treatment options are limited and not evidence based, including hydration, alkalization, analgesia, oxygenation to prevent further sickling, and exchange transfusion. Patients who do not respond within 4 hours often require a painful invasive procedure that includes aspiration of blood from the corpus cavernosum and phenylephrine injections. Case reports have described a therapeutic benefit from oral pseudoephedrine, sildenafil, and intravenous (IV) arginine, however controlled clinical trials are lacking. Although a 50:50 nitrous oxide/oxygen mix is commonly used in France to enhance analgesia in patients with SCD and vasoocclusive pain events (VOE) not sufficiently responding to IV morphine, there are no reports of its use to treat priapism. We describe the effects of N2O for the treatment of acute priapism associated with SCD in a pediatric ED.MethodsThis is a case series of two adolescent boys with Hb‐SS who on 3 separate occasions presented to the ED with acute priapism that failed oral therapy (pseudoephedrine and opioids). N2O gas was utilized to help facilitate IV catheter placement.ResultsIn each presentation (at ages 8 and 10 years for patient 1; age 15 years for patient 2), the patient experienced complete resolution of the priapism within 4‐15 min of receiving N2O (max 60%). The patients were discharged from the ED following each presentation and had no recurrence during the subsequent week.ConclusionsPriapism is a challenging complication of SCD associated with long‐term morbidity and a paucity of treatment options. Opioids are commonly used. Given the risks and inconsistent results of current recommended therapy, N2O may represent a potential opioid‐sparing treatment option for priapism presenting to the ED that warrants further investigation. Although anecdotal, N2O inhalation is an intervention to consider during a time when a treating ED physician may have few alternatives.