急性铊中毒14例临床分析  

Clinical analysis of acute thallium poisoning in fourteen patients

作　　者：张晓然[1] 邱泽武[2] 崔文华[2] 彭晓波[2] 

机构地区：[1]解放军军医进修学院 [2]军事医学科学院附属医院消化科

出　　处：《药物不良反应杂志》2013年第2期83-86,共4页Adverse Drug Reactions Journal

摘　　要：目的分析总结急性铊中毒的临床表现及治疗方法。方法收集2009至2011年军事医学科学院附属医院收治的所有急性铊中毒患者病历资料进行回顾性分析。结果 2009至2011年共收治急性铊中毒患者14例,男性8例,女性6例,年龄9~68岁,平均42岁。1例自诉被他人投毒;1例疑似误服;2例与铊中毒者有共同生活史;10例中毒原因不明。铊中毒早期临床表现主要为恶心、呕吐、腹痛等胃肠道症状(5例)和四肢麻木、酸胀疼痛、记忆力减退等神经系统症状(13例),10例出现肝功能异常,8例出现毛发脱落,1例指甲出现Mees纹。治疗前患者血铊浓度为3764.0~19.7μg/L,尿铊浓度为29 100.0~0.2μg/L,给予单纯支持(1例)、口服普鲁士蓝(4例)和口服普鲁士蓝联合血液灌流(9例)等治疗后,血铊浓度降至68.0~2.4μg/L,尿铊浓度降至542.0~11.3μg/L。13例出现神经系统症状者在住院期间症状明显缓解,但出院时仍有轻度四肢麻木、疼痛等症状。5例出现胃肠道症状者在1周内症状缓解或消失。10例出现肝功能异常者的肝酶水平在2~4周内恢复正常。8例毛发脱落者中5例在住院期间好转,3例未见明显变化。出现Mees纹者体征无变化。结论患者出现不明原因胃肠道症状且同时伴有神经系统症状时,应考虑重金属中毒的可能。普鲁士蓝联合血液灌流治疗铊中毒安全有效。Objective To analyze and summarize the clinical manifestations and treatments of acute thallium poisoning. Methods The clinical data of patients with acute thallium poisoning, who were hospitalized in Affiliated Hospital of Academy of Military Medical Science from 2009 to 2011 were collected and analyzed retrospectively. Results Fourteen patients with acute thallium poisoning comprised 8 males and 6 females with an average age of 42 years （ rang 9 to 68 ） were hospitalized from 2009 to 2011. Of them, 1 case complained poisoning by others; 1 case suspected poisoning by accidental mistake; 2 cases lived together with thallium poisoned patients; the other 10 poisoned cases were of unknown aetiology. The e/~rly clinical manifestations of thallium poisoning were gastrointestinal symptoms including nausea, vomiting, and abdominal pain （5 cases）, and neurological symptoms including acroanesthesia, pain, and memory loss （13 cases）. Ten patients developed abnormal hepatic function, 8 patients developed hair loss, and in one patient Mees line appeared. Before treatment, the patients＇ serum and urine thallium levels were 3764.0 to 19. 7 p^g/L and 29 100.0 to 0.2 I^g/L, respectively. After the supportive therapy （ 1 case）, prussian blue therapy （4 cases） and prussian blue combined with hemoperfusion therapy （9 cases）, the patients＇ serum and urine thallium levels decreased to 68.0 to 2.4 p^g/L and 542.0 to 11.3 p^g/L, respectively. Thirteen patients with neurological symptoms were markedly improved during the hospitalization period, but the mild aeroanesthesia and pain in limbs were still existed after discharge. The gastrointestinal symptoms in five patients were alleviated or disappeared within a week. The liver enzyme levels in ten patients with abnormal hepatic function returned to the normal levels within 2 to 4 weeks. Of the 8 patients with hair loss, 5 were improved during the hospitalization period, the other 3 had no obvious changes. No significant change of sign appeared in the patient w

关 键 词：铊 中毒 亚铁氰化物 血液灌流 

分 类 号：R595.2[医药卫生—内科学]