急性1,2-二氯乙烷中毒脑脊液常规指标的动态监测  

Dynamic monitoring on common indicators of cerebrospinal fluid of acute 1,2-dichloroethane poisoning patients

作　　者：杨志前[1] 范远玉[1] 张伊莉[1] 陈育全[1] 刘移民[1] YANG Zhiqian;FAN Yuanyu;ZHANG Yili;CHEN Yuquan;LIU Yimin(Guangzhou Twelfth Municipal People’s Hospital,Guangzhou,Guangdong 510620,China)

机构地区：[1]广州市第十二人民医院,广东广州510620

出　　处：《职业卫生与应急救援》2020年第4期361-364,共4页Occupational Health and Emergency Rescue

基　　金：广东省医学科学技术研究基金项目(A2016429);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：目的探讨脑脊液(cerebral spinal fluid,CSF)常规检查在急性1,2-二氯乙烷(1,2-DCE)中毒诊治中的价值。方法68例急性1,2-DCE中毒患者入院后行CSF压力、常规及生化检查,并在病程中动态监测及分析CSF各项指标的变化。结果急性1,2-DCE中毒患者入院时CSF外观无色透明、细胞数均正常;CSF压力增高阳性率为47.1%(32/68),其中脑水肿组为66.7%,无脑水肿组无增高;脑水肿组CSF压力均值高于无脑水肿组(P<0.01);蛋白质浓度正常或轻微升高占16.2%,无脑水肿组总蛋白与白蛋白浓度高于脑水肿组(P<0.05);葡萄糖和氯化物大致正常;重度中毒组CSF压力均值显著高于轻度中毒组(P<0.05);急性1,2-DCE中毒患者入院后CSF压力持续升高,于病程(脱离接触)31~60 d最高,治疗后期患者CSF压力恢复缓慢,CSF压力的回落滞后于高颅压的临床表现及CT、MR等影像学改变。结论动态监测CSF压力及各项常规指标对急性1,2-DCE中毒的临床诊治具有重大价值。Objective To explore the role of routine cerebrospinal fluid(CSF)examination in diagnosis and treatment of acute 1,2-dichloroethane(1,2-DCE)poisoning.Methods A total of 68 patients with acute 1,2-DCE poisoning were dynamically examined for CSF pressure,routine and biochemical examination after their admission to hospital,and the changes of CSF indexes were analyzed.Results On admission,the patients’CSF was colorless and transparent and the cell number was normal.Totally 32 cases(47.1%)had pressure increase;66.7%of the patients with brain edema had CSF pressure increase,while no occurrence among patients without brain edema.The CSF pressure of patients with brain edema was higher than the patients without brain edema(P<0.01);16.2%patients had normal or slightly increased protein concentration;the total protein and albumin concentrations of patients without brain edema were higher than patients with brain edema(P<0.05).The glucose concentration and chloride concentration in the patients were mostly normal.The mean value of CSF pressure in patients with severe poisoning was significantly higher than the patients with mild poisoning(P<0.05).The CSF pressure continued to rise after admission,and reached the peak at 31-60 days of the disease course.In the later stage of treatment,the CSF pressure recovered very slowly and lagged behind improvement of clinical manifestations of high cranial pressure or examination of CT,MR and other imaging.Conclusion Dynamic monitoring on CSF pressure and routine indexes is of great value in the clinical diagnosis and treatment of acute 1,2-DCE poisoning.

关 键 词：1 2-二氯乙烷 中毒 中毒性脑病 脑脊液 脑水肿 

分 类 号：R135.1[医药卫生—劳动卫生]