中南大学学报（医学版）
中南大學學報（醫學版）
중남대학학보（의학판）
JOURNAL OF CENTRAL SOUTH UNIVERSITY (MEDICAL SCIENCES)
2012年
8期
849-853
,共5页
隐匿性中毒%抗凝血灭鼠剂%维生素K缺乏
隱匿性中毒%抗凝血滅鼠劑%維生素K缺乏
은닉성중독%항응혈멸서제%유생소K결핍
occult poisoning%anticoagulant rodenticide%vitamin K deficiency
目的:探索长效抗凝血灭鼠剂致隐匿性中毒的特点及其诊断与治疗.方法:对2008年7月至2011年4月在外院误诊后转人中南大学湘雅医院的抗凝血灭鼠剂隐匿性中毒12例患者临床表现、血浆凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、首诊医院误诊情况及我院诊治效果进行回顾性分析.结果:抗凝血灭鼠剂中毒临床表现隐匿,可表现为皮肤瘀斑、血尿、阴道流血、消化道出血等；实验室检查显示PT和APTT明显延长；每日补充维生素K1治疗,止血效果明显.治疗前后PT和APTT差异均有统计学意义(p＜0.01).结论:长效抗凝血灭鼠剂中毒患者为获得性维生素K依赖的凝血因子减少导致的凝血功能异常,由于病史隐匿,中毒症状推后出现,并累及多个器官,容易导致误诊并危及生命.因此,详细的病史收集,全面体查,可提高诊断准确性.一旦确诊为抗凝血灭鼠剂中毒,维生素K1应尽早使用.
目的:探索長效抗凝血滅鼠劑緻隱匿性中毒的特點及其診斷與治療.方法:對2008年7月至2011年4月在外院誤診後轉人中南大學湘雅醫院的抗凝血滅鼠劑隱匿性中毒12例患者臨床錶現、血漿凝血酶原時間(PT)、活化部分凝血酶時間(APTT)、首診醫院誤診情況及我院診治效果進行迴顧性分析.結果:抗凝血滅鼠劑中毒臨床錶現隱匿,可錶現為皮膚瘀斑、血尿、陰道流血、消化道齣血等；實驗室檢查顯示PT和APTT明顯延長；每日補充維生素K1治療,止血效果明顯.治療前後PT和APTT差異均有統計學意義(p＜0.01).結論:長效抗凝血滅鼠劑中毒患者為穫得性維生素K依賴的凝血因子減少導緻的凝血功能異常,由于病史隱匿,中毒癥狀推後齣現,併纍及多箇器官,容易導緻誤診併危及生命.因此,詳細的病史收集,全麵體查,可提高診斷準確性.一旦確診為抗凝血滅鼠劑中毒,維生素K1應儘早使用.
목적:탐색장효항응혈멸서제치은닉성중독적특점급기진단여치료.방법:대2008년7월지2011년4월재외원오진후전인중남대학상아의원적항응혈멸서제은닉성중독12례환자림상표현、혈장응혈매원시간(PT)、활화부분응혈매시간(APTT)、수진의원오진정황급아원진치효과진행회고성분석.결과:항응혈멸서제중독림상표현은닉,가표현위피부어반、혈뇨、음도류혈、소화도출혈등；실험실검사현시PT화APTT명현연장；매일보충유생소K1치료,지혈효과명현.치료전후PT화APTT차이균유통계학의의(p＜0.01).결론:장효항응혈멸서제중독환자위획득성유생소K의뢰적응혈인자감소도치적응혈공능이상,유우병사은닉,중독증상추후출현,병루급다개기관,용역도치오진병위급생명.인차,상세적병사수집,전면체사,가제고진단준학성.일단학진위항응혈멸서제중독,유생소K1응진조사용.
Objective:To explore the clinical characteristics and diagnosis and treatment of occult poisoning caused by long-acting anticoagulant rodenticides.Method:Records of 12 patients from July 2008 to April 2011 diagnosed as anticoagulant rodenticide occult poisoning,who had been misdiagnosed initially at other hospitals were analyzed retrospectively.Elements from the records included clinical symptoms and signs,laboratory findings for prothrombin time (PT) and activated partial prothrombin time (APTT),and initial misdiagnosis and treatment outcome at our hospital.Results:The clinical presentations of patients were insidious and serious,often presented as skin ecchymose,hematuria,menorrhagia and gastrointestine bleeding.Laboratory examinations showed prolonged PT and APTT; bleeding was controlled effectively by administoring vitamin K1 daily.There were statistical difference between PT and APTT before and after the treatment (P＜0.01).Conclusion:Coagulation disorders might be caused by the reduced acquisition in vitamin K dependent coagulation factors,which tends to be neglected due to a hidden medical history,delayed signs of poisoning,and various organs involved.A detailed patient history and systematic review may improve the diagnostic accuracy.Once diagnosed is made,vitamin K1 should be given as soon as possible.
