急性毒鼠强中毒的临床治疗评价

Evaluation of therapeutic project on acute tetramethyle ne disulphotetramine poisoning and effects on intelligence in children

目的评价4种治疗方法对急性毒鼠强中毒的疗效,以及毒鼠强中毒对儿童智力发育的影响.方法将86例入选急性毒鼠强中毒患者随机分为基础治疗组、丙戊酸钠组、二巯丙磺钠组和血液灌流组,给予相应治疗后观察治疗效果.另选30例毒鼠强中毒儿童,与健康儿童按年龄、居住地、性别、受教育情况和家庭经济状况等因素进行1:1配对, 使用韦氏儿童智力量表中国修订本进行智商测定.结果基础组、丙戊酸钠组与二巯丙磺钠组在癫痫控制时间、地西泮用量、出现精神症状及精神症状持续时间等治疗评价指标上,差异均无统计学意义;血液灌流治疗的13例患者中10例癫痫发作停止,3例发作次数明显减少,从每日10～16次减少到1～2次.血液灌流前后血浆中毒鼠强的含量并不降低.毒鼠强中毒儿童的总智商、言语智商和操作智商比对照儿童明显降低,均值分别比对照组降低了9.1、8.8和7.7分;中毒病情重的儿童总智商下降更明显,均值比对照组降低了15分.结论二巯丙磺钠和丙戊酸钠对急性毒鼠强中毒的治疗效果并不优于单纯使用地西泮和苯巴比妥,血液灌流对毒鼠强中毒有肯定疗效.毒鼠强中毒对儿童的智力发育有一定影响.

Objective To evaluate four th erapeutic measures on acute tetramethylene disulphotetramine (TETS) poisoning an d the effects of it on intelligence of children.Methods All 86 patients of acute TETS poisoning were randomly divided into 4 groups ( t he control group, sodium valproate group, sodium dimercaptopropane sulfonate gro up and the hemoperfusion group).The therapeutic effects were observed after th e arranged treatment was administrated.According to age, residence, sex, educa tion and domestic economy, 30 children were matched by 1∶1 with childr en of TETS poisoning.Results The termination time of se izure, doses of diazepam, mental symptoms and the continual time of mental sympt oms were not significantly different among these three groups.After hemoperfus ion, the seizure of patients was terminated or the frequency was obviously decre ased, but the level of TETS in blood was not reduced.The average scores of ful l intelligence quotient (FIQ), the verbal intelligence quotient (VIQ) and the pe rformance intelligence quotient (PIQ) of children in poisoning group were 9.1, 8.8 and 7.7 less than the controls.The average scores of FIQ of children wit h bad state were 15 less than the controls.Conclusion Th erapeutic effects of sodium valproate and sodium dimercaptopropane sulfonate on acute TETS poisoning should be not better than using diazepam and sodium phenoba rbital.Therapeutic effects of hemoperfusion on TETS poisoning is good.TETS p oisoning should have a great influence on intelligence of children.