70例急性四乙基铅中毒临床分析

结合我院急性四乙基铅中毒病例,分析总结我国近20年报道的70例四乙基铅(TEL)中毒患者临床表现、实验室检查及救治过程。TEL中毒临床表现主要为神经精神症状,中毒性脑病常出现持续性抽搐。由于四乙基铅及代谢毒物毒性大,缺少特效解毒药,早期识别四乙基铅中毒及正确综合治疗是救治成功的关键。     

7例急性重度四乙基铅中毒临床观察

目的对7例重度四乙基铅(TEL)中毒患者进行全面的医学观察。方法详细观察7例患者的临床表现、病程发展、实验室及诊断仪器检查指标。结果6例表现为急性精神病型,1例表现为昏迷型。实验室检查见6例心肌酶学明显增高。对4例进行头颅磁共振成像检查均呈双侧脑室周围、半卵圆中心白质脱髓鞘改变。结论重度四乙基铅中毒以精神运动性兴奋、意识障碍为突出表现;镇静、抗惊厥、抗精神病药物的合理应用是救治的关键。     

14例急性四乙基铅中毒临床分析

总结14例急性四乙基铅(TEL)中毒患者临床表现特点及救治过程。急性TEL中毒比较少见,临床上以神经精神症状为主要表现,由于没有特效解毒剂,及早识别急性四乙基铅中毒性精神障碍及脑病,并及时给予对症支持治疗是救治成功的关键。 更多还原     

一起急性四乙基铅中毒事故中毒患者脑电图分析

四乙基铅中毒的主要临床表现为神经衰弱综合征、自主神经功能紊乱及神经精神障碍。现将我院收治的一起急性四乙基铅中毒事故的19例中毒患者的脑电图观察结果进行分析,探讨四乙基铅对人体生物电的影响。     

职业性急性四乙基铅中毒诊断标准及处理原则

1 主题内容与适用范围 本标准规定了职业性急性四乙基铅中毒诊断标准及处理原则。 本标准适用于四乙基铅和乙基液作业人员,也适用于高浓度乙基汽油作业人员中产生的急性中毒。2 诊断原则 根据短期大量接触四乙基铅的职业史和以神经精     

四乙基铅中毒的植物神经功能研究

1.本文报告四乙基铅慢性和急性中毒,以及急性中毒后遗症时植物神经功能观察的结果。2.通过两侧皮肤温度对称性的测定和体温调节试验,初步发现3组四乙基铅中毒患者都有一定的间脑体温调节功能失调;并提出皮肤温度测定方法比较简易,对亚急性四乙基铅中毒或急性中毒后遗症的诊断有参考意义。3.慢性及亚急性四乙基铅中毒者的卧立反射和立卧反射均较健康对照组反应为强,也显示中毒患者有轻度全身植物神经功能不稳定的趋势。     

一起急性四乙基铅中毒事故的临床救治分析

目的 通过对一起急性四乙基铅中毒事故的成功救治体会,探讨急性四乙基铅中毒的临床特点,探索个体化治疗方案。 方法 通过职业卫生现场调查、临床分析及实验室检查血铅尿铅值,对7名症状轻微者做对症治疗,对6名中毒性脑病的重度患者进行全程连续监测心肌酶谱等监测至恢复正常,对其中1名患者加用驱铅治疗,动态观察心肌酶谱、神经、精神症状等。 结果 6名中毒者心肌酶升高明显,与神经、精神症状平行。其中驱铅治疗者心肌酶异常时间及病程明显延长。治疗后所有患者恢复良好,随访半年后所有症状消失。 结论 心肌酶谱可作为判断中毒严重程度的依据之一,常规驱铅治疗方案是否适用于四乙基铅中毒值得商榷。     

急性四乙基铅中毒14例报告

四乙基铅具有高度的脂溶性,是剧烈的神经毒物。群体发生的急性四乙基铅中毒尚不多见,现将我院收治的１４例急性四乙基铅中毒病例报告如下。１中毒经过１９８９年７月１５日个体业者杨某为某公司加工部件,将２００个原装有四乙基铅的空桶堆放在一露天场地,堆放处北面１...     

