职业性急性草酸二甲酯中毒性肾病临床分析  

Clinical analysis of occupational acute toxic nephropathy by dimethyl oxalate

作　　者：徐沙 凌瑞杰 汪毅 XU Sha;LING Ruijie;WANG Yi(Hubei Provincial Hospital of Integrated Chinese and Western Medicine,Hubei Hospital of occupational disease,Wuhan,Hubei 430015,China)

机构地区：[1]湖北省中西医结合医院湖北省职业病医院,湖北武汉430015

出　　处：《中国职业医学》2018年第4期489-491,共3页China Occupational Medicine

摘　　要：目的探讨职业性急性草酸二甲酯(DMO)中毒性肾病病例临床特点及治疗方法。方法对1例职业性急性DMO中毒病例的职业史、临床表现、实验室检查、治疗等临床资料进行回顾性分析。结果患者短期内接触大量DMO,出现头晕、乏力、恶心、呕吐、腹胀、少尿等症状。于病程48 h时肾小球滤过功能降低,血清尿素氮为21.9 mmol/L、血清肌酐为788μmol/L;肾穿刺活检显示出现肾小球节段系膜增生性病变,肾小管间质病变,小动脉内膜增厚,玻璃样变性。早期予血液透析及血液灌流、激素冲击疗法、保护心肌、肾功能、改善循环等治疗,临床预后良好。结论职业性急性DMO中毒临床表现以急性肾损伤为主,应早期予血液净化治疗和激素冲击治疗。Objective To investigate the clinical features and treatment methods of occupational acute dimethyl oxalate（DMO） toxic nephropathy. Methods Occupational history,clinical manifestation,laboratory examination and therapy of one occupational DMO poisoning case were retrospectively analyzed. Results The patient was exposed to a large amount of DMO in a short time,with the main symptoms of dizziness,fatigue,nausea,vomiting,bloating,and oliguria.Glomerular filtration reduced after 48 hours of disease onset,serum urea nitrogen was 21. 9 mmol/L and serum creatinine was 788 μmol/L. Renal biopsy showed glomerular mesangial proliferative lesions,tubulointerstitial lesions,small arterial intima thickening and hyaline degeneration. Early treatment,including hemodialysis,hemoperfusion,hormone shock therapy,protection of myocardium,renal function,and improvement of circulation achieved a good clinical prognosis.Conclusion The main clinical manifestation of acute DMO poisoning is acute kidney injury. Blood purification treatment and hormone shock therapy should be used early.

关 键 词：草酸二甲酯 中毒性肾病 急性肾损伤 职业中毒 治疗 

分 类 号：R135[医药卫生—劳动卫生]