儿童鼠药中毒致凝血功能障碍恢复时间及相关因素研究

Recovery time and risk factors of childhood coagulopathy caused by rodenticide poisoning

目的通过对抗凝血类鼠药中毒导致的凝血功能障碍病例的分析和随访,研究其恢复时间及相关危险因素,为临床随访及监测工作提供依据。方法回顾性分析2014年1月至2016年12月重庆医科大学附属儿童医院96例抗凝血类鼠药中毒致凝血功能障碍患儿的临床资料,追踪随访预后情况,研究凝血功能的恢复时间及相关因素。结果1.患儿均为第2代抗凝血类鼠药中毒所致凝血功能障碍。33例患儿血液中仅检测出溴鼠灵成分,中位质量浓度为364 μg/L(55~4 654 μg/L);7例仅检测出溴敌隆成分,中位质量浓度为130 μg/L(18~652 μg/L);8例同时检测出溴鼠灵及溴敌隆成分,溴鼠灵中位质量浓度为741 μg/L(63~6 000 μg/L),溴敌隆中位质量浓度为11 μg/L(3~3 694 μg/L)。2.成功随访57例患儿,其中经口中毒18例,经皮肤中毒16例,否认涉毒23例。7例并脏器功能损害。随访时间12~54个月,接受特效解毒剂维生素K治疗后均治愈,预后良好,无后遗症。3.鼠药中毒致凝血功能障碍恢复中位时间为2.5个月。4.凝血功能恢复时间与溴鼠灵血药浓度呈正相关(r=0.619,P<0.01)。5.恢复时间与是否合并脏器功能损害及涉毒方式无明显相关性(均P>0.05)。结论儿童抗凝血类鼠药中毒致凝血功能障碍恢复时间较长,溴鼠灵毒物浓度越高,恢复时间越长;临床上应给予足够疗程的维生素K治疗,并根据凝血功能随访情况指导临床疗程。

Objective To explore the recovery time and risk factors of coagulopathy caused by rodenticide poisoning through analyzing and following up the confirmed cases, and to provide more useful guidance information for the clinic practice. Methods A total of 96 cases with coagulation dysfunction caused by anticoagulant rodenticide poiso-ning in Children′s Hospital, Chongqing Medical University from January 2014 to December 2016, were analyzed retrospectively.The recovery time of coagulation function and the relationship between recovery time and drug involved way, dysfunction organs and poison concentration were studied respectively. Results (1) A total of 96 patients were hospitalized because of severe coagulopathy caused by the poisoning of second generation anticoagulant rodenticide.Brodifacoum was detected from 33 blood samples and the median concentration was 364 μg/L (55-4 654 μg/L). Bromadiolone was detected from 7 blood samples and the median concentration was 130 μg/L (18-652 μg/L). Brodifacoum and Bromadiolone were both detected from 8 cases and the median concentration was 741 μg/L (63-6 000 μg/L) and 11 μg/L (3-3 694 μg/L), respectively.(2) A total of 57 cases of the patients were successfully followed up.A total of 18 cases were confirmed with oral poisoning, 16 cases with dermal poisoning, while 23 cases denied any involved ways of poisoning, and 7 cases had organs dysfunction.The follow-up time was 12-54 months.All the hospitalized patients were given specific antidote Vitamin K treatment and recovered successfully without any sequelae.(3) The median recovery time of coagulopathy caused by rodenticide poisoning was 2.5 months.(4) The recovery time of coagulation function was positively correlated with the plasma concentration of Brodifacoum(r=0.619, P<0.01).(5) There was no significant correlation between recovery time and organ dysfunction or drug involved ways of poisoning involvement (all P>0.05). Conclusions The recovery time of coagulation dysfunction caused by anticoagulant rodenticide in children is much longer.The higher the concentration of Brodifacoum poison is, the longer the recovery time.Enough supplementation course of Vitamin K should be given according to the follow-up of coagulation function.