抗凝血杀鼠剂中毒27例误诊误治剖析

摘要

Objective To analyze clinical characteristics and misdiagnosis causes of anticoagulant rodenticide poisoning in order to improve final diagnosis rate.Methods Clinical data of 27 misdiagnosed patients with anticoagulant rodenticide poisoning admitted during December 2013 and September 2016 was retrospectively analyzed.Results The misdiagnosed time was 1 day-7 months, and the average time was 24.8 days.Clinical manifestations were 23 patients with hematuria, 10 patients with gingival (oral) bleeding, 8 patients with otorrhagia or nasal bleeding, 5 patients with limb pain or activity limitation, 4 patients with vaginal bleeding or menorrhagia, 2 patients with back pain, 2 patients with abdominal pain and 1 patient with hematochezia and 1 patient with disorders of hemostasis.The misdiagnosed time was 43 times including 14 diseases, and the top four misdiagnosed diseases were as follow ureteral calculi, coagulation disorders, urinary infection and gingival bleeding.There were 21 patients with different degrees of anemia and 19 patients with coagulation disorders.There were 18 patients with brodifacoum, 18 patients with bromadiolone and 9 patients with brodifacoum and bromadiolone by blood detection.After confirming the diagnosis, the patients received treatments such as fluid replacement and decorporation, vitamin K1 supplement, plasma infusion and hemoperfusion with good prognoses.Conclusion Anticoagulant rodenticide poisoning is insidious with various clinical manifestations, and therefore clinicians should give related examinations in time in order to avoid misdiagnosis and mistreatment for highly suspected patients with anticoagulant rodenticide poisoning.%目的 分析抗凝血杀鼠剂中毒的临床特征及误诊原因,提高确诊率.方法 对我院2013年12月-2016年9月收治的曾误诊为其他疾病的抗凝血杀鼠剂中毒27例的临床资料进行回顾性分析.结果 本组误诊时间1 d~7个月,平均24.8 d;临床表现为尿血(血尿)23例,牙龈(口腔)出血10例,耳鼻出血8例,肢体疼痛(或活动受限)5例,阴道出血(月经量多)4例,腰痛、腹痛各2例,便血、凝血功能异常各1例.误诊43例次14种疾病,居前4位的分别是肾输尿管结石、凝血功能障碍、泌尿系感染和牙龈出血.本组有不同程度的贫血21例,出现凝血功能障碍19例,血液中检测到溴鼠灵、溴敌隆各18例,同时检出溴鼠灵和溴敌隆9例.均确诊为抗凝血杀鼠剂中毒,予补液促排、补充维生素K1、输注血浆、血液灌流等治疗,预后良好.结论 抗凝血杀鼠剂中毒起病隐匿,临床表现多样,对高度怀疑中毒者,及时行相关检查,减少误诊误治.