20例碳酸锂中毒患者的临床特征分析及文献复习  

Clinical features and literature review of 20 patients with lithium carbonate poisoning

作　　者：唐郭 张天山 杨莹[1] 杨莎 蒋臻[1] 姚蓉[1] Tang Guo;Zhang Tianshan;Yang Ying;Yang Sha;Jiang Zhen;Yao Rong(Emergency Medicine Laboratory,the Emergency Department of West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院急诊科急诊医学研究室,四川成都610041

出　　处：《中国急救医学》2024年第4期350-355,共6页Chinese Journal of Critical Care Medicine

基　　金：四川省科技厅重点研发项目(2022YFS0273);成都市科技局重大科技应用示范项目(2022-YF09-00021-SN);四川省自然科学基金面上项目(2022NSFSC0669)。

摘　　要：目的通过总结20例碳酸锂中毒患者的临床特征及诊治经过,分析碳酸锂中毒的临床特点并结合文献进行复习。方法回顾性分析2018年4月1日至2022年4月30日四川大学华西医院急诊科收治的碳酸锂中毒患者的一般资料、临床表现、治疗经过及预后。根据患者住院期间的病情危重程度分为入重症监护病房(ICU)组与未入ICU组;采用单因素分析筛选可能入ICU的危险因素。结果共纳入20例碳酸锂中毒患者,年龄16~67岁,平均年龄18.5(16,21)岁。20例患者均有精神疾病病史,其中12例患者有双向情感障碍(12/20),6例患者有抑郁症(6/20),1例患者有双向情感障碍合并抑郁症(1/20),1例患者有躁狂症(1/20)。碳酸锂中毒后临床表现以神经系统及消化系统症状为主;20例患者中2例出现心脏毒性(2/20),1例出现肾功能障碍(1/20);12例患者接受血液净化治疗(12/20),3例患者因需呼吸机辅助通气入住ICU(3/20)。与未入ICU组患者相比,入ICU组患者就诊时嗜碱性粒细胞绝对值更低(P=0.023),而呼吸频率(P=0.003)、舒张压(P=0.014)、单核细胞绝对值(P=0.029)、间接胆红素(P=0.013)和血清胱抑素C(P=0.045)更高。所有患者均好转出院(20/20)。结论结合临床特征及文献复习,碳酸锂中毒多见于有精神疾病病史患者(以女性及青少年居多),临床表现以神经系统及消化系统症状为主,部分患者出现心脏损伤及肾功能障碍。就诊时嗜碱性粒细胞绝对值降低,而呼吸频率、舒张压、单核细胞绝对值、间接胆红素和血清胱抑素C升高可能为入住ICU的危险因素。Objective To analyze and summarize the clinical features of lithium carbonate poisoning in 20 patients.Methods We retrospectively analyzed the general information,clinical manifestation,treatment history,and prognosis of patients admitted to the Emergency Department of West China Hospital of Sichuan University from April 1,2018 to April 30,2022.According to the severity of the patient′s condition during hospitalization,they were divided into the Intensive Care Unit(ICU)group and the non-ICU group.Univariate analysis was used to screen potential risk factors for ICU admission.Results A total of 20 patients with lithium carbonate poisoning were included in the study,with ages ranging from 16 to 67 years and a mean age of 18.5(16,21)years.All 20 patients suffered from psychiatric disorders,among which 12 were diagnosed with bipolar disorder(12/20),6 with depression(6/20),1 with comorbid bipolar disorder and depression(1/20),and 1 with mania(1/20).The clinical manifestations of lithium carbonate poisoning were predominantly neurological and gastrointestinal symptoms,2 exhibited cardiotoxicity(2/20),and 1 showed renal impairment(1/20).Twelve patients received hemodialysis treatment(12/20),and 3 required admission to the ICU for ventilatory support(3/20).Compared to the patients not admitted to the ICU,those admitted to the ICU had significantly lower absolute eosinophil counts(P=0.023),but the higher respiratory rates(P=0.003),diastolic blood pressure(P=0.014),absolute monocyte counts(P=0.029),indirect bilirubin levels(P=0.013),and cystatin C(P=0.045).Following treatment,all the patients improved and were discharged from the hospital(20/20).Conclusions Lithium carbonate poisoning is most commonly observed in the patients with a history of mental illness,particularly women and adolescents.The clinical manifestations primarily involve the nervous and digestive systems,including heart damage and renal dysfunction.Reduced absolute eosinophil counts and elevated respiratory rates,diastolic blood pressure,absolute monocyt

关 键 词：碳酸锂 中毒 血药浓度 预后 血液净化治疗 重症监护病房(ICU) 

分 类 号：R595[医药卫生—内科学]