抗凝血杀鼠剂中毒71例临床分析

摘要

目的 总结抗凝血杀鼠剂中毒的临床特征及治疗效果,以提高对该病的认识和诊治水平.方法 选取2013-12～2016-09全军中毒救治中心收治的71例第二代抗凝血杀鼠剂中毒住院患者为研究对象,对其一般情况、中毒原因、中毒时间、临床表现、血红蛋白及凝血功能、毒检等化验指标,诊治及预后情况进行回顾性分析.结果 71例患者男性44例,女性27例,平均年龄40岁(15 ～79),平均中毒时间12 d,平均住院时间12 d,轻度中毒10人,中度中毒24人,重度中毒37人.出院时凝血功能较入院时明显好转,差异有统计学意义(P＜0.05).入院时维生素K1平均用量为60 mg/d,出院时为10 mg/d,出院后平均停药时间为3个月,平均停药时毒检为11 ng/mL.42例患者为要求出院,29例为好转出院.尿血(血尿)、牙龈出血(口腔)、(耳)鼻出血是该病的主要首发症状.患者的性别、中毒原因、入出院凝血功能指标(PT、APTT、活动度)有明显的差异性.患者的中毒时间与入院凝血功能、毒检量有相关性,差异有统计学意义(P＜0.05).维生素K1用量与凝血功能指标、血红蛋白、毒检量有相关性,差异有统计学意义(P＜0.05).停药时间与毒检量有相关性,差异有统计学意义.2例患者出院后未用维生素K1,不治死亡.结论 对不明原因出现尿血(血尿)、牙龈出血(口腔)、(耳)鼻出血等症状患者,应考虑抗凝血杀鼠剂中毒可能.维生素K1为抗凝血杀鼠剂中毒的特效拮抗剂,维生素K1用量及用药时间与毒物浓度、凝血酶原时间呈正相关,与凝血酶原活动度、血红蛋白呈负相关,治疗上应根据凝血功能和体内毒物浓度逐渐调至最低维生素K1用量,适时补充悬浮红细胞.%Objective To summarize the clinical characteristics and therapeutic effect of second-generation anticoagulant rodenticide poisoning,so as to improve the understanding and diagnosis and treatment of this disease.Methods We retrospectively analyzed 71 misdiagnosed cases with anticoagulant rodenticide poisoning,admitted to Poisoning Treatment Center of the Army during December 2013 and September 2016,including the general situation,the cause of poisoning,poisoning time,clinical manifestation,hemoglobin and blood coagulation function,poison detection,diagnosis,prognosis and so on.Results 71 patients with anticoagulant rodenticide poisoning comprised 44 males and 27 females with an average age of 40 years (15 to 79).The average poisoning time was 12 days,and the average hospitalization time was 12 days.10 patients were mild poisoning,24 patients were moderate poisoning,and 37 patients were severe poisoning.The index of blood coagulation function was significantly better than that of admission,which was statistically significant.The average amount of vitamin K1 intake was 60 mg/d,the dosage was 10 mg/d after discharge,the average vitamin K1 time of withdrawal was 3 months after discharge,and the average concentration of anticoagulant rodenticide was 11 ng/mL when vitamin K1 was stopped.42 patients required discharge,and the other 29 cases were discharged after improvement.Hematuria,gingival bleeding (oral),and (ear) nasal bleeding were the main symptoms of the disease.There were significant differences in the gender,the causes of poisoning,and the indexes of blood coagulation (PT,APTT,activity).There was a significant correlation between the time of poisoning and the function of blood coagulation and the amount of poison.There was a correlation between the amount of vitamin K1 and the indexes of blood coagulation function,hemoglobin and poison.Vitamin K1 withdrawal time was correlated with the amount of toxicant,which was statistically significant.2 patients did not use vitamin K1 after discharge,and died.Conclusion The patients with unexplained hematuria,(mouth) bleeding gums,(ears) nasal bleeding and other symptoms should be considered anticoagulant rodenticide poisoning.Vitamin K1 is a specific antagonist of anticoagulant rodenticide poisoning.The dosage of vitamin K1 and the time of drug use are positively correlated with the concentration of toxin and prothrombin time,but negatively correlated with prothrombin activity and hemoglobin.The treatment should be based on coagulation function and the concentration of anticoagulant rodenticide gradually adjust the amount of vitamin K1,timely supplement of red blood cells.