CAJ | 학술논문

目的探讨铊中毒患者的临床表现和治疗方法.方法对2008年5月就诊于我院的6例确诊急慢性铊中毒患者的临床表现和治疗经过进行回顾性分析.结果 6例患者中男性4例,女性2例,年龄12～50岁,来自同一家庭(为一对姐妹和各自的丈夫及儿子).其中5例患者[3例为急性中毒,2例为慢性中毒(半年内第2次中毒)]均以多发性周围神经炎起病,表现为肢体末端麻木、疼痛、感觉异常,伴或不伴消化道症状;1例为12岁男性患儿,尿铊浓度超过中毒量,却无相关的临床表现.治疗上采用补钾、利尿、导泻、口服普鲁士蓝(氰化铁合亚铁)、肌注二巯基丙磺酸钠等措施,其中2例同时采用血液灌流治疗.最后2例患者好转出院,2例转专科医院进一步治疗,另2例慢性铊中毒患者病情进展迅速,最后昏迷,因多器官功能衰竭而死亡.结论铊中毒临床表现主要包括多发性周围神经炎、胃肠道症状和皮肤损害,对于出现类似症状的患者应高度警惕铊中毒的可能性,避免漏诊、误诊.治疗上除传统的普鲁士蓝效果肯定外,血液灌流亦可能是疗效更加肯定的措施.
목적 탐토사중독환자적림상표현화치료방법.방법 대2008년5월취진우아원적6례학진급만성사중독환자적림상표현화치료경과진행회고성분석.결과 6례환자중남성4례,녀 성2례,년령12～50세,래자동일가정(위일대저매화각자적장부급인자).기중5례환자[3례위급성중독,2례위만성중독(반년내제2차중독)]균이다발성주위신경염기병,표현위지체말단마목、동통、감각이상,반혹불반소화도증상;1례위12세남성환인,뇨사농도초과중독량,각무상관적림상표현.치료상채용보갑、이뇨、도사、구복보로사람(청화철합아철)、기주이구기병광산납등조시,기중2례동시채용혈액관류치료.최후2례환자호전출원,2례전전과의원진일보치료,령2례만성사중독환자병정진전신속,최후혼미,인다기관공능쇠갈이사망.결론 사중독림상표현주요포괄다발성주위신경염、위장도증상화피부손해,대우출현유사증상적환자응고도경척사중독적가능성,피면루진、오진.치료상제전통적보로사람효과긍정외,혈액관류역가능시료효경가긍정적조시.
Objective To further investigate clinical manifestations and management for thallium poisoning. Methods Clinical data of 6 patients who were hospitalized in Union Hospital of Tongji Medical College in May 2008 with diagnosis of acute or chronic thallium poisoning,were retrospectively analyzed.Results Six patients (4 male and 2 female) ,aged from 12 to 50,came from one family (two sisters with their husbands and sons). Five of them (3 acute and 2 chronic,for the second time in half a year,thallium poisoning) initiated with peripheral neuritis,represented with severe burning pain,numbness,paresthesia in the lower limbs,accompanied with or without gastrointestinal symptoms. A 12 year-old boy with obviously elevated urinary thallium concentration was asymptomatic. Blood and urinary thallium concentrations of the patients were determined by atomic absorption spectrophotometry and were all significantly elevated.Treatment was initiated using potassium supplementation,diuresis,oral laxatives,Prussian blue and intramuscular injection of dimercaptopropansulfonate sodium.Meanwhile two of them were treated with hemoperfusion. Finally,two of them recovered,another two were transferred to a specialized hospital for continuous treatment,and the rest two deteriorated rapidly with occurrence of unconsciousness and died of multiple organ failure. Conclusions The main clinical manifestations of thallium poisoning are multiple peripheral neuritis,gastrointestinal symptoms and dermatological changes. In order to avoid missed diagnosis and misdiagnosis,a high suspicion should be arose for thallium poisoning when a patient suffering from the above symptoms.Prussian blue was considered traditionally as an effective therapeutic strategy for the condition,and hemoperfusion may be a more effective treatment for acute thallium poisoning.