急性砷化氢中毒多器官损害的临床特征分析

Clinical analysis of patients with multiple organ damage caused by acute hydrogen arsenide poisoning

目的分析急性砷化氢(AsH3)气体中毒发生多系统损害的临床特征。方法对甘肃省中医药大学第三附属医院1988年至2011年收治的21例急性AsH3中毒患者的临床资料进行回顾性分析。结果21例急性AsH3中毒患者中,2例未经救治早期死亡,最终纳入19例患者,其中轻度中毒者5例,中度中毒者4例,重度中毒者10例。临床主要发生了急性中毒性血管内溶血性贫血、急性中毒性肾病、血小板减少症,甚至急性呼吸衰竭,严重者合并脑、心、肺、肝等中毒性多器官功能障碍综合征(MODS)导致死亡。肺局部尸检病理发现毛细血管透明样血栓的病理特征。临床以血小板减少(100%)、肾损害(100%)、溶血性贫血(84.2%)、头痛头晕(84.2%)、发热(68.4%)较为常见。发生溶血性尿毒症的典型“三联征”3例,占14.3%,主要分布在轻度中毒组;发生血栓性血小板减少性紫癜(TTP)的典型“五联征”9例,占42.9%,主要分布在中度中毒组;多器官功能障碍(多联征)6例,占28.6%,主要分布在重度中毒组;死亡5例(其中3例因多器官功能衰竭死亡),病死率为23.8%;无复发病例。结论结合群起发病的卫生事件现场调查与临床结果分析说明,急性AsH3气体中毒可继发血栓性微血管病(TMA),伴多器官损害的重度AsH3气体中毒患者预后差,病死率高。

Objective To analyze the clinical features of occurrence of multiple system damage in patients with acute hydrogen arsenide(AsH3)gas poisoning.Methods The clinical data of 21 patients with acute AsH3 poisoning during 1988-2011 in the Third Affiliated Hospital of Gansu University of Chinese Medicine were retrospectively analyzed.Results Among the 21 patiens with acute AsH3 poisoning,2 cases died without early treatment,finally 19 cases were involved,including 5 mild cases,4 moderate cases and 10 severe cases.The main clinical manifestations were the acute toxic intravascular hemolytic anemia,acute toxic nephropathy,thrombocytopenia,even acute respiratory exhaustion,complicated with intoxication in brain,heart,lung,liver,etc.in severe cases resulting in toxic multiple organ dysfunction syndrome leading to death.The autopsy examination of the lung discovered that the"transparent"blood embolus in the capillaries was the lung pathological characteristics.Clinically,thrombocytopenia(100%),renal damage(100%),hemolytic anemia(84.2%),headache and dizziness(84.2%),fever(68.4%)were relatively common.There were 3 cases with typical triad of hemolytic uremia(14.3%),mainly in mild group;9 cases had typical pentalogy of thrombocytopenic purpura(TTP,42.9%),mainly in moderate group;6 cases had multiple organ dysfunction(28.6%),mainly in severe groups,respectively.Five cases died(3 due to multisystem failure),the mortality was 23.8%;no recurrence was seen.Conclusion The clinical results analysis combined with field investigation of health events of mass illness suggests that the acute AsH3 gas poisoning could cause secondary thrombotic microangiopathy(TMA),the prognosis of severe patients with multiple organ damage caused by AsH3 poisoning is poor,and their mortality is high.