急性三甲基氯化锡中毒后遗症的临床分析

Clinical analysis of sequelae of acute trimethyltin oxide poisoning

目的分析三甲基氯化锡(TMT)中毒患者2年后所留后遗症的临床表现。方法于2018年9月,对2016年8月赣州市某废料再生产公司的16例TMT中毒患者进行2年后的问卷调查及量表评定,包括汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、简易智能精神状态检查量表(MMSE)、日常生活能力(ADL)、国际协作共济失调量表(ICARS);对6例重度中毒患者进行头颅MRI检查。结果16例TMT中毒患者中部分患者仍有头痛、头晕等症状。重度中毒患者:4例行走不稳,并且头颅MRI表现为颞叶、海马、岛叶、小脑萎缩明显及脑室扩大;2例患者评定为重度混合性焦虑和抑郁状态,1例中度混合性焦虑和抑郁状态,1例轻度焦虑状态;3例患者诊断为痴呆,1例为轻度认知功能障碍;2例患者ICARS评分分别为66、63分(完全依赖生活能力),2例ICARS评分分别为28、6分(轻度依赖生活能力),2例ICARS评分均为0分(可独立生活能力)。轻、中度中毒患者:各有2例轻度混合性焦虑和抑郁状态,各有1例为轻度认知功能障碍,所有患者轻、中度ICARS评分均为0分(可独立生活能力)。结论部分患者TMT中毒2年后仍残留头晕、头痛等一般临床症状,也有焦虑、抑郁及认知功能减退等精神智能症状;重度中毒者部分出现痴呆、小脑性共济失调,甚至丧失独立生活能力。

Objective Clinical analysis of sequelae of 16 patients with trimethyltin chloride (TMT) poisoning after 2 years. Methods Sixteen patients with TMT poisoning from a waste recycling company in Ganzhou City in August 2016 were enrolled. They were investigated by questionnaires and assessed by various scales after two years. 6 cases of severe poisoning were examined by head MRI. The scale includes Hamilton Anxiety Scale (HAMA), Depression Scale (HAMD), Simple Mental State Examination Scale (MMSE), Activity of Daily Living (ADL), International Cooperative Ataxia Rating Scale (ICARS). Results 16 cases of TMT poisoning still have headache, dizziness and other symptoms. Instability of walking in 4 patients with severe poisoning, and the brain MRI manifestations included obvious atrophy of temporal lobe, hippocampus, insula lobe, cerebellum and ventricle enlargement. Two patients were rated as severe mixed anxiety and depression, one as moderate mixed anxiety and depression, and one as mild anxiety. 3 cases were diagnosed as dementia and 1 case as mild cognitive impairment. Two cases were totally dependent on living ability. ICARS scores were 66 points and 63 points respectively. Two cases were mildly dependent on living ability. ICARS scores were 28 points and 6 points respectively. There were 2 cases of mild mixed anxiety and depression in mild and moderate poisoning patients, and 1 case of mild cognitive impairment in each patient. They could live independently. ICARS scores were 0. Conclusion After 2 years of TMT poisoning, some patients still have general clinical symptoms such as dizziness, headache and so on. There are also mental and intellectual symptoms such as anxiety, depression and cognitive impairment. Some of patients with severe poisoning presented with dementia and cerebellar ataxia, and even lost independent living ability.