职业性急性草酸二甲酯中毒致急性肾损伤5例  

Five cases of acute kidney injury caused by occupational acute dimethyl oxalate poisoning

作　　者：余溱 吴歌[1] YU Qin;WU Ge(The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450001, China)

机构地区：[1]郑州大学第一附属医院,河南郑州450001

出　　处：《中国职业医学》2018年第3期355-358,362,共5页China Occupational Medicine

基　　金：河南省科技厅项目(132300410110)

摘　　要：目的探讨职业性急性草酸二甲酯(DMO)中毒所致急性肾损伤的临床特点及治疗方法。方法回顾性分析5例职业性急性DMO中毒所致急性肾损伤患者临床资料。结果急性事故后现场调查可见工作场所有大量的DMO晶体。5例患者急性起病,主要表现为头晕、乏力、恶心、呕吐、纳差、腰腹痛、皮肤烧灼感、少尿,脖颈、前胸、会阴部可见皮肤脱屑,并出现低钙、贫血、肺部感染;实验室检查显示急性肾功能损伤,起病时肌酐159~421μmol/L,病程中肌酐最高可达848μmol/L。1例患者肾脏病理活检显示急性肾小管损伤,小管管腔可见草酸盐结晶沉积。4例少尿患者经血液净化(以血液透析为主,间断行连续性血液滤过和血液灌流)联合抗氧化应激、护肝、营养支持等对症支持治疗后,肾功能均恢复正常。结论职业性急性DMO中毒主要导致肾损伤;治疗以血液透析、抗氧化应激为主,预后较好。Objective To investigate the clinical features and treatment methods of acute kidney injury induced by occupational acute dimethyl oxalate（ DMO） poisoning.Methods Retrospective analysis was performed on the clinical data of 5 patients with acute kidney injury induced by occupational DMO poisoning.Results A large number of crystals of DMO were found in the workplace in field investigation.Five patients had acute onset.The main manifestations included dizziness,fatigue,nausea,vomiting,anorexia,lumbar and abdominal pain,skin burning sensation,oliguria,peeling changes on the skin of neck,the front chest and perineum,and low calcium,anemia,and pulmonary infection.The laboratory examinations suggested acute kidney injury,creatinine at the onset was 159-421 μmol/L.The highest creatinine level was up to 848μmol/L in the course.The renal pathology of a case suggested acute tubular injury with tubular deposition of oxalate crystals in the lumen.After blood purification（ treated with hemodialysis mainly,combined with continuous hemofihration and hemoperfusion intermittently） combined with anti-oxidative stress,liver protection,nutritional support and other symptomatic treatment,renal function of the 4 cases with oliguria returned to normal.Conclusion Occupational acute DMO poisoning mainly leads to kidney injury.The treatment is mainly based on hemodialysis and anti-oxidative stress.The prognosis of patients is good.

关 键 词：草酸二甲酯 急性肾损伤 中毒 治疗 血液净化 血液透析 

分 类 号：R135[医药卫生—劳动卫生]