敌草快相关中毒性脑病7例报道  

Seven cases of toxic encephalopathy associated with diquat poisoning

作　　者：王君君 仝帅 张唐娟[1] 刘明科 赵璐[2] 杨耀辉 贾新雅[1] 兰超[1] Wang Junjun;Tong Shuai;Zhang Tangjuan;Liu Mingke;Zhao Lu;Yang Yaohui;Jia Xinya;Lan Chao(Emergency Intensive Care Unit,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Neurology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院急诊重症监护病区,郑州450000 [2]郑州大学第一附属医院神经内科,郑州450000

出　　处：《中华急诊医学杂志》2022年第12期1648-1653,共6页Chinese Journal of Emergency Medicine

基　　金：河南省科技厅重点研发与推广专项(212102310728);睿E(睿意)急诊医学研究专项基金(R2019005)。

摘　　要：目的提高对敌草快致中毒性脑病临床特征的认识。方法收集整理2021年4月至2022年4月郑州大学第一附属医院收治的7例急性敌草快中毒合并中枢神经系统损害患者的诊疗过程,并以“敌草快”“中毒”,“Diquat”“Poisoning”为关键词检索中国知网、万方数据库,Pubmed中英文数据库,查阅既往病例文献进行汇总分析。结果7例患者中男2例、女5例,平均年龄31岁(14~57岁),平均服毒量为23.14 g(10~40 g),在救治过程中3例出现烦躁、抽搐,3例出现昏迷,1例出现全身强直性阵挛发作;死亡4例,存活3例,其中2例恢复正常生活学习,1例遗留精神行为异常(现长期随访中)。3例存活病例出现神经系统症状的时间均较晚,患者清醒时间在服药后30 d左右。结论敌草快相关中毒性脑病进展快、预后差,病死率极高。本研究发现首次出现神经系统症状时间>48 h出院存活率远高于≤48 h患者,而性别、年龄、估计口服量、首次出现神经系统症状的表现类型对出院存活率的影响不大。但是出现神经系统症状时间越早,提示预后不良的可能性越大。Objective To improve the understanding of the clinical features of toxic encephalopathy associated with diquat poisoning.Methods This study collected and analyzed the diagnosis and treatment process of 7 patients with acute diquat poisoning combined with central nervous system complications admitted to the First Affi liated Hospital of Zhengzhou University from April 2021 to April 2022."Diquat"and"Poisoning"were used as keywords to search in CNKI,Wanfang database and PubMed database,and the literature of previous cases was reviewed for summary analysis.Results Among the 7 patients in our hospital,there were 2 males and 5 females,with an average age of 31 years(range14-57)and an average dose of 23.14 g(10-40).During the treatment,3 patients developed irritability and convulsions,3 patients occurred coma,and one had generalized tonic-clonic seizures.Four patients died and 3 survived,of which 2 patients returned to normal life and study,and one remained abnormal mental behavior(currently in long-term follow-up).All three survivors developed neurological symptoms later than those who died,and were awake about 30 days after taking the drug.Conclusions Toxic encephalopathy associated with diquat poisoning has rapid progression,poor prognosis and high mortality.This study found that the survival rate of patients with>48 h of first onset of neurological symptoms is much higher than that of patients with≤48 h of fi rst onset of neurological symptoms,while sex,age,estimated oral dose,and type of presentation of neurological symptoms for the fi rst time have little effect on the survival rate of hospital discharge.The earlier neurological symptoms appear,the greater the likelihood of a poor prognosis.

关 键 词：敌草快 中毒 中毒性脑病 中枢神经系统并发症 癫痫样发作 脑桥中央髓鞘溶解综合征 脑水肿 

分 类 号：R595.4[医药卫生—内科学] R747.9[医药卫生—临床医学]