临床分析23例抗凝血灭鼠剂中毒导致的凝血障碍

Clinical analysis of 23 patients with disturbances of blood coagulation caused by anticoagulant rodenticide poisoning

目的探讨抗凝血类灭鼠剂中毒的临床特点及治疗方法。方法回顾性分析在该院诊治的抗凝血类灭鼠剂中毒导致凝血功能障碍23例患者的临床表现、实验室检查及维生素K1治疗前后凝血功能变化。结果临床以全身自发性出血为主要表现。凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)和国际标准化比值(INR)均延长,凝血因子Ⅸ(FⅨ)活性显著降低,凝血因子Ⅷ(FⅧ),凝血因子Ⅺ(FⅪ)和凝血因子Ⅻ(FⅫ)活性不变。用维生素K1治疗后PT、APTT和INR与治疗前比较明显缩短(P<0.01),凝血因子Ⅸ活性与治疗前比较明显升高(P<0.01),凝血因子Ⅷ,Ⅺ,Ⅻ活性与治疗前比较差异无统计学意义(P>0.05);23例患者治疗7d后凝血功能基本恢复正常。结论如患者有多部位反复出血表现,且PT、APTT明显延长,应高度怀疑灭鼠剂中毒的可能。灭鼠剂中毒患者需接受维生素K1长疗程治疗。

Objective To explore the clinical characteristics and therapeutic methods caused by anticoagulant rodenticide poisoning.Methods We analysed retrospectively the clinical features,laboratory examination and curative effect of vitamin K1 of 23patients in our hospital about disturbances of blood coagulation caused by anticoagulant rodenticide poisoning.Results The clinical characteristic was systemic spontaneous bleeding.Prothrombin time（PT）,activated partial thromboplastin enzyme time（APTT）and international normalized ratio（INR）were prolonged,the levels of clotting factorⅨ（FⅨ）was significantly elevated,clotting factorⅧ,Ⅺ,Ⅻ（FⅧ,FⅪ,FⅫ）were constant.After vitamin K1 therapy,the APTT,PT and INR were obviously shorter than those of prior treatment（P〈0.01）;the levels of clotting factorⅨ was significantly prolonged compared to those of prior treatment（P〈0.01）.The levels of clotting factorⅧ,Ⅺ,Ⅻ had no difference compared to those of prior treatment（P〉0.05）;all patients′s blood coagulation were back to normal.Conclusion When recurrent hemorrhage in multiple sites accompanying with much prolonged PT and APTT,it should be highly suspected anticoagulant rodenticide poisoning.Rodenticide poisoning patients should be taken into the long-term treatment with of vitamin K1.