116例灭鼠药中毒患者的临床特征和用药分析

Analysis of Drug Use and Clinical Features in 116 Patients with Rodenticide Poisoning

目的分析灭鼠药中毒患者的临床特征和用药情况,为临床合理用药提供参考。方法回顾性分析2017年4月~2020年3月某院收治的116例灭鼠药中毒患者的临床资料,包括性别、年龄、灭鼠剂种类、住院时间、住院金额和实验室指标及用药情况包括药品数量、药品金额和用药频度(DDDs)、日均费用(DDC)、排序比(B/A)等。结果 116例灭鼠药中毒患者,男性66例(56.9%),年龄3~85岁,平均(43.0±18.7)岁;44例为急性神经毒性灭鼠剂中毒,62例为慢性抗凝血灭鼠剂中毒;慢性灭鼠剂中毒患者住院天数[17(9,29.25)d]最长,全体患者的住院天数为[11(6,18.75)d];急性灭鼠剂中毒患者的药品金额[0.80(0.46,1.40)万元]和住院金额[1.95(1.08,3.08)万元]最高,全体患者的药品金额和住院金额分别为[0.52(0.24,0.92)万元]和[1.46(0.80,2.40)万元];慢性灭鼠剂中毒患者凝血指标异常,治疗后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶原活动度(PTA)、纤维蛋白原(FIB)和国际标准化比值(INR)均较治疗前改善,治疗前后差异有统计学意义(P<0.05),急性灭鼠剂中毒患者血常规、凝血功能和肝肾功能治疗前后无明显差异。用药频度排序前3位的药品类别分别为血液系统药物、水电解质和酸碱平衡及营养类和肝胆用药;用药频度排序前3位的药品分别为维生素K1、还原型谷胱甘肽和奥美拉唑,急性组为神经节苷脂钠、还原型谷胱甘肽、奥美拉唑,慢性组为维生素K1、还原型谷胱甘肽、维生素B6。结论灭鼠药中毒应尽早给予解毒抢救、水电解质和酸碱平衡及营养类、护肝护胃等药物治疗。

OBJECTIVE To analyze the clinical features and drug use in rodenticide poisoning patients, and to provide reference for rational drug use. METHODS The clinical data of 116 patients with rodenticide poisoning admitted from April 2017 to March 2020 were retrospectively analyzed.The data included gender, age, types of rodenticides, the length of hospitalization, the amount of hospitalization, laboratory indicators and the amount of drugs, defined daily doses(DDDs), defined daily cost(DDC), consumption sum/DDDs sorts(B/A) were collected. RESULTS There were 66 males(56.9%) in 116 cases, aged 3-85 years, with an average age of(43.0±18.7)years.44 cases were acute neurotoxic rodenticide poisoning, and 62 cases were anticoagulant rodenticide poisoning in 116 cases.The patients with anticoagulant rodenticide had the longest hospital stay [17(9,29.25)d], the length of hospital stay for all patients was [11(6,18.75)d].The patients with acute rodenticide poisoning had the highest cost for drug [0.80(0.46,1.40)ten thousand yuan] and hospitalization[1.95(1.08,3.08)ten thousand yuan], the amount of drug and hospitalization for all patients were [0.52(0.24,0.92)ten thousand yuan] and [1.46(0.80,2.40)ten thousand yuan]respectively.After treatment, levels of prothrombin time(PT), activated partial thromboplastin time(APTT), prothrombin activity(PTA), fibrinogen(FIB) and international standardized ratio(INR) in patients with anticoagulant rodenticide were significantly improved compared with those before treatment(P<0.05). There were no significant differences in blood routine, coagulation function, liver and kidney function in patients with acute rodenticide poisoning before and after treatment.The top 3 kinds of drugs ranked by DDDs were blood system drugs, water-electrolyte acid-base balance regulating drugs and nutrients drugs and hepatobiliary drugs.The top 3 drugs ranked by DDDs were vitamin K1, reduced glutathione and omeprazole, respectively.DDDs in patients with acute neurotoxic rodenticide were ganglioside sodium, reduced glutathione, omeprazole.DDDs in patients with anticoagulant rodenticide were vitamin K1, reduced glutathione and vitamin B6. CONCLUSION The rodenticide poisoning should be given detoxification drugs, water-electrolyte acid-base balance regulating drugs, nutrition, liver and stomach protection and other drugs treatment as soon as possible.