189例儿童急性中毒的临床诊断与治疗

Diagnosis and treatment of acute poisoning in 189 children

目的 探讨儿童急性中毒的诊断与治疗评价,分析儿科临床急性中毒的原因。方法 应用荧光偏振免疫法(FPIA)或气相色谱-质谱联用方法(GC／MS)定性定量分析中毒物质,采用血液灌流法(HP)治疗中毒患儿,调查189例急性中毒儿童的年龄、中毒物质及其原因。结果 189例儿童急性中毒者,应用FPIA定量测定的20例(11％);应用GC／MS定性鉴别的101例(53％)。189例中抢救成功173例(92％),死亡16例(8％);必须采用HP治疗的17例。灭鼠药中毒的危重患儿全部抢救成功,有效率100％。1-7岁患儿130例(70％)为儿童急性中毒的高发期;引起儿童急性中毒的物质有化学药品68例(36％)、中药4例(2％)、有机物类121例(59％),其中农药和灭鼠药中毒的患儿101例(90％,101／112),以及食物源性5例(3％);急性中毒的原因是医源性药物中毒22例(12％)、患儿家属自行或不遵医嘱用药38例(20％)、患儿偷食家人药品或其它物质12例(6％)、食物源性5例(3％)、毒物污染环境或食物引起中毒112例(59％)。结论 FPIA定量测定和GC／MS定性鉴别,在儿童急性中毒的临床诊断和治疗评价中有非常的意义;HP为治疗灭鼠药中毒危重患儿的有效手段。预防儿童各种意外中毒应引起人们的高度重视。

OBJECTIVE: To study the diagnosis and treatments of acute poisoning in children, and to investigate their causes. METHODS: The blood drug concentrations were monitored by fluorescence polarization immunoassay (FPIA). The liquid of washing stomach were analyzed by gas chromatography - mass spectrometry (GS/MS). The patients were treated with hemoperfusion (HP). The age, sex, poisoning substances and reasons, and diagnosis and treatments of the patients were analyzed. RESULTS: Biosamples from 20 cases (11%) and 101 cases (53%) of the 189 cases were analyzed by FPIA and GC/MS, respectively. The rates of treatment effectiveness and mortality were 92% (173/189) and 8% (16/189), respectively. 17 severe cases were saued successfully by HP. The acute poisoning accident most frequently occurred in children aged 1-7 years (130/189). The poisoning substances were pharmaceutics 36% (68/189), Chinese herb 2% (4/189), organic substances 59% (121/189) and food 3% (5/189). The accidents were caused by medicine-toxication 12% (22/189), self-medication or disobedience 20% (38/189), taking drugs or other substance on the sly 6%(12/189), environment or food pollution 59% (112/ 189) or food 3% (5/189). CONCLUSION: The results showed that it is very important to qualitatively and quantitatively analyze the poisonous substances. HP is a safe and effective treatment for severe children with acute poisoning. Attention should be payed to take precautions against childhood injury.