急性四乙基铅中毒7例临床分析

对7例急性四乙基铅中毒病人的临床资料进行了分析,精神症状出现早且重,部分病人尿铅高,自主神经功能异常。     

一氧化碳中毒迟发性脑病

一氧化碳中毒后迟发性脑病DEACMP(Delayed encephalopathy after acute carbon monoxide poisoning)是指一氧化碳中毒患者经抢救在急性中毒症状恢复后经过数天或数周表现正常或接近正常的"假愈期"后再次出现以急性痴呆为主的一组神经精神症状.或者部分急性一氧化碳中毒患者在急性期意识障碍恢复正常后,经过一段时间的假愈期,突然出现以痴呆、精神和锥体外系症状为主的脑功能障碍.一般发生在急性中毒后的两个月内.     

Tetramethyl lead absorption: a report of human exposure to a high level of tetramethyl lead.

Accidental human exposure to a high level of tetramethyl lead is described. Tetramethyl lead is blended with petrol as an antiknock agent, and it has similar physical properties to tetraethyl lead. The patient had high levels of lead in urine, averaging 4-75 mumol (983 mug) daily for the first four days after exposure and he continued to have raised levels of urinary lead for six months. He had no symptoms or physical signs of lead poisoning and comparisons are made between this case and previously reported cases of poisoning by tetraethyl lead. In the cases of tetraethyl lead poisoning all the patients had symptoms, some severe, yet in no instance did the urinary lead levels approach those described in this patient. The effects of chelation therapy with calcium disodium versenate are discussed and the results are similar to those found in tetraethyl lead poisoning. Blood lead levels of up to 3-91 mumol/l (81 mug/100 g) occurred but these levels were not raised commensurate with the urinary lead output. The levels of deltaaminolaevulinic acid (ALA) in the urine were not significantly raised and this report shows that the urinary lead levels give a better guide to the degree of absorption of tetramethyl lead compared with the blood lead or urinary ALA levels. The report illustrates that tetramethyl lead is less toxic to man than tetraethyl lead.     

急性毒鼠强中毒的临床观察及二巯丙磺钠的治疗效果评价

目的：观察急性毒鼠强中毒的临床表现，评价二巯丙磺钠对毒鼠强中毒的疗效。方法：将55例急性毒鼠强中毒患者随机分入对照组和治疗组，给予相应的治疗，并观察其临床表现和治疗效果。结果：急性毒鼠强中毒以中枢神经系统损伤的表现为主，二巯丙磺钠在控制抽搐时间、地西泮用量及精神症状持续时间等方面与对照组差异无统计学意义。结论：二巯丙磺钠对急性毒鼠强中毒无明显治疗效果。     

Lead poisoning in a historical perspective

Lead poisoning existed and was already known in Antiquity but was forgotten, at least in the literature, until the end of the Middle Ages, where it was mentioned sporadically. In the 19th century this disease, which reached epidemic dimensions during the period of industrialization, was "rediscovered." Several comprehensive clinical articles appeared in the literature. The clinical picture deepened during the beginning of the 20th century, and preventive efforts were started. However, the concept of poisoning remained strictly clinical. During the latter half of the 20th century a new concept emerged: subclinical and early forms became recognized as undesirable effects. This led to a substantial lowering of hygienic standards. Pediatric poisoning has also been a serious problem during the 20th century. After the 1920s, environmental pollution by lead caused by the introduction of tetraethyl lead in gasoline became an alarming public health problem. The use became restricted in the 1980s; its effects on blood lead levels are now evident. Today's research focuses on the effects of low exposure, often with the aim of defining noneffect levels for different types of effects.     

护理程序在急性刺激性气体中毒和刺激反应救护中的应用

目的探讨护理程序在急性刺激性气体中毒和刺激性反应急救护理工作中的合理运用。方法回顾性分析2006年7月14日发生在某厂氯气外泄事故,而引起66例氯气刺激反应和中毒患者紧急救治的临床资料。结果66例中毒患者诊断为急性重度中毒2例,急性中度中毒5例,急性轻度中毒26例,急性刺激反应33例,采取综合救治护理措施后全部痊愈,成功率100%。结论迅速离开事故现场,早期使用激素,保持呼吸道通畅、吸氧、雾化吸入、预防肺水肿、加强心理护理,是这次抢救成功的关键。     

