儿童抗凝血灭鼠药中毒流行病学与防治探讨  

Epidemiology and prevention of anticoagulant rodenticide poisoning in children

作　　者：陈小龙 沈亚娟[1] 陈桂锋[1] 谢晓恬[2] CHEN Xiaolong;SHEN Yajuan;CHEN Guifeng;XIE Xiaotian(Department of Pediatrics,First People′s Hospital of Jiashan County,Zhejiang Province 314100,China;Department of Pediatrics,Tongji Hospital affiliated to Tongji University,Shanghai 200065,China)

机构地区：[1]浙江省嘉善县第一人民医院儿科,浙江嘉善314100 [2]上海市同济大学附属同济医院儿科,上海200065

出　　处：《中国小儿血液与肿瘤杂志》2021年第3期160-165,共6页Journal of China Pediatric Blood and Cancer

摘　　要：目的分析归纳国内文献报道抗凝血类灭鼠药中毒的流行病学和临床表现特征,为提高儿童鼠药中毒防范率、早期诊断率和临床有效率提供参考依据。方法收集国内所有儿童抗凝血杀鼠药中毒文献报道中基本数据完整可供分析的109例患儿及我院6例患儿(共计115例)的临床资料,并进行临床特点统计分析。结果文献报道的我国儿童抗凝血鼠药中毒临床特征如下:(1)性别:男性(55%)多于女性(45%)。(2)年龄:幼儿期(1~3岁)最为常见(47.0%);(3)高发季节:先后为秋季、春季、夏季和冬季。(4)地点:86%发生于农村,其中38%为留守儿童。(5)病史:仅20%可有明确抗凝血鼠药接触史,近60%最终毒物来源不明。(6)症状:多为皮肤黏膜出血(56.5%),部分内脏出血(16.5%)。(7)凝血功能:主要表现(96.7%)为PT和APTT明显延长,而TT和FIB基本正常。(8)误诊率41.7%,多被误诊为其他凝血功能异常性疾病。(9)维生素K1(Vit K1)疗效显著,疗程2~6个月。结论现有文献报道的儿童抗凝血鼠药中毒以农村为主,多见于婴幼儿,常无明确毒物接触史,起病隐匿,临床初诊的漏诊率较高。上述流行病学特征为临床防治重点,提示需要提高对于儿童抗凝血鼠药中毒的认识,以利早期诊断和及时进行Vit K1治疗。Objective To analyze and summarize the epidemiological and clinical characteristics of children′s anticoagulant rodenticide poisoning in our country,so as to provide a reference for improving the prevention rate,early diagnosis rate and clinical effectiveness of children′s rodenticide poisoning.Methods The clinical data of 109 children whose basic data were complete and available for analysis in the literature reports of all children′s anticoagulant rodenticide poisoning,and 6 children in First People′s Hospital of Jiashan County(a total of 115 cases)were collected and analyzed.Results Existing data showed that the clinical characteristics of children′s anticoagulant rodenticide poisoning were as follows:(1)Gender:Males(55%)were more than females(45%).(2)Age:Early childhood(1 to 3 years old)was the most common(47.0%);(3)High incidence season:fall,spring,summer and winter successively.(4)Location:86%occurred in rural areas,and 38%of the latter were left-behind children.(5)Medical history:Only 20%had a clear history of exposure to anticoagulant rodenticide,and nearly 60%of them were eventually source of poison unknown.(6)Symptoms:mostly skin and mucous membrane bleeding(56.5%),and some internal organ bleeding(16.5%).(7)Coagulation function:The main manifestation(96.7%)was that Prothrombin time(PT)and activated partial thromboplastin time(APTT)significantly prolonged,while thrombin time(TT)and fibrinogen(FIB)basically normal.(8)The misdiagnosis rate was 41.7%,and most of them were misdiagnosed as other coagulation disorders.(9)Vit K1 was effective,and the course of treatment was 2-6 months.Conclusions The above-mentioned data suggest that children′s anticoagulant rodenticide poisoning occurs mainly in rural areas,and it is more common in infants and young children.There is often no clear history of exposure to toxicants,the onset is hidden,and the rate of missed diagnosis in the first clinical diagnosis is relatively high.The above-mentioned epidemiological features are the focus of clinical prevention a

关 键 词：儿童 中毒 抗凝血鼠药 维生素K1 凝血功能 

分 类 号：R725.9[医药卫生—儿科]