以低钾血症为突出表现的急性三甲基氯化锡中毒临床分析  

Acute trimethyltin chloride poisoning with hypokalemia as prominent manifestation

作　　者：杨志前[1] 范远玉[1] 张程[1] Yang Zhiqian;Fan Yuanyu;Zhang Cheng(Occupational Disease Department,Guangzhou Twelfth Municipal People’s Hospital,Guangzhou 510620,China)

机构地区：[1]广州市第十二人民医院职业病科,510620

出　　处：《国际医药卫生导报》2020年第14期2021-2024,共4页International Medicine and Health Guidance News

基　　金：广州市高水平临床重点专科建设项目(职业病科)(穗卫函〔2019〕1555号)。

摘　　要：目的分析三甲基氯化锡(trimethyltin chloride,TMT)对接触者血钾、尿锡及醛固酮水平的影响,探讨有机锡引起低钾血症的机制。方法收集2006年5—8月某塑料制品厂急性TMT中毒事故中29名TMT接触工人的临床资料,对中毒患者临床特点、TMT接触人员的血钾、尿锡、血浆醛固酮等资料进行回顾性分析。结果确诊急性TMT中毒10例,中毒患者病程中均出现重度低钾血症(血钾<2.5 mmol/L),但中枢神经受损表现不明显,住院治疗后血钾于5~25 d后恢复;尿锡浓度与脱离接触TMT的时间(天数)呈显著负相关关系(r=-0.917,P<0.01);1例患者病程中血浆醛固酮异常增高;29例TMT接触人员,血钾偏低18例(62.1%),血钾与尿锡呈显著负相关关系(r=-0.515,P<0.01)。结论急性TMT中毒血钾降低与中枢神经受损程度不平行,血钾是有机锡接触人员良好的生物监测指标,接触有机锡后出现低钾血症,推测可能与醛固酮分泌增多有关。Objects To analyze the changes of serum potassium(K+),urinary tin and aldosterone in workers exposed to trimethyltin chloride(TMT),and to explore the mechanism of hypokalemia induced by organotin.Methods 29 workers who exposed to TMT in a plastic product factory that had an acute TMT poisoning accident from May to August,2006 were selected as research objects.Their clinical data were collected.Their clinical characteristics,blood potassium,urine tin,plasma aldosterone,and other data were retrospectively analyzed.Results 10 cases were diagnosed with acute TMT poisoning,with severe hypokalemia(blood potassium<2.5 mmol/L)in the course of disease,but no obvious central nerve damage.After 5 to 25 days’treatment,the workers'serum potassium increased to normal level.There was a negative correlation between urinary tin contents and the disengage time from TMT(r=-0.917,P<0.01).One patient had an abnormal increase of plasma aldosterone.Among the 29 cases,18(62.1%)had hypokalemia,and their serum potassium had a negative correlation with urinary tin(r=-0.515,P<0.01).Conclusion The decrease of blood potassium in patients with acute TMT poisoning is not parallel to the degree of central nervous damage.Blood potassium is a good biological monitoring indicator for organotin exposed persons.After contacting organotin,the workers’emergence of hypokalemia may be related to the increase of aldosterone secretion.

关 键 词：有机锡 三甲基氯化锡 低钾血症 醛固酮 

分 类 号：R135.1[医药卫生—劳动卫生]