灭鼠药致继发性凝血功能障碍13例诊治分析

Analysis of thirteen cases with secondary coagulation disorder caused by raticide exposure

目的 总结灭鼠药致继发性凝血功能障碍患儿临床特征,探讨诊断及治疗措施.方法 回顾分析2009-2010年13例住院治疗的灭鼠药中毒致凝血功能障碍患儿的临床资料.结果 该组患儿以鼻衄、牙龈出血、皮肤瘀点、瘀斑等皮肤黏膜出血为主要临床表现（66.6%）,既往身体健康,无类似出血表现.凝血像检查均有活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）延长,凝血因子Ⅱ缺乏,Ⅶ、Ⅸ、Ⅹ因子水平降低.纤维蛋白原均正常.13例患儿血、尿毒物检测,均检测出化学毒物灭鼠药（然而其中12例患儿均无明确进食灭鼠药史）.使用凝血酶原复合物,新鲜血浆和维生素K1（VitK1）治疗有效.6例患儿2～3周后再次发生出血.结论 儿童继发性凝血功能障碍疾病需高度警惕抗凝血灭鼠药中毒可能.及时补充凝血因子,早期使用VitK1有效.因灭鼠药排泄慢,VitK1治疗时间宜大于2个月或更长,应随访检测凝血指标并决定是否停药.

Objective To summarize the clinical characteristics of secondary coagulation disorders caused by exposure to posion （raticide） in children and to investigate the diagnosis and corresponding treatment Method The process of diagnosis, clinical characteristics, response to treatment and the prognosis were analyzed. Results The main clinical manifestation was mucosal bleeding （66. 6% ） , including epistaxis, gingivaJ bleeding, hematomas and so on. All these children were previously well and had no history of bleeding. Activated partial thromboplastin time （APTT） and prothrombin time （PT） were prolonged, factor Ⅱ was undetectable and the levels of factors Ⅶ, Ⅸ, and Ⅹ were lower. The fibrinogen was normal. A raticide was detected in blood and urine of 13 children although 12 of the patients had no definite history of raticide ingestion. Prothrombin complex,fresh frozen plasma and vitamin K, were effective in these cases. However, 2-3 weeks later, 6 patients presented with recurrent bleeding. Conclusion For children with secondary coagulation disorders of unknown cause, intoxication of raticide should be considered. The administration of blood coagulation factors and vitamin K1 are effective in early treatment, and the treatment period should be more than 2 months. The PT and APTT should be followed up. Vitamin K1 should be stoped when PT and APTT are normal.