9例敌草快中毒患儿的急性期临床特点和随访结局

Acute clinical characteristics and follow-up outcome of 9 pediatric patients with diquat poisoning

目的总结敌草快对中毒患儿器官功能的长期影响,从而为临床医生提供诊治经验。方法采用回顾性研究方法。选择2018年11月至2021年12月中国医科大学附属盛京医院小儿重症监护病房(PICU)收治的9例敌草快中毒患儿急性期的临床资料,并对其进行出院后1年的跟踪随访,判断敌草快对中毒患儿的长期影响。结果9例中毒患儿中3例为误服敌草快,药量较少,6例为自行口服。7例患儿中毒后出现不同程度的消化道症状,如恶心、呕吐、腹痛;3例患儿出现呼吸道症状,呼吸急促、胸闷、胸痛;1例患儿出现泌尿系统症状,少尿;1例患儿出现神经系统症状,精神萎靡。器官损伤情况:急性肾损伤3例,肺损伤3例,肝损伤1例,心肌损害1例,横纹肌溶解症1例。入院后给予患儿洗胃、吸附、导泻、抗氧化等对症治疗,5例给予血液灌流,1例给予血浆置换,2例给予连续性肾脏替代治疗(CRRT),住院时间3~16 d,所有患儿病情均好转后出院,后续随访无器官功能损伤。结论敌草快中毒可引起肺、肝、肾功能及横纹肌在内的器官损伤,但经积极治疗后预后相对良好,无长期后遗症发生,中毒后尽快阻止毒物吸收,促进毒物排泄,抗氧化及血液净化治疗可减轻器官功能损伤及改善预后。

Objective To summarize the long-term effect of diquat on organ function in poisoned children,so as to provide experience in diagnosis and treatment for clinicians.Methods A retrospective study method was adopted.The clinical data of 9 children with diquat poisoning treated in the department of pediatric intensive care unit(PICU)of Shengjing Hospital Affiliated to China Medical University from November 2018 to December 2021 were selected,and they were followed up for one year after discharge,in order to judge the long-term effects of diquat on the poisoned children.Results Among the 9 cases,3 cases were taken by mistake with low dose,6 cases were taken orally by themselves.After poisoning,7 cases had different degrees of gastrointestinal symptoms,such as nausea,vomiting,abdominal pain;3 cases had respiratory symptoms,including shortness of breath,chest tightness,chest pain;1 case had urinary symptom,oliguria;1 case had neurdogical symptom,lethargy.Organ injury:acute renal injury in 3 cases,lung injury in 3 cases,liver injury in 1 case,myocardial injury in 1 case,rhabdomyolysis in 1 case.After admission,the children were given symptomatic treatment such as gastric lavage,adsorption,catharsis and antioxidation,5 cases were given hemoperfusion,1 case was given plasma exchange,and 2 cases were given continuous renal replacement therapy(CRRT).The hospitalization time was 3-16 days.All the children were discharged after improvement,and no organ function damage was found in the follow-up.Conclusions Diquat poisoning can cause organ damage including lung,liver and kidney function and striated muscle.However after active treatment,the prognosis is relatively good,and no long-term sequelae.It is crucial to prevent poison absorption and facilitate poison excretion immediately after poisoning.Implementing antioxidation and blood purification therapy can help minimize organ function damage and enhance prognosis.