5例山豆根中毒儿童的诊治报道及临床体会

Diagnosis and treatment report and clinical experience of 5 cases of children with radix sophorae subprostratae poisoning

目的探讨儿童山豆根中毒的临床表现、诊治经过及转归,为儿童山豆根中毒的临床防治提供参考依据。方法选取2017年1月至2019年12月空军军医大学西京医院儿科收治的5例山豆根中毒患儿的病例资料,回顾性分析患儿的临床表现、相关辅助检查、诊治方法及转归情况,并总结临床救治体会。结果5例山豆根中毒患儿均出现头晕、恶心、呕吐、腹痛、腹泻、步态不稳、四肢无力等症状,其中3例中毒症状重的患儿出现意识障碍、言语不清及失语、视物不清,甚至频繁抽搐、呼吸骤停等严重中枢神经系统损害表现。4例头颅MRI检查结果显示,病变可累及双侧齿状核、豆状核,甚至丘脑、基底节区。患儿经积极给予洗胃、促排、利尿、营养神经、减轻脑水肿、血液灌流、补液等对症支持治疗后,3例临床治愈出院,1例好转后自行出院,1例死亡。出院3个月后随访,3例无任何后遗症,1例遗留神经系统后遗症。结论山豆根中毒对儿童可造成严重的脑损害,尤其中枢神经系统损害是其最主要的表现,临床医师需提高认识,并注意加强防范,一旦发生中毒应及早诊治。

Objective To investigate the clinical manifestations,diagnosis,treatment and prognosis of children with radix sophorae subprostratae poisoning,and to provide references for clinical prevention and treatment of children with radix sophorae subprostratae poisoning.Methods The clinical data of 5 children with radix sophorae subprostratae poisoning admitted in Xijing hospital of air force military medical university from January 2017 to December 2019 were retrospectively analyzed,including the clinical manifestations,relevant auxiliary examinations,diagnosis and treatment method,and outcomes,and the clinical treatment experience was summarized.Results All 5 children with radix sophorae subprostratae poisoning had symptoms such as dizziness,nausea,vomiting,abdominal pain,diarrhea,unsteady gait and weakness of limbs.Among them,3 children with severe symptoms of poisoning developed confusion,slurred speech,aphasia and unclear vision,and even frequent convulsions,respiratory arrest and other severe central nervous system damage manifestations.Four cases of head MRI showed that the lesions could involve bilateral dentate nucleus,lenticular nucleus,and even thalamus and basal ganglia.After active symptomatic and supportive treatments such as gastric lavage,drainage promotion,diuresis,nutrient nerve,reducing encephaledema,hemoperfusion and fluid replacement,3 cases were cured and discharged,1 case was discharged after improvement,and 1 case died.Follow-up 3 months after discharge,3 cases had no sequelae and 1 case had neurological sequelae.Conclusion Radix sophorae subprostratae poisoning can cause serious brain damage for children,especially the central nervous system damage is the most important manifestation.Clinicians need to raise awareness and pay attention to strengthening prevention.Once poisoning occurs,early diagnosis and treatment should be carried out.