实用临床医学
實用臨床醫學
실용림상의학
Practical Clinical Medicine
2014年
5期
80-82,87
,共4页
复方地芬诺酯%中毒%儿童
複方地芬諾酯%中毒%兒童
복방지분낙지%중독%인동
compound diphenoxylate%poisoning%children
目的：探讨2例儿童误服复方地芬诺酯中毒后的临床表现、中枢系统影像学特点、治疗及预后，进而提高临床对该疾病的早期识别。方法对2例明确诊断为复方地芬诺酯中毒患儿的资料进行总结并复习相关文献，分析其临床特点及神经系统影像学的表现。结果2例患儿均以急性中毒性脑病起病；临床表现为发热、昏迷、抽搐、呼吸抑制等，实验室检查肝功能转氨酶、心肌酶谱均有明显升高；均行头颅MR检查，提示大脑皮层、皮层下、脑干、小脑及基底节区广泛性损害；积极主动的对症和支持治疗是其影响存活的主要因素，包括洗胃、机械通气、早期应用足量的纳诺酮及维持水电解质平衡等；均预后不良，其中1例家属放弃治疗。结论儿童误服复方地芬诺酯后部分临床症状危重，神经系统影像学提示大脑弥漫性损害明显，治疗效果不佳。预防误服可以避免该类事件的发生。
目的：探討2例兒童誤服複方地芬諾酯中毒後的臨床錶現、中樞繫統影像學特點、治療及預後，進而提高臨床對該疾病的早期識彆。方法對2例明確診斷為複方地芬諾酯中毒患兒的資料進行總結併複習相關文獻，分析其臨床特點及神經繫統影像學的錶現。結果2例患兒均以急性中毒性腦病起病；臨床錶現為髮熱、昏迷、抽搐、呼吸抑製等，實驗室檢查肝功能轉氨酶、心肌酶譜均有明顯升高；均行頭顱MR檢查，提示大腦皮層、皮層下、腦榦、小腦及基底節區廣汎性損害；積極主動的對癥和支持治療是其影響存活的主要因素，包括洗胃、機械通氣、早期應用足量的納諾酮及維持水電解質平衡等；均預後不良，其中1例傢屬放棄治療。結論兒童誤服複方地芬諾酯後部分臨床癥狀危重，神經繫統影像學提示大腦瀰漫性損害明顯，治療效果不佳。預防誤服可以避免該類事件的髮生。
목적：탐토2례인동오복복방지분낙지중독후적림상표현、중추계통영상학특점、치료급예후，진이제고림상대해질병적조기식별。방법대2례명학진단위복방지분낙지중독환인적자료진행총결병복습상관문헌，분석기림상특점급신경계통영상학적표현。결과2례환인균이급성중독성뇌병기병；림상표현위발열、혼미、추휵、호흡억제등，실험실검사간공능전안매、심기매보균유명현승고；균행두로MR검사，제시대뇌피층、피층하、뇌간、소뇌급기저절구엄범성손해；적겁주동적대증화지지치료시기영향존활적주요인소，포괄세위、궤계통기、조기응용족량적납낙동급유지수전해질평형등；균예후불량，기중1례가속방기치료。결론인동오복복방지분낙지후부분림상증상위중，신경계통영상학제시대뇌미만성손해명현，치료효과불가。예방오복가이피면해류사건적발생。
Objective To report the clinical manifestations, imaging features of central nervous system, treatment and prognosis of compound diphenoxylate poisoning in children, and to improve the early identification of the disease. Methods Clinical data of 2 children diagnosed as compound diphenoxylate poisoning were summarized and the literature was reviewed. The clinical characteristics and imaging performance of nervous system were analyzed. Results The two children had the onset of acute toxic encephalopathy. Clinical manifestations of compound diphenoxylate poisoning included fever, coma, convulsion, respiratory depression, etc. Laboratory examination showed an obvious increase in liver transaminase and myocardial enzyme levels. Cranial MRI showed extensive damage in cerebral cortex, subcortex, brainstem, cerebellum and basal ganglia. Aggressive symptomatic and supportive treatments were the main factors affecting survival, including gastric lavage, mechanical ventilation, early application of adequate amounts of naloxone and maintenance of water and electrolyte balance. Poor prognosis occurred in both cases and family members of one of them abandoned treatment. Conclusion Clinical symptoms are severe and MRI features of nervous system show diffuse brain damage in children with compound diphenoxylate poisoning. Moreover, the treatment is associated with poor outcome. The effective prevention may be the best way to avoid compound diphenoxylate poisoning.
