急性铊中毒30例误诊误治分析  

Analysis of Misdiagnosis and Mistreatment of 30 Patients with Acute Thallium Poisoning

作　　者：董建光 赵骏秀 高萌 刘仲英 张韧铮 邱泽武 DONG Jian-guang;ZHAO Jun-xiu;GAO Meng;LIU Zhong-ying;ZHANG Ren-zheng;QIU Ze-wu(Department of Poisoning Treatment,the Fifth Medical Center of PLA General Hospital,Beijing 100071,China)

机构地区：[1]解放军总医院第五医学中心(南院区)中毒救治科,北京100071

出　　处：《临床误诊误治》2020年第9期10-13,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析急性铊中毒的临床特征及误诊原因、防范措施。方法回顾性分析误诊为其他疾病的急性铊中毒30例的临床资料。结果本组7例明确为他人投毒,23例中毒史不详;主要表现为双下肢或四肢疼痛、肢体麻木、腹痛、脱发等症状。本组误诊时间2 d^1年,平均65.3 d;误诊为Guillain-Barre综合征6例,急性胃肠炎4例,周围神经病、胰腺炎、阑尾炎各2例,急性炎症性脱髓鞘性多发性神经病、多发性周围神经炎、癔症、躯体形式障碍、胸膜炎、胃肠感冒、神经炎、痛风、腰椎间盘突出症、胆囊炎、结肠炎、胃炎、类风湿关节炎、急腹症各1例。所有患者入院后均完善血细胞分析、生化检查、凝血功能检测、毒物检测、头颅CT、头颅MRI、肌电图、心电图等医技检查,结合临床表现,确诊为急性铊中毒,给予补液促排、口服普鲁士蓝、营养神经、维持水电解质平衡、血液净化等对症支持治疗。29例病情好转或痊愈出院,1例死亡。出院后随访3~6个月,重症4例遗留神经系统损伤后遗症。结论急性铊中毒起病隐匿,临床表现多样,对于高度怀疑铊中毒患者,尤其是相继出现消化系统症状、神经系统损伤、脱发等时,要尽快完善相关检查,争取早期明确诊断,以改善预后。Objective To analyze the clinical characteristics of acute thallium poisoning,the causes of misdiagnosis and preventive measures.Methods The clinical data of 30 cases of thallium poisoning misdiagnosed as other diseases was analyzed retrospectively.Results In this group,7 cases were definitely poisoned by others,while the other 23 patients had no definite history of poisoning.The main manifestations were limb pain,numbness,abdominal pain and alopecia.The duration of misdiagnosis was 2 d to 1 year,with an average of 65.3 d.Six cases were misdiagnosed as Guillain Barre syndrome,4 cases as acute gastroenteritis,2 cases as peripheral neuropathy,2 cases as pancreatitis and 2 cases as appendicitis,as well as 1 case of acute inflammatory demyelinating polyneuropathy,multiple peripheral neuritis,hysteria,somatoform disorder,pleurisy,gastrointestinal cold,neuritis,gout,prolapse of lumbar intervertebral disc,cholecystitis,colitis,gastritis,rheumatoid arthritis and acute abdomen,respectively.After admission,all patients received blood cell analysis,biochemical examination,coagulation function test,poison detection,head CT,head MRI,electromyography,electrocardiogram and other medical and technical examinations.Combined with clinical manifestations,they were diagnosed as acute thallium poisoning.They were given symptomatic and supportive treatment such as rehydration to promote excretion,oral Prussian blue,drugs to nourish nerves,maintaining water electrolyte balance,and blood purification.Twenty-nine cases were discharged with improved condition or after recovery,and 1 case died.During 3-6 month follow-up after discharge,4 severe patients had sequelae of nervous system injury.Conclusion Thallium poisoning is occult at the beginning and has various clinical manifestations.For those who are highly suspected of poisoning,especially those who have symptoms such as digestive system symptoms,nervous system injury,and hair loss,timely and relevant laboratory tests should be performed,to make definite diagnosis and reduce misdiagnos

关 键 词：中毒 铊 误诊 GUILLAIN-BARRE综合征 胃肠炎 胰腺炎 阑尾炎 癔症 

分 类 号：R595.2[医药卫生—内科学]