CAJ | 학술논문

目的验证中毒事件病因判定模型在新疆维吾尔自治区塔城地区发生的一起乌头属植物中毒事件病因判定中的作用. 方法中毒事件病因判定模型的要点是根据现场、病例和实验研究结果进行综合判定.接到中毒事件报告后,当地疾病预防控制中心(CDC)专业人员迅速赶往现场开展流行病学调查,了解中毒患者临床情况,采集中毒患者的血液、呕吐物样本及可疑有毒植物新鲜样本,国家CDC组织相关专业机构进行可疑有毒植物的形态学鉴定、DNA分子鉴定和毒素检验,并按照中毒病因判定模型,综合3方面的结果进行病因判定,指导临床诊断和救治. 结果 2010年5月30日,新疆塔城地区某县某矿业金属有限公司13名员工食用在附近山上采集的“野芹菜”后15 ～ 30 min内陆续出现口唇及四肢麻木、全身乏力、恶心、呕吐等症状,立即被送往当地医院,运送途中死亡4人,9人送到医院进行抢救,其中2人抢救无效均于中毒后4h左右死亡.可疑有毒植物新鲜样本形态学鉴定确认为毛茛科乌头属植物.1例呕吐物样品和3例血液样品中检测出乌头碱,血液样品中乌头碱含量分别为0.17、0.25和0.48μg/L.DNA分子鉴定结果显示现场采集的可疑有毒植物新鲜叶片与乌头属植物属于同一类.综合上述结果,明确该起事件为误采误食乌头属植物茎叶所致突发中毒事件. 结论中毒事件病因判定模型在中毒事件病因判定中可起到重要指导作用.
목적 험증중독사건병인판정모형재신강유오이자치구탑성지구발생적일기오두속식물중독사건병인판정중적작용. 방법 중독사건병인판정모형적요점시근거현장、병례화실험연구결과진행종합판정.접도중독사건보고후,당지질병예방공제중심(CDC)전업인원신속간왕현장개전류행병학조사,료해중독환자림상정황,채집중독환자적혈액、구토물양본급가의유독식물신선양본,국가CDC조직상관전업궤구진행가의유독식물적형태학감정、DNA분자감정화독소검험,병안조중독병인판정모형,종합3방면적결과진행병인판정,지도림상진단화구치. 결과 2010년5월30일,신강탑성지구모현모광업금속유한공사13명원공식용재부근산상채집적“야근채”후15 ～ 30 min내륙속출현구진급사지마목、전신핍력、악심、구토등증상,립즉피송왕당지의원,운송도중사망4인,9인송도의원진행창구,기중2인창구무효균우중독후4h좌우사망.가의유독식물신선양본형태학감정학인위모간과오두속식물.1례구토물양품화3례혈액양품중검측출오두감,혈액양품중오두감함량분별위0.17、0.25화0.48μg/L.DNA분자감정결과현시현장채집적가의유독식물신선협편여오두속식물속우동일류.종합상술결과,명학해기사건위오채오식오두속식물경협소치돌발중독사건. 결론 중독사건병인판정모형재중독사건병인판정중가기도중요지도작용.
Objective To validate the effects of the etiological judgment model for poisoning event in a poisoning event caused by Aconitum in Tacheng District,Xinjiang Uygur Autonomous Region.Methods The main point of the etiological judgment model for poisoning event was synthesized determination according to the results of the scene,cases and laboratory research.After receiving the report of poisoning event,the specialists in local Center for Disease Control and Prevention (CDC) hastened to the scene to conduct epidemiological investigation,to obtain the clinical features of the poisoning patients,and to collect the specimen of blood and vomitus of patients and the fresh sample of suspicious poisonous plants.Chinese Center for Disease Control and Prevention organized the relevant institutes to conduct morphological and DNA molecular identification of the poisonous plant,toxin detection of the blood and vomitus specimen.The above-mentioned results were synthesized to determine the poisoning reason and provide guidance for clinical diagnosis and treatment.Results On May 30,2010,13 staffs in a metal company in Tacheng District picked and ate the "wild celery" which grew in nearby mountain.Within 15 to 30 minutes after eating the "wild celery",they successively developed numbness in mouth,lips,and limbs,as well as asthenia,nausea and vomiting.They were sent to a local hospital,4 patients died on the way to the hospital,other 9 patients received rescue therapy in the hospital,2 of them died about 4 hours after poisoning despite resuscitation attemempts.The morphological identification of fresh sample of suspected poisonous plants was demonstrated as Aconitum,Raunnculaceae.Aconitine was detected in a vomitus specimen and 3 blood specimens.The aconitine content in blood specimens were 0.17,0.25 and 0.48 μg/L,respectively.The result of DNA molecular identification showed that the fresh leaves of suspected poisonous plants collected from the scene belonged to the same species of Acontium.This event was determined as a sudden poisoning event caused by picking and eating Acontium stems and leaves by mistaken.Conclusion The etiological judgment model for poisoning event might play an important guiding role in the determination of the cause of poisoning events.