肝损伤型毒蕈中毒的救治效果分析

目的探讨毒蕈中毒的临床特点和救治要点。 方法对同批5例肝损伤型毒蕈中毒患者于中毒3 d入院后的临床特点、氨基转移酶(ALT)、凝血功能(PT)、血小板数(PLT)和胆红素(TBIL)等变化进行回顾性分析。 结果中毒后第4天所有患者ALT、TBIL已明显升高,其中重症者ALT于第4天已达到高峰,随后快速下降,而TBIL进行性升高,于第7天后维持在高峰状态(TBIL>350 μmol,ALT<300 U/L),呈现"酶-胆分离"现象;中毒后第4天重症者PT活性显著降低(PT<20%),PLT随病情发展快速降低(PLT<50×10⁹/L),并维持在低水平;重症者约中毒4天后进入肝性昏迷,10 d内死亡。 结论尽早全肠灌洗、预见性血液灌流或早期血浆置换等是救治肝损伤型毒蕈中毒的关键。     

腺苷蛋氨酸治疗白毒伞中毒的初步探索

目的 观察腺苷蛋氨酸(SAMe)治疗白毒伞中毒的临床疗效.方法 回顾性分析12例白毒伞中毒病例资料,按是否使用SAMe治疗分为两组:A组接受洗胃、导泻、补液、利尿、护肝、抗感染及血液净化等治疗;B组在A组治疗的基础上加用SAMe.比较两组病例中毒后第1、3、5及7天肝功能变化及病死率.结果 A组6例患者中毒后2人死亡,病死率为33.3%(2/6),2例死亡病例的天冬氨酸转氨酶(AST)和丙氨酸转氨酶(ALT)在3、5 d持续增加(5 d时＞2000 U/L),在7 d下降;总胆红素(TBIL)则3、5及7 d持续增加.B组6例患者中毒后无死亡病例.SAMe治疗后7 d,TBIL下降,5例ALT升高,3例AST降低.结论 腺苷蛋氨酸可能对降低白毒伞中毒的病死率起到重要作用.

Abstract：

Objective To observe the curative effects of transmetil on Amanita verna poisoning.Methods Twelve cases with Amanita verna poisoning were reviewed. The patients were divided into 2 groups according to usage of transmetil: Group A was treated with traditional protocol (gastric lavage, catharsis,rehydration, diuresis, anti-infection and hemodialysis), Group B was treated with traditional protocol combined with transmetil. The liver function changes on the 1st, 3rd, 5th and 7th day after poisoning and the mortality were compared between 2 groups. Results Two cases in group A (6 patients) died. The mortality of group A was 33.3%. The AST levels continued to increase on the 3rd and 5th day, but decreased on the 7th day. TBIL continued to increased on the 1st, 3rd, 5th and 7th day. None in group B died. The TBIL level dropped at 7 d 5 patients showed an increase in ALT at 7 d and 3 patients showed a decrease in AST at 7 d.Conclusion Transmetil may play an important role in reducing the mortality of Amanita vema poisoning.     

