皖北地区抗凝类杀鼠剂中毒临床特征及维生素K1用药方案对疗效的影响分析  

Clinical characteristics of anticoagulant rodenticide poisoning in northern Anhui analysis of the effect of the vitamin K1 medication regimen on the efficacy

作　　者：陶言言[1] 汤亚杰 王丽丽 王方莉[1] 陆国玉[1] 范方田 TAO Yanyan;TANG Yajie;WANG Lili;WANG Fangli;LU Guoyu;FAN Fangtian(Department of Emergency Medicine,The First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,Anhui,China;College of Pharmacy,Bengbu Medical College,Bengbu 233000,Anhui,China)

机构地区：[1]蚌埠医学院第一附属医院急诊内科,安徽蚌埠233004 [2]蚌埠医学院药学院,安徽蚌埠233000

出　　处：《中国临床药理学与治疗学》2023年第11期1263-1268,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：蚌埠医学院自然科学重点研究项目(2021byzd157);安徽省教育厅高校科学研究重大项目(KJ2021ZD0083)。

摘　　要：目的:对抗凝血杀鼠剂中毒临床特点及维生素K1用量进行回顾性分析,以提高临床诊疗水平。方法:回顾性分析我院急诊内科2020年1月至2022年12月收治住院的51例抗凝血杀鼠剂中毒患者的临床资料,包括中毒方式、中毒时间(毒物暴露至入院治疗时间)、临床表现、凝血功能、维生素K1用量及治疗结果等,所有患者随访3个月。结果:51例患者中,溴敌隆中毒27例(52.94%),占比最高。出院时凝血功能凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)较入院时明显改善(P<0.01)。23例入院时有出血症状,中毒严重度评分(PSS):轻度中毒12例,中度中毒7例,重度中毒4例;46例有明确毒物暴露史。患者根据中毒时间分为≥48 h组与<48 h组,比较两组入院时凝血功能异常程度,有统计学差异(P<0.01)。28例入院时凝血功能异常,根据维生素K1用量分为≤40 mg/d组12例和>40 mg/d组16例,≤40 mg/d组出血症状消失时间和凝血功能恢复时间较长,但差异无统计学意义(P>0.05)。结论:抗凝血杀鼠剂中毒症状以凝血功能障碍、出血为主,中毒时间长凝血异常更加显著。维生素K1较大剂量较普通剂量疗效无显著差异,维生素K1治疗的及时性和维持时间更重要。AIM:To analyze the clinical characteristics of anticoagulant rat poisoning and vitamin K1 to improve clinical diagnosis and treatment.METHODS:The clinical data of 51 patients hospitalized in the emergency department of our hospital from January 2020 to December 2022,including poisoning mode,poisoning time(poison exposure to admission time),clinical manifestations,coagulation function,vitamin K1 dosage and treatment results,etc.All patients were followed up for 3 months.RESULTS:Among the 51 patients,27(52.94%)were toxic,the highest proportion.PT,APTT,and INR improved significantly at discharge compared to admission(P<0.01).Twenty three patients had bleeding symptoms during admission,PSS score:12 mild,7 moderate and 4 severe;Forty six patients with clear history of toxic exposure were divided into 48 h and<48 h groups according to the poisoning time.By comparison between the two groups,the difference was significant(P<0.01).Twenty eight patients had abnormal coagulation function on admission,which was divided into 12 and 16 in 40 mg/d and>40 mg/d and a long time in 40 mg/d group,but not statistically significant(P>0.05).CONCLUSION:The symptoms of anticoagulant rat dose poisoning are coagulation dysfunction and bleeding;the prolonged coagulation abnormality is more significant;the larger dose of vitamin K1 is not significantly different than the normal dose,and the timeliness and maintenance time of vitamin K1 treatment are more important.

关 键 词：抗凝类杀鼠剂 中毒 凝血功能障碍 维生素K1 

分 类 号：R979.8[医药卫生—药品]