19例重症野生毒伞蕈中毒临床分析

The clinical study of 19 cases with serious Amannita phalloides poisoning

目的 探讨毒伞蕈中毒的临床特征及其治疗方法。方法 研究本市一起 1 9例野生毒伞蕈中毒患者的临床表现、实验室结果、重要器官的组织学改变、对治疗的反应。结果 全部患者均于 1h内出现严重的恶心、呕吐、腹痛、腹泻等胃肠道症状 ,一老妇和一男童于中毒后 6h内死亡 ,其余患者胃肠道症状均于 2 4h内缓解。中毒后 4～ 5d ,1 0例患者出现不同程度的出血、黄疸、神经精神症状 ;辅助检查发现 ,这些患者均有严重的转氨酶升高、黄疸、内源性凝血功能异常、部分患者胆酶分离 ,组织学检查示肝小叶破坏、肝细胞广泛坏死 ;入院后给予积极的透析、保肝、抗炎、抗氧化、支持等治疗 ,透析后凝血功能很快恢复 ,但肝功能恢复缓慢 ,这 1 0例患者中 7例死亡 ,3例痊愈出院。另外 7例患者在胃肠道症状缓解后无后续症状。中毒后半年、1年随访 ,存活的1 0例患者未发现异常。结论 毒伞蕈中毒以损伤肝脏为主 ,在胃肠道症状后有 2～ 3d的假愈期 ,早期检查肝功能 ,及时透析和有关综合治疗是避免发生致死性肝损害的唯一途径 。

Objective To investigate the clinical character of Amanita phalloides poisoning and effective treatment.Methods The clinical phenomena,laboratory test,histological changes of important organ and results of treatment about a disaster of 19 Amanita phalloides poisoning patients were studied.Results All 19 patients came from a large family had serous nausea,vomiting,abdominalgia and diarrhea in one hour after eating Amanita phalloides cooked thoroughly.A 73 years old woman and 3 years old boy died in 6 hours after poisoning.Other 17 patients' gastrointestianal tract symptom disappeared in 24 hours after poisoning.But,when 4 to 5 days post poisoning,10 patients became to have jaundice,hemorrhage,nervous and mental abnormality.Laboratory assay showed that these serious sick patients had obvious transaminase and cholerythrin elevation,endogenic blood coagulation system disorder.Someone showed dissociation of transaminase and cholerythrin.The biopsy showed extensive liver cell necrosis with the destruction of hepatic lobule.The hemodialysis or petritoneal dialysis as well as the regime of protective liver,anti inflammation,anti oxidation,and supporting treatment were carried out.After dialysis,the coagulation function recovered rapidly,but not for the liver function. Anyhow,7 of the 10 serious ill patients died in a week after poisoning,3 of the 10 were full recovered in a month post poisoning.The other 7 patients had not secondary symptom after the gastrointestinal symptom.The all alive 10 patients showed normal when be investigated half a year and a year later.Conclusion Amanita phalloides toxin chiefly attacks the liver cells.There is a pseudo cured time about 3 to 4 days after the gastrointestinal symptom.It is the best way to check the liver function and dialysis as well as other colligating treatment as early as possible.It is a signal suggesting death that if anyone had serious elevation or dissociation of transaminase and cholerythrin.