大剂量细胞色素C在抢救儿童急性磷化氢中毒的临床作用

Clinical effect of high dose cytochrome C on rescue of acute phosphine poisoning in children

目的探讨儿童急性磷化氢中毒的临床特点,及大剂量细胞色素C的临床作用。方法收集2013年11月-2018年6月本中心救治的急性磷化氢中毒儿童22例临床资料,并回顾性分析。结果男13例,女9例;年龄29 d^13岁;轻中度磷化氢中毒10例,重度磷化氢中毒12例;轻中度中毒患儿出现症状至就诊时间明显短于重度中毒患儿(P=0.029)。轻中度磷化氢中毒主要表现为头晕、恶心、呕吐、腹痛;重度中毒主要表现为昏迷、口唇紫绀、低血压,甚至心源性休克。实验室检查:脑钠肽异常升高12例;心肌酶异常12例;血乳酸升高10例;心电图异常16例,均表现为快速心律失常,其中1例为尖端扭转型心律失常。除常规治疗外,均给予大剂量细胞色素C治疗,轻中度中毒患儿均治愈,重度中毒患儿治愈6例,死亡6例,22例儿童磷化氢中毒总死亡率为27.3%,重度磷化氢中毒死亡率50%。结论儿童急性磷化氢中毒死亡率高,在常规治疗的基础上,给予静脉应用大剂量细胞色素C可明显降低儿童急性磷化氢中毒的死亡率。

Objective To explore the clinical features of children with inhaled phosphine poisoning and the clinical effect of high dose cytochrome C on the rescue of phosphine poisoning in children.MethodsThe data of 22 children with acute phosphine poisoning who were treated in the hospital(center) from November 2013 to June 2018 were collected and retrospectively analyzed.ResultsThere were 13 males and 9 females aged 29 days-13 years. There were 10 cases of mild and moderate phosphine poisoning and 12 cases of severe phosphine poisoning. The time from onset to the clinic of the children with mild to moderate poisoning was significantly shorter than that of the children with severe poisoning, and there was a statistically significant difference between the two groups. The clinical manifestations of the children with mild to moderate phosphine poisoning usually were dizziness, nausea, vomiting and abdominal pain;the clinical manifestations of the children with severe phosphine poisoning were characterized by coma, cyanotic lips, hypotension, and even cardiogenic shock. The laboratory examinations showed that abnormal brain natriuretic peptide(BNP) increasing in 12 cases, myocardial enzyme abnormalities in 12 cases, blood lactic acid increasing in 10 cases, ECG abnormalities in 16 cases, including a torsade arrhythmia in 1 case. On the basis of the conventional treatment, the high dose of cytochrome C was given, and all the children with mild and moderate phosphine poisoning were cured but among the children with severe phosphatide poisoning,6 were cured and 6 died. The mortality rate of 22 children with acute phosphine poisoning in the center was 27.3%, and that of severe phosphine poisoning was 50%.Conclusion The mortality rate of children with inhaled hydrogen phosphine poisoning is very high. On the basis of conventional treatment, the intravenous administration of high dose cytochrome C can significantly reduce the mortality.