严重肝病患者静脉误用二甘醇中毒的临床分析

Venous diethylene glycol poisoning in patients with preexisting severe liver disease:a clinical analysis

目的分析严重肝病患者静脉误用二甘醇后中毒的临床特点,探讨其中毒的可能相关因素。方法使用病例分析方法,分析静脉注入二甘醇的64例患者的临床及病理特点;应用病例对照研究方法比较二甘醇中毒组与无中毒组临床特点的差异,分析发生中毒的可能相关因素。结果15例患者发生二甘醇中毒,且都出现少尿型急性肾功能衰竭。其中11例出现消化道症状或消化道症状加重;10例出现神经系统受损,以颅神经及外周神经为主;13例发生代谢性酸中毒;中毒后血WBC、RBC、Hb分别为(9.78±3.75)×10~9/L、(2.32±0.76)×10^(12)/L、(79.5±23.6)g/L,WBC明显升高(P=0.008),RBC和Hb降低(P值分别为0.014和0.018)。中毒患者肾组织活检表现为急性肾小管坏死及间质炎症。12例中毒患者死亡。两组患者用药前诊断为重型肝炎、治疗过程中合并使用利尿剂、腹水、存在肾脏基础疾病的比例差异有统计学意义(P<0.05);两组患者之间静脉注射二甘醇前血中性粒细胞计数、BUN、Cr、钙离子和磷离子水平差异有统计学意义(P<0.05)。结论静脉二甘醇中毒主要表现为少尿型急性肾功能衰竭、代谢性酸中毒、胃肠道症状以及外周神经系统损害,贫血和WBC增高;病死率高;用药前存在严重肝脏疾患、肾脏疾病、潜在肾损害、感染可能是发生静脉二甘醇中毒的相关因素。

Objective To describe the clinical features of venous diethylene glycol poisoning and to identify factors correlating with such kind of poisoning, Methods Retrospective chart review was performed to analyze the epidemiology, clinical presentation, hepatorenal functions, hemodynamics and pathological characteristics of 64 patients with severe liver diseases who received intravenous diethylene glycol, Comparative analyses of correlating factors and causes of poisoning were based on the presence or absence of poisoning, Results Fifteen cases of poisoning were reported, After a 5 day incubation period, all poisoned patients displayed acute renal failure and 11 cases with digestive tract symptoms and（or） symptom exacerbations were noted, Neurological system impairment was observed in 10 cases after 2 weeks. Metabolic acidosis developed in 13 cases, Poisoned patients exhibited significantly lower red blood celI（RBC）[（2. 32 ± 0. 76） ）〈 10^12/L], hemoglobin（Hb） [（79. 5 ± 23. 6）g/L] value and higher white blood cell（WBC）[（9. 78 ± 3. 75） ）〈 10^9/L] count, Renal biopsy of poisoned patients revealed acute tubular necrosis and interstitial nephritis. Twelve poisoned patients died, Significant differences were found between groups regarding preexisting severe hepatitis, ascites, renal disease and diuretic therapy. Prior to diethylene glycol injections, mean values of neutrophil, blood urea nitrogen（BUN）, creatinine（Cr） and calcium and phosphorousions differed significantly between groups. Conclusions Features of venous diethylene glycol poisoning include oliguric acute renal failure, metabolic acidosis, digestive symptoms, nervous system impairment and a high probability of anemia and WBC proliferation. Mortality is high. Correlative factors include preexisting severe liver disease, renal disease and infection.