急性毒蕈中毒病例的临床分析

对一次全家 5口三代人急性毒蕈中毒的症状、体征及实验室检查指标进行了观察 ,发现本次中毒为中毒性肝炎型 ,经输液、保肝、巯基药物治疗 1月痊愈     

Our experience in the treatment of acute Amanita phalloides poisoning

INTRODUCTION: The present study aimed at investigating phalloid mushroom poisoning and the toxicological aid services in Plovdiv region as this pathology shows in this country high mortality rate (40-100%) and increasing incidence; it is difficult to diagnose and is far from featuring adequately in the literature in our country. MATERIAL AND METHODS: A caseload of 270 patients with mushroom poisoning from Plovdiv region, Bulgaria, admitted for treatment to the Clinic of Toxicology, Higher Medical Institute, Plovdiv, for the period 1991-1998 was studied. Of these 270 patients 25 (9.26%) had an acute phalloid poisoning. The following indicators were registered: gender, age, reported type of consumed mushrooms, time of appearance of the first complaints after the mushroom consumption, time of medical aid, disease outcome. The diagnosis and the applied treatment was based on our own diagnostic-therapeutic protocol for phalloid intoxication. RESULTS: All phalloid poisoning cases were accidental by character. The most frequently reported type of ingested mushroom was unidentified wild edible mushrooms. Of all the patients males were 56%, females--44% with mean age of 47.71 years (SD = 17.53). From 25 phalloid poisoning cases 15 survived (60%), 10 died (40%). The summer-fall seasonal pattern of phalloid poisoning occurrence was apparent. The mean duration of the latency period was 12 hours (SD--6.66). In 4 (16%) patients the disease exhibited an unusually early onset--up to 2 hours after the mushroom ingestion. The mean time period from the mushroom ingestion to the presentation in a medical institution for first medical aid was 32 hours (SD--21.69), for men--27.59 hours, for women--43.75 hours. Almost one third (32%) of the diseased presented for medical help more than 36 hours after the poisoning. CONCLUSIONS: The acute mushroom poisoning cases in adults comprise 7.01% of the total acute poisoning caseload. The phalloid poisoning accounts for 9.26% of the total number of patients with mushroom poisoning admitted for treatment. The application of contemporary diagnostic-therapeutic protocol lowers the hospital lethality rate from phalloid poisoning to 40%. There were no statistically significant differences in the compared parameters between the subgroups of patients with favorable and lethal outcome and between the subgroups of men and women--most probably due to the small sample. In order to lower the incidence and mortality rate from phalloid mushroom poisoning the authors recommend preventive health education on the problem, targeting the population at risk and the introduction of contemporary diagnostic and treatment methods--determining the amatoxins, intravenous application of Silibinin and liver transplantation.     

Descriptive epidemiology of mushroom poisoning in Japan]

The Incidence of mushroom poisoning was surveyed statistically from 1959 to 1988 in Japan. The results are summarized as follows: 1. During the past three decades, the total number of incidents of mushroom poisoning was 2,096, which involved 10,924 patients and 72 deaths. The average number of incidents was 70 cases per year, involving 364 patients and 2.4 deaths, and the number of incidents decreased gradually every year. Mushroom poisoning usually happened most frequently in September and October. 2. Considering regional differences, the incidence of mushroom poisoning was more frequent in the northeastern part of Japan than in the southwestern part. The incidences of mushroom poisoning in the prefectures of Nagano, Hokkaido, Niigata, Iwate and Fukushima were relatively high. 3. Three species of mushrooms, L. japonicus, R. rhodopolius (R. sinuatus) and T. ustale caused the majority of all poisonings. 4. The rates of total patients and fatalities for each type of poisoning, which were classified according to the symptoms caused, were 90.3% and 10.7% in the type with cholera-like symptoms, 90.2% and 0.2% in that with gastro-intestinal irritation, and 74.1% and 0% in that with neurological symptoms, respectively.     

毒蕈集体中毒的救治体会

2004年4月,我院急诊科处理两起(共5例)毒蕈集体中毒事件,经积极抢救,无1例死亡。现将临床资料报告如下。 1.临床资料:两起毒蕈中毒事件其中一起是一对中年夫     

急性药物中毒

1　概述药物在疾病的治疗上起着重要的作用 ,但使用不当或使用过量可引起各种药物反应 (药源性疾病 ) ,超量服用则可引起中毒。急性药物中毒是指短时间内或一次超量服用某种药物而造成人体器官的器质性或功能性损害 ,一般来说 ,具有明确的剂量 效应关系。2　药物中毒原因( 1)误服　见于误认药物为一般食品、药物用量过大、医疗单位发错药等。在老年及儿童中发生率较高。 ( 2 )自杀　以药物作为自尽的一种手段 ,常见为安眠镇静药物和有机磷农药 ,以成年人为主。 ( 3 )他杀　采用有毒药物或化学物作为谋害他人的一种手段。 ( 4 )服用过量　多…