急性毒鼠强中毒患者临床特征分析

Analysis of clinical manifestation in patients with acute tetramine poisoning

目的分析急性毒鼠强(TEM)中毒的临床特征。方法观察67例急性TEM中毒患者的临床症状、体征及脑电图(EEG)改变,并对其肝功能、心肌酶活力、心电图(ECG)与67名门诊体检人员(对照组)进行动态观察。结果急性TEM中毒患者以恶心、呕吐为主要症状,以抽搐为主要体征;EEG异常率91.0%;肝功能及心肌酶活力在中毒1 d内均不同程度升高,在中毒第3天,丙氨酸转移酶(ALT)、血清总胆红素(TBIL)、天门冬氨酸转移酶(AST)、肌酸磷酸激酶(CPK)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(-αHBDH)、肌酸激酶同工酶(CK-MB)异常率分别为82.1%、56.7%、86.6%、98.5%、94.0%、89.6%、79.1%;轻、中、重度中毒组同期比较,差异有非常显著意义(P<0.001),病情越重,酶活力越高。ECG异常率为49.3%,心肌酶检测明显优于ECG检查。结论急性TEM中毒可引起多脏器损害;但其对机体的损害是可逆的,一般不留后遗症。

Objective To analyse the clinical significance of acute tetramine （TEM） poisoning.Method To observe the clinical symptom, physical sign and EEG changes of 67 patients with acute TEM poisoning, and to take dynamic observations about the hepatic function, activities of myocardial enzymes, ECG of patients between poisoning group and control group.Result Nausea and vomiting were the main symptoms and jerk was the main physical sign in acute TEM poisoning cases.The abnormality rate of EEG was 91.0% . The hepatic function and activities of myocardial enzymes in poisoning group were increased in some degree within the first day. On the thirdday the abnormality rates of ALT, TBIL, AST, CPK, LDH, α-HBDH, CK-MB, were 82.1%, 56.7%, 86.6%, 98.5%, 94.0%, 89.6%, 79.1% respectively. The myocardial enzymes levels of different stages were significant difference in comparative observation of the mild, moderate and serious poisoned patients （ P 〈 0.001）, the more serious, the higher activities of myocardial enzymes. The abnormality rate of ECG was 49.3%. Detection of myocardial enzymes had significant advantage over ECG examination.Conclusion Acute TEM poisoning can bring multi-organ damage. The damage to human body is reversible, and the sequelae are seldom observed.