抗凝血型灭鼠剂中毒临床误诊分析  

Analysis of Clinical Misdiagnosis of Anticoagulant Rodenticide Poisoning

作　　者：邢选林 李毅云[1] 王子玉 张林明[2] 宋玉艮 游昕玥 熊桂飞 梁星玲 张秋娟 张冰冉 刘明伟[1] XING Xuanlin;LI Yiyun;WANG Ziyu;ZHANG Linming;SONG Yugen;YOU Xinyue;XIONG Guifei;LIANG Xingling;ZHANG Qiujuan;ZHANG Bingran;LIU Mingwei(Department of Emergency,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Neurology,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Infectious Diseases,Kunming Children's Hospital,Kunming 650100,China;Xingsha Branch of Hunan People's Hospital,Changsha 410000,China)

机构地区：[1]昆明医科大学第一附属医院急诊科,昆明650032 [2]昆明医科大学第一附属医院神经内科,昆明650032 [3]昆明市儿童医院感染科,昆明650100 [4]湖南省人民医院星沙院区,长沙410000

出　　处：《临床误诊误治》2023年第12期14-18,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨抗凝血型灭鼠剂中毒误诊原因及防范误诊措施。方法回顾性分析2018年11月—2022年9月收治的抗凝血型灭鼠剂中毒29例的临床资料。结果29例临床表现主要为不同程度的皮肤淤点淤斑19例、肉眼血尿10例、鼻出血9例、牙龈出血7例及口腔黏膜出血、便血各6例等。误诊为凝血功能障碍19例次,鼻出血7例次,牙龈出血6例次,消化道出血5例次,泌尿道感染和泌尿道结石各3例次,失血性休克2例次,肠梗阻、药物中毒、胸腔积液、脑出血、肢体活动异常、软组织血肿各1例次。误诊时间1~60 d。入院后依据临床及相关医技检查、灭鼠剂成分检测(溴鼠灵、溴敌隆、塞鼠酮等),确诊为抗凝血型灭鼠剂中毒。29例均予首剂静脉滴注维生素K 1制剂治疗后凝血功能好转。随访3个月~1年,3例失访,余26例预后良好。结论抗凝血型灭鼠剂中毒病史不清楚,症状无特异性,容易漏诊误诊。临床应提高警惕,及时行血清灭鼠剂成分检测,以减少误诊。Objective To explore the causes of misdiagnosis of anticoagulant rodenticide poisoning and measures to prevent misdiagnosis.Methods The clinical data of 29 patients with anticoagulant rodenticide poisoning treated from November 2018 to September 2022 were retrospectively analyzed.Results The main clinical manifestations of the 29 patients were different degrees of skin petechial ecchymosis(n=19),gross hematuria(n=10),epistaxis(n=9),gingival bleeding(n=7),oral mucosal bleeding(n=6)and hematochezia(n=6).They were misdiagnosed as coagulopathy 19 times,nose bleeding 7 times,gum bleeding 6 times,digestive tract bleeding 5 times,urinary tract infection 3 times,urinary tract calculus 3 times,hemorrhagic shock 2 times,and intestinal obstruction,drug poisoning,pleural effusion,cerebral hemorrhage,abnormal limb movement,and soft tissue hematoma 1 time,respectively.Misdiagnosis lasted from 1 to 60 d.After admission,according to the clinical and relevant medical technical examination,and detection of rodenticide ingredients(bromurin,brodiolone,and difethialone),the anticoagulant rodenticide poisoning was confirmed.The coagulation function of 29 patients was improved after the first dose of intravenous infusion of vitamin K 1 preparation.After 3 months to 1 year of follow-up,3 patients were lost to follow-up,and the remaining 26 patients had a good prognosis.Conclusion The history of anticoagulant rodenticide poisoning is not clear,and the symptoms are not specific,which,therefore,are more likely to cause miss diagnosis and misdiagnosis.In order to reduce misdiagnosis,it is necessary to be vigilant and detect serum rodenticide components in time.

关 键 词：抗凝血型灭鼠剂 中毒 误诊 凝血功能障碍 鼻出血 泌尿道感染 尿路结石 失血性休克 

分 类 号：R595.54[医药卫生—内科学]