急性三氯丙烷中毒18例临床分析

The clinical ananlysis of 18 cases with acute trichloropropane poisoning

目的总结18例急性三氯丙烷（trichloropropane，TCP）中毒病例的临床特点，为诊治提供参考。方法分析18例急性TCP中毒患者的中毒经过、临床表现、实验室检查结果、中毒原因及治疗，并将急性TCP中毒患者的外周血微核试验结果与健康检查者（33例）的微核试验结果进行比较。结果发病初期中毒患者出现呼吸道症状，其中胸闷13例，咽干、咽痛7例，咳嗽、流涕2例；胃肠道症状明显，其中腹痛18例，恶心、呕吐14例；仅1例患者发生了较明显的肝功能损害，治疗后肝功能指标逐渐恢复正常。18例患者血清中均检出TCP，浓度为39．0～310．0ng／ml，平均（68．9±42．1）ng／ml。所有患者均出现典型的中毒性周围神经病的表现，乏力、四肢麻木18例，双下肢远端烧灼痛14例，下肢对称性袜套样分布的痛觉、触觉和音叉震动觉障碍13例，肌力减退7例，膝反射减退4例，跟腱反射减退3例。周围神经传导速度测定结果显示，18例腓肠神经感觉神经传导速度减慢，8例腓总神经运动神经传导速度减慢，远端潜伏期延长。18例患者的外周血淋巴细胞中均发现了微核，微核发生率为（10．06‰±2．80‰），健康对照组微核发生率为（8．24‰±2．67‰），两组比较，差异有统计学意义（P〈0．05）。结论呼吸道接触TCP中毒后，患者出现呼吸道症状、胃肠道症状及中毒性周围神经病的表现，无明显肝功能损害，外周血淋巴细胞中均发现微核。

Objective To summarise the clinical features of 18 eases with acute triehloropropane（TCP） poisoning for improving the diagnosis and treatment of the disease. Methods Exposure history,clinical manifestations, laboratorial examinations, poisoning causes and treament were retropeetively reviewed in 18 eases with acute TCP poisoning. The results of peripheral lymphocyte mieronueleus tests were compared with the healthy control group （n=33）. Resul The common clinical symptoms were as following： respiratory symptoms were the earlier oneset, such as ehest tightness in 13, dry and sore throat in 7, cough and runny nose in 2. Gastrointestinal symptoms were more common, such as abdominal pain in 18, nausea and vomit in 14. Only 1 out of 18 patients was found with liver injury. The major manifestation was the increase in ALT and AST, which was returned to nomal after treatment. ALL of the 18 patients were found TCP in their serum which concentration was from 39.0 to 310.0 ng/ml, and the average was （68.9±42.1） ng/ml. The symptoms of toxic peripheral neuropathy were typical in all the patients, such as fatigue and numb limb in 18, burning pain of the distal lower limbs in 14, the symmetrical sock-like sensory dysfunction of pain,touch and vibration of the lower limbs in 13, muscle strength reduced in 7, hyporeflexia knee-jerks in 4, hyporeflexia ankle-jerks in 3. The peripheral nerve conduction ve｜oeity （NCV） examinations were as followed： the （sensore-nerve conduction velocity） SCV of peroneus super nerve in 18 and the （motor-nerve conduction velocity） MCV of tibial nerve in 8 was slowed down and the distal latency in 18 was prolonged. Mieronueleus were found in all 18 eases. The mieronueleus rate was 10.06‰±2.80‰ and 8.24‰ ±2.67‰ in acute TCP poisoning group and healthy control group, respectively. The difference was significant （P〈0.05）.Conelusion The common clinical manifestations of respiratory exposure of TCP poisoning patients were respiratory symptoms, gastrointestinal symptoms and the symptoms of toxic peripheral neuropathy. Liver injury in those 18 eases was not obvious. Lymphocyte mieronueleus of peripheral blood were found in all 18 eases.