急性铊中毒4例临床救治分析

Four case studies with clinical treatments for acute thallium poisoning

本文对2011年9月—2019年9月郑州大学第一附属医院收治的4例铊中毒患者进行回顾性分析,以了解铊中毒患者的临床特征及救治方法。4例患者中位确诊时间38 d,其中2例患者在诊疗过程中均被误诊为格林巴利综合征,3例患者出现脱发,2例患者在治疗期间发现米氏纹。4例患者均出现不同程度的心动过速,1例患者出现声音嘶哑,1例出现胸背部疼痛,1例出现消化道出血,1例出现心脏骤停,2例出现呼吸衰竭。给予普鲁士蓝口服,二巯基丙磺酸钠肌注及血液净化等驱铊治疗。1例因中毒量大,病情迅速恶化,放弃治疗,其余3例患者均好转或治愈。铊中毒最易被误诊为吉兰巴雷综合征,鉴别除了毒物接触史外,下肢肌肉疼痛、脱发、米氏纹均为特征性的表现。铊中毒的患者应尽早给予二巯基丙磺酸钠、普鲁士蓝、血液净化联合治疗,迅速地降低患者体内的铊浓度。

This paper reviews the clinical characteristics and treatment of 4 patients with thallium poisoning treated in our hospital from September 2011 to September 2019.The median diagnosis time of the 4 patients was 38 days,of which 2 patients were misdiagnosed as Guillain-Barre syndrome during diagnosis and treatment,3 patients had alopecia,and 2 patients found Mees'lines during treatment.All 4 patients had tachycardia of varying degrees,1 patient had hoarseness,1 patient had chest and back pain,1 patient had gastrointestinal bleeding,1 patient had cardiac arrest,and 2 patients had respiratory failure.The treatment was given by oral Prussian blue,intramuscular injection of sodium dimercaptopropyl sulfonate and blood purification.Due to the large amount of poisoning,the condition of 1 patient deteriorated rapidly and gave up treatment,and the other 3 patients were improved or cured.Thallium poisoning is most commonly misdiagnosed as Guillain-Barre syndrome.In addition to the history of exposure to the poison,pain in the muscles of the lower extremities,alopecia,and Mees'lines are the characteristic manifestations in the differential diagnosis.Combined treatment with sodium dimercaptopropanesulfonate,Prussian blue and blood purification should be given to patients with thallium poisoning as soon as possible to rapidly reduce the concentration of thallium in the body and improve the prognosis of patients.