以癫痫样发作为突出表现的急性敌草快中毒四例并文献复习

Four cases of acute diquat poisoning with prominent epileptoid seizure and literature review

目的提高对急性敌草快中毒临床特征的认知。方法于2020年1月,分析2017年1月1日至2019年12月31日武警特色医学中心综合重症医学科收治并诊断的以癫痫样发作为突出表现的急性敌草快中毒4例,并以"敌草快"和"Diquat"或"Deiquat"或"Reward"为关键词检索中国知网、Pubmed等中英文数据库,检索时间为建库至2019年12月31日,进行分析讨论。结果4例患者中男3例、女1例,平均年龄28岁(22~33岁),服毒量为8~20 g,给予洗胃、导泻、补液、血液灌流等治疗,在救治早期突发癫痫样发作,初始常规抗癫痫药物效果差,后予丙泊酚、咪达唑仑联合泵入,癫痫发作减轻,但病情迅速恶化,最终患者均死亡。对纳入研究的3篇文献中3例患者进行分析,其临床经过与上述4例相似,3例患者均进行尸检,结果为脑水肿、弥漫性脑水肿伴基底神经节血管周围出血灶等。结论急性敌草快中毒能够引起癫痫样发作,一旦出现,病情迅速进展,多短期内死亡,临床可尝试大剂量镇静药物联合抗癫痫,以期改善预后。

Objective To further improve the awareness of the clinical feature of acute diquat poisoning.Methods A retrospective analysis was performed on 4 cases of acute diquat poisoning with epileptoid seizure as the main clinical manifestation,which were admitted and diagnosed by the Characteristic Medical Center of Chinese People's Armed Police Force from January 1,2017 to December 31,2019.Take"Diquat"or"Deiquat"or"Reward"as keyword search for CNKI,Pubmed,and EMbase in both Chinese and English.The date of literature retrieval was from the database founding to December 31,2019.Results Of the 4 patients,3 were male and 1 female,with an average age of 28 years(22-33 years).The estimated dose was 8-20 g.All patients were treated with gastric lavage,catharsis,fluid replacement,blood perfusion,and in the early stage of treatment of epileptic seizures,the initial routine antiepileptic drugs had poor effect.Then propofol and midazolam were injected into the treatment.The epilepsy was relieved,but the condition deteriorated rapidly,and the patients died eventually.The literature search retrieved 3 patients in the 3 literatures included in the study were analyzed,and their clinical course was similar to that of 4 cases in the center.Necropsy was performedon all 3 patients,and the results were cerebral edema,diffuse cerebral edema,and hemorrhage around the basal ganglia.Conclusion Acute diquat poisoning can cause epileptic seizures.Once it occurs,the disease progresses rapidly and the prognosis is poor.The combination of large dose of sedative drugs can be used to treat epilepsy in order to improve the prognosis.