儿童毒蕈中毒49例临床分析

Clinical analysis of 49 cases of mushroom posining in children

目的:探讨儿童毒蕈中毒的常见症状、治疗及预后,提高临床诊治水平。方法:回顾分析49例儿童毒蕈中毒的首发症状、治疗及转归情况。结果:49例患儿毒蕈中毒首发症状多样,以呕吐多见(93.9%),其他依次为腹泻(55.1%)、腹痛(44.9%)、精神萎靡(20.4%)、抽搐(18.4%)、头晕(16.3%)、便血(14.3%)、黄疸(12.2%)、昏迷(12.2%)、无尿(10.2%)、头痛(10.2%)、谵妄(8.1%)、浮肿(6.1%)、发热(6.1%)、咳嗽(4.1%)等。36例患儿出现肝细胞损害,其中28例患儿丙氨酸氨基转移酶(Alanine aminotransferase,ALT)高于1 000 U/L。在内科对症支持治疗基础上,35例患儿给予血液净化治疗(血液滤过,血液透析、血液灌流、血浆置换以及联合血液净化)。血液净化治疗可显著降低ALT值。治愈14例(28.6%),好转16例(32.7%),19例(38.8%)死亡。结论:儿童毒蕈中毒表现多样,可累及多器官,后果严重。儿童毒蕈中毒可引起严重肝细胞损害,血清ALT升高明显,大多超过1 000 U/L,对ALT的监测可用于评估预后。血液净化治疗儿童毒蕈中毒可显著降低ALT值,改善毒蕈中毒的预后。

Objective：To improve the level of clinical diagnosis and treatment by studying the common symptom,treatment and prognosis of mushroom poisoning in children. Methods：The primary symptoms,treatment and prognosis of 49 cases of mushroom poisoning in children were retrospectively reviewed. Results：The primary symptoms of mushroom poisoning were diverse;the most common primary symptom was vomiting（93.9%）,followed by diarrhea（55.1%）,abdominal pain（44.9%）,depression（20.4%）,convulsion（18.4%）,dizziness（16.3%）,bloody stools（14.3%）,jaundice（12.2%）,coma（12.2%）,anuria（10.2%）,headache（10.2%）,delirium（8.1%）,edema（6.1%）,fever（6.1%）,cough（4.1%）,etc. There were 36 children had liver cell damage;28 children with alanine aminotransferase（ALT）higher than 1 000 U/L. On the base of symptomatic and supportive treatment,35 children were given blood purification therapy（hemofiltration,hemodialysis,hemoperfusion,plasmapheresis and combined with blood purification）. Blood purification used for mushroom poisoning in children could significantly reduce ALT. Fourteen cases（28.6%）were cured,16 cases（32.7%）were turned better,19 cases（38.8%）were died. Conclusion：The symptoms are diverse in children with mushroom poisoning,which might lead to multiple organs dysfunction and serious consequences. Children with mushroom poisoning can cause severe liver cell damage and ALT increase significantly（the majority ALT is higher than 1 000 U/L）. In addition,the ALT monitoring may be used for the assessment of prognosis. Blood purification used in the treatment of mushroom poisoning in children can significantly reduce ALT and improve the prognosis.