抗凝血类灭鼠药中毒患者凝血功能分析

Analysis of coagulation function in patients with anticoagulant rodenticide poisoning

目的观察抗凝血类灭鼠药溴敌隆和溴鼠灵中毒患者入院第1天凝血功能指标的异常情况,并探讨其对诊断的意义。方法回顾性分析2015年1月—2017年5月西南医科大学附属医院确诊的56例溴敌隆和溴鼠灵中毒患者入院第1天凝血功能指标,包括凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)、凝血酶原活动度(PTA)、凝血酶原时间比值(PTR)、国际标准化比值(INR)、纤维蛋白原(FIB)及凝血因子Ⅱ、Ⅶ、Ⅷ、Ⅸ、Ⅹ、Ⅺ等,与纠正试验后的结果进行比较分析。结果 56例抗凝血类灭鼠药中毒患者中,7例患者入院第1天凝血指标正常或部分正常;49例患者入院第1天凝血指标出现异常,表现为PT、APTT延长,PTR、INR和凝血因子Ⅷ升高,PTA和凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ减少;纠正试验显示,上述凝血指标全部正常,纠正前后比较差异有统计学意义[PT(s):12.23±1.39比98.71±45.32,APTT(s):30.06±13.28比90.29±36.44,PTA:(91.25±29.34)%比(36.05±17.02)%,PTR:1.12±0.49比7.09±4.62,INR:1.12±0.94比6.93±5.46,均P<0.05]。结论抗凝血类灭鼠药溴敌隆和溴鼠灵中毒可影响患者的凝血功能,入院第1天凝血功能即可出现障碍;部分及时送医或中毒量较少的患者入院时凝血指标可能暂时正常或部分正常,临床应引起足够重视。

Objective To investigate the abnormality of coagulation function indicators of patients with anticoagulant rodenticide bromadiolone and brodifacoum poisoning on the 1 st day after admission, and to explore its diagnostic significance. Methods From January 2015 to May 2017, 56 patients with the confirmed diagnosis of bromadiolone and brodifacoum poisoning in the Affiliated Hospital of Southwest Medical University were enrolled in the study and their blood coagulation function indicators on the first day after admission were retrospectively analyzed; the indicators detected included prothrombin time（PT）, activated partial thromboplastin time（APTT）, thrombin time（TT）, prothrombin activity（PTA）, prothrombin time ratio（PTR）, international normalized ratio（INR）, fibrinogen（FIB） and coagulation factors Ⅱ, Ⅶ, Ⅷ, Ⅸ, Ⅹ, Ⅺ etc, the results were compared with those tested after treatment and an analysis was carried out. Results In the 56 patients with anticoagulant rodenticide poisoning, on the first day after admission, there were 7 patients whose coagulation indicators were normal or partially normal and 49 patients with abnormalities in coagulation indicators, showing PT and APTT prolonged, PTR, INR and the coagulation factor Ⅷ elevated, the levels of PTA and coagulation factors Ⅱ, Ⅶ, Ⅸ, Ⅹ reduced; After treatment for the poisoning, the tests results showed that all the coagulation indicators were within normal range. The test results before and after treatment were compared, showing statistical significant differences [PT（s）： 12.23±1.39 vs. 98.71±45.32, APTT（s）： 30.06±13.28 vs. 90.29±36.44, PTA：（91.25±29.34）% vs.（36.05±17.02）%, PTR： 1.12±0.49 vs. 7.09±4.62, INR： 1.12±0.94 vs. 6.93±5.46, all P 〈0.05]. Conclusion The poisoning of anticoagulant rodenticides, bromadiolone and brodifacoum, may affect patients＇ coagulation function. Coagulation dysfunction may occur on the first day of admission. Some patients who suffer from mild poisoning or go to emergency department promptly, their test results of coagulation function on the first day after admission may be normal or partially normal temporarily that should be paid high attention to clinically.