抗凝血类灭鼠剂中毒的诊治分析

Analysis of diagnosis and treatment of anticoagulant rodenticide poisoning

目的:通过对抗凝血类灭鼠剂中毒患者的临床特征分析,探讨抗凝血类灭鼠剂中毒的临床特征、治疗方案和再发出血的原因。方法:回顾性分析28例抗凝血类灭鼠剂中毒患者的病例资料及患者出院后进行电话随访,分析其中毒原因、临床表现、实验室检查、诊断、治疗及预后情况。结果:共有28例抗凝血类灭鼠剂中毒患者,男16例,女12例。3例为皮肤接触,23例为口服,2例不详。口服患者5例为敌鼠钠,15例为溴敌隆,3例为嗅鼠灵,口服患者中有10例为服用沾有灭鼠剂的食物。在首诊的28例中,急诊内科15例、儿科4例、精神病重症监护病房(PICU)1例、血液内科4例、耳鼻咽喉科2例、泌尿外科1例、妇科1例。其中发生误诊漏诊6例,儿科1例、PICU1例、耳鼻咽喉科2例、泌尿外科1例、妇科1例。(1)治疗前检测血常规:28例平均血红蛋白为87 g/L(52 g/L^133 g/L),血小板计数均在正常范围。(2)28例中26例出现凝血功能异常,对这些病例的凝血功能变化按照治疗前及治疗后进行比较。治疗前后凝血功能变化:经维生素K_1治疗后第1天、第2天、第5天检测的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)与治疗前比较显著缩短,差异有统计学意义(P<0.01)。对所有患者进行维生素K_(1)10~40 mg/天静脉滴注治疗,2~5天后26例有出血症状的患者出血症状改善,凝血功能恢复正常。随访至患者出院后半年,4例失访,共6(6/24)例出院后再次出现凝血功能障碍就诊,复发率25%;其中4例在1月内再次出现凝血功能异常,1例在3月后出现凝血功能异常,1例在6月后出现出血,无死亡病例。结论:临床医师应提高对抗凝血类灭鼠剂中毒的认识。在治疗上,应予维生素K长期治疗。

Objective:To investigate the clinical characteristics, treatment and recurrence of bleeding poisoning of anticoagulant rodenticide by analysing the clinical characteristics of anticoagulant rodenticide poisoning patients. Methods:A retrospective analysis of 28 cases of discharged patients of anticoagulant rodenticide poisoning patients and the telephone follow-up were carried out, and the cause of poisoning, clinical manifestation, laboratory examination, diagnosis, treatment and prognosis were analyzed.Results:In 28 patients,there were 16 males and 12 females.3 cases of skin contact, 23 cases of oral, 2 was unknown. 5 patients with oral diphacin, 15 cases of bromadiolone, 3 cases of brodifacoum. 10 oral patients with rodenticide food. In the first diagnosis of 28 cases, there were 15 cases of emergency internal medicine, 4 cases of pediatrics, 1 case of PICU, 4 cases of blood medicine, 2 cases of ear, nose and throat department, 1 case of urology and 1 case of gynecology. Among them, there were 6 cases of misdiagnosis and missed diagnosis, 1 case of pediatric patients, 1 case of PICU, 2 cases of ENT department, 1 case of urology department and 1 case of gynecology.(1)Blood routine examination before treatment:In 28 patients,the average hemoglobin was 87g/L(52g/L^133g/L),platelet counts were within the normal range.(2)There were 26 cases of abnormal coagulation function in 28 patients. The changes of coagulation function were compared before and after treatment. Coagulation function changes before and after treatment:PT,APTT and INR of first day, second day and fifth day after vitamin K_1 treatment were significantly shorter than before treatment, the difference was statistically significant(P<0.01). For all patients with vitamin K_1 10 ~ 40mg/day of intravenous infusion treatment, the bleeding symptoms of 26 cases with bleeding improved after 2 to 5 days, blood coagulation function returned to normal. Follow up to six months after discharge, 4 patients lost to follow-up, 6(6/24) patients with recurrence of coagulation disorders, the recurrence rate of 25%; among them, 4 cases with abnormal coagulation function within 1 month, 1 case with abnormal coagulation function after 3 months, 1 case with bleeding after 6months, here was no death case. Conclusions:Clinicians should improve the knowledgement of anticoagulant rodenticide poisoning. In the treatment, we should be treated with vitamin K for a long time.