48例急性毒蕈中毒患者临床分析

Clinical analysis of 48 patients with acute mushroom poisoning

目的 分析急性毒蕈中毒患者的临床表现及治疗方案。方法 采用回顾性研究方法，分析2016年1月至2017年5月解放军第三〇七医院中毒救治科收治的48例急性毒蕈中毒患者的临床资料。收集患者的性别、年龄、临床分型、发病季节、首发症状、潜伏期、住院时间、治疗及预后等相关信息。重症肝脏损害型患者除给予常规治疗外加用连续性血液净化（CBP）治疗，观察CBP治疗前及治疗1、3、7 d血常规、生化指标、血氨和凝血功能的变化。结果 48例急性毒蕈中毒患者中，男性29例（占60.4%），女性19例（占39.6%）；平均年龄（48.10±13.14）岁；其中胃肠炎型9例，肝脏损害型26例，神经精神型8例，溶血型2例，肾脏损害型3例。中毒的发生有明显的季节性，主要集中在秋季，以8月最多，占66.7%（32/48）。中毒患者首发症状以恶心、呕吐为主（占50.0%）；5种不同类型中毒患者中，神经精神型潜伏期〔（1.44±1.15）h〕和住院时间〔（3.50±2.33）d〕均最短，肝脏损害型潜伏期〔（10.63±3.50）h〕和肾脏损害型住院时间〔（20.67±0.58）d〕最长。患者入院后根据分型及时给予对症治疗，其中12例重症肝脏损害型患者加用CBP治疗。治疗后患者的丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）和凝血酶原活动度（PTA）均较治疗前明显改善，治疗7 d与治疗前比较差异有统计学意义〔ALT（U/L）：213.08±127.30比2？766.83±1？909.66，AST（U/L）：50.00（41.00，85.00）比2？142.00（1？225.00，3？126.00），CK-MB（U/L）：24.09±8.87比44.75±22.09，LDH（μmol·s-1·L-1）：3.70±1.46比13.03±12.77，PTA：（79.08±24.29）%比（35.25±19.85）%，均P〈0.01〕。48例患者中，47例痊愈出院；1例肝脏损害型患者因肝功能障碍持续加重，出凝血异常，消化道大出血而死亡。结论 急性毒蕈中毒的发生具有明显的季节性，以肝脏损害型居多，首发症状以恶心、呕吐等胃肠道表现为主；急性毒蕈中毒患者应给予早期及时对症治疗，重症患者尽早给予CBP治疗，可以保护肝脏和心肌，提高疗效，降低病死率，改善预后。

Objective To analyze the clinical manifestation and therapeutic method in patients with acute mushroom poisoning.Methods A retrospective study was conducted. The clinical data of 48 patients with acute mushroom poisoning admitted to Department of Poisoning Treatment of the 307th Hospital of PLA from January 2016 to May 2017 were analyzed. The clinical data including gender, age, clinical symptoms, onset season, initial symptoms, incubation time, the length of hospital stay, treatment, and prognosis. In addition to the conventional treatment, the patients with severe liver damage were treated with continuous blood purification （CBP）. The changes in routine blood test, biochemical parameters, blood ammonia and coagulation function before and 1, 3 and 7 days after CBP were observed.Results There were 29 of male （60.4%） and 19 of female （39.6%） in 48 patients with acute mushroom poisoning, with an average age of （48.10±13.14） years. There were 9 patients suffering from gastroenteritis type, 26 suffering from liver damage type, 8 suffering from neuro-psychosis type, 2 suffering from hemolytic type, and 3 suffering from renal damage type. All of the poisoned patients had evident seasonal characteristic, mainly concentrated in the autumn, especially in August, according for 66.7% （32/48）. The initial symptoms of poisoning patients were mainly manifested as nausea and vomiting （50.0%）. In five kinds of poisoned patients, the incubation time [（1.44±1.15） hours] and the length of hospital stay [（3.50±2.33） days] of neuro-psychosis type was the shortest, and the incubation time of liver-damaged type [（10.63±3.50） hours] and the length of hospital stay of renal damage type [（20.67±0.58） days] was the longest. Patients received symptomatic treatment according to different types, among whom 12 patients with severe liver damage received additional treatment for CBP. After the treatment, alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, MB isoenzyme of creatine kinase （CK-MB）, lactate dehydrogenase （LDH）, and prothrombin activity （PTA） were significantly improved as compared with those before CBP treatment, with significant differences between 7 days after CBP and before CBP [ALT （U/L）： 213.08±127.30 vs. 2？766.83±1？909.66, AST （U/L）： 50.00 （41.00, 85.00） vs. 2？142.00 （1？225.00, 3？126.00）, CK-MB （U/L）： 24.09±8.87 vs. 44.75±22.09, LDH （μmol·s-1·L-1）： 3.70±1.46 vs. 13.03±12.77, PTA： （79.08±24.29）% vs. （35.25±19.85）%, all P 〈 0.01]. Among 48 patients, 47 were cured and discharged, and 1 patient with liver failure died due to aggravation of liver dysfunction, abnormal coagulation and bleeding, and massive hemorrhage of gastrointestinal tract.Conclusions Acute mushroom poisoning patients demonstrated obvious seasonal characteristics, mostly liver-damaged type, and its initial symptoms were mainly presented as nausea, vomiting and other gastrointestinal manifestations. Early clarification of diagnosis, timely treatment, as well as providence with CBP treatment in severe patients should be carried out as soon as possible. In such a way the curative effect can be enhanced, the mortality can be reduced, and the prognosis of the patients could be improved.