砷中毒所致皮肤毒性的临床诊断及治疗

Clinical diagnosis and treatment of skin toxicity caused by arsenic poisoning

目的探讨砷中毒所致皮肤毒性的临床诊断及治疗方法,为临床治疗提供治疗思路。方法选取我院收治的160例砷中毒患者作为受试对象,随机分为对照组与观察组,其中对照组患者使用二巯丙磺钠进行驱砷治疗,皮肤治疗使用泼尼松进行对症治疗:观察组患者在对照组治疗的基础上口服维胺酯胶囊并外用维胺酯乳膏,同时给予维生素C。两组患者均连续治疗3个疗程。观察两组患者治疗前后尿砷、发砷浓度、血清中SOD水平、血红蛋白(Hb)含量以及治疗效果。结果 160例患者中55例为轻度症状,74例为中度症状,31例为重度症状。三组患者发砷水平、尿砷水平和Hb水平比较,差异有统计学意义(P<0.05)。对照组与观察组患者治疗后发砷水平、尿砷水平、Hb水平和SOD水平与治疗前比较,差异均有统计学意义(P<0.05);对照组与观察组治疗后发砷水平、尿砷水平之间差异无统计学意义(P>0.05);而两组治疗后Hb、SOD水平比较,差异有统计学意义(P<0.05)。对照组80例患者中35例有效,45例无效,有效率为43.75%;观察组80例患者中57例有效,23例无效,有效率为71.25%,观察组总有效率显著高于对照组(P<0.05)。结论皮肤角化过度是最常见的砷中毒所致的皮肤症状,及早诊断疾病、隔离砷源是最为重要的预防措施。在砷中毒皮肤损伤患者的治疗过程中使用维胺醋治疗皮肤损伤效果明显,可以在临床上推荐应用,但是必须明确适应证。

Objective To explore the clinical diagnosis and treatment of skin toxicity caused by arsenic poisoning to provide therapeutic ideas for clinical treatment. Methods A total of 160 cases of arsenic poisoning patients admitted in our hospital were chosen and randomly divided into control group and observation group. The patients in the control group were treated with dieumylsulfonate for eliminating arsenic treatment, and prednisone for symptomatic treatment methods in skin treatment. Patients in observation group were given oral viaminate capsules, external viaminate cream and VC based on the treatment in the control group. The patients in two groups were treated continuously for 3 courses. The concentration of urinary arsenic, hair arsenic, serum SOD level, hemoglobin （Hb） content and therapeutic effect were observed before arid after treatment in both groups. Results In 160 cases, 55 patients＇ symptoms were mild, and 74 eases were moderate, and 3~1 ca.ses were severe. There were significant dif.ference in hair arsenic levels, urinary ar- senic levels e^nd Hb levels among the three groups, indicating a sigoificant correlation between the severity of skin le- sions and arsenic levels, nrinary arsenic levels and Hb levels. There was significant difference in hair arsenic level, urinary arsenic level, Hb level and SOD level before and after treatment in observation group and control group（P〈0.05）. There was no significant difference ila hair arsenic levels, urinary arsenic levels between the control group and the ob- servation group after treatment（P〉0,05）. The levels of Hb and SOD were significantly different between the control group and the observation group after treatment （/）〈0.05）. In the control group of 80 patients, 35 cases were effective and 45 cases were ineffective, with the effective rate 43.75%. Of the 80 patients in the observation group, 57 cases were effective and 23 cases were ineffective, with the effective rate 71.25%. Compared with the control group, the total effective rate of the observation group was significantly higher than that of the control group （P〈O.05）. Conclusion Skin hyperkeratosis is the most common skin symptoms caused by arsenic poisoning; Early diagnosis of disease and isolating arsenic source are the most important prevention measures. The theraPic effect of viaminate on skin injury in the treatment course of arsenic poisoning in patients with skin damage damage is obvious. Viaminate can be clinically rec- ommended, but the indications must be clear.