急性毒鼠强中毒的临床治疗评价

目的 评价4种治疗方法对急性毒鼠强中毒的疗效,以及毒鼠强中毒对儿童智力发育的影响。方法 将86例入选急性毒鼠强中毒患者随机分为基础治疗组、丙戊酸钠组、二巯丙磺钠组和血液灌流组,给予相应治疗后观察治疗效果。另选30例毒鼠强中毒儿童,与健康儿童按年龄、居住地、性别、受教育情况和家庭经济状况等因素进行1：1配对,使用韦氏儿童智力量表中国修订本进行智商测定。结果 基础组、丙戊酸钠组与二巯丙磺钠组在癫痫控制时间、地西泮用量、出现精神症状及精神症状持续时间等治疗评价指标上,差异均无统计学意义;血液灌流治疗的13例患者中10例癫痫发作停止,3例发作次数明显减少,从每日10～16次减少到1～2次。血液灌流前后血浆中毒鼠强的含量并不降低。毒鼠强中毒儿童的总智商、言语智商和操作智商比对照儿童明显降低,均值分别比对照组降低了9．1、8．8和7．7分;中毒病情重的儿童总智商下降更明显,均值比对照组降低了15分。结论 二巯丙磺钠和丙戊酸钠对急性毒鼠强中毒的治疗效果并不优于单纯使用地西泮和苯巴比妥,血液灌流对毒鼠强中毒有肯定疗毒鼠强中毒对儿童的智力发育有一定影响。     

铅中毒病人周围神经电生理的研究

目的　观察无周围神经病临床症状的铅中毒病人是否存在亚临床周围神经病 ,并为其诊断提供科学依据。方法　随机选择的 30名无周围神经病临床症状的铅中毒病人 (根据GB1 1 5 0 3— 89诊断 )作为铅中毒组 ,测定单侧正中神经、尺神经、胫神经和腓神经运动神经传导速度 (MNCV)和运动神经远端潜伏期(DML)及尿铅。结果　研究组平均MNCV减慢、DML延长 ,与对照组比较差异均有显著性 (P <0 0 1 )。研究组正中神经MNCV减慢与尿铅浓度呈明显负相关 ,r=- 0 6 82 ,P <0 0 5。结论　无周围神经病临床表现的铅中毒病人存在亚临床周围神经病 ,MNCV、DML检查可作为铅中毒亚临床周围神经病的早期诊断指标之一。     

急性生活性砷化物中毒临床特征及其影响因素

目的 探讨急性生活性砷化物中毒的临床特征及其影响因素.方法 分析47例急性砷化物中毒患者临床表现,其中男20例,女27例.参照国家职业卫生相关标准,确诊观察病例2例,轻度中毒40例,重度中毒5例.结果 急性砷化物中毒患者心肌酶活力与年龄、尿砷浓度相关,控制年龄后两者仍有明显相关.心肌酶、肝丙氨酸转氨酶(ALT)、总胆红素(TBil)、间接胆红素(IBil)与呕吐次数呈负相关,差异均有统计学意义(P<0.05),而尿砷浓度、呕吐次数均与饮汤量相关,差异均有统计学意义(P<0.05).尽管年龄和饮汤量接近,但呕吐和腹泻次数明显者,其尿砷浓度、心肌酶、肝酶浓度明显低于呕叶和腹泻次数少者,差异有统计学意义(P<0.05).结论 急性砷化物中毒可引起心、肝、神经系统等多脏器损害,心肌损害出现最早且持续时间长;损害程度与患者进食量、呕叶、腹泻程度及尿砷浓度相父;及早采用洗胃、催吐、导泻措施清除毒物,尽早规范使用解毒药加速毒物排出,配合积极对症治疗是抢救急性砷化物中毒成功的关键.     

Clinical lead poisoning in England: an analysis of routine sources of data

OBJECTIVE: To examine the occurrence of clinical lead poisoning in England based on routine sources of data. METHODS: Three routine data sources were examined, over different periods according to availability of data: (a) mortality for England, 1981-96; (b) hospital episode statistics data for England, for the 3 years 1 April 1992-31 March 1995; (c) statutory returns to the Health and Safety Executive under the reporting of injuries, diseases, and dangerous occurrences regulations (RIDDOR), also for the period 1 April 1992-31 March 1995. Also, analyses of blood lead concentrations carried out by the Medical Toxicology Unit, Guy's and St Thomas' Hospital Trust in London during the period 1 January 1991-31 December 1997 were examined. The analyses were performed both for industrial screening purposes and in response to clinicians' requests where lead poisoning was suspected. This is one of several laboratories carrying out such analyses in the United Kingdom. RESULTS: One death, of a 2 year old girl, was coded to lead poisoning in England during 1981-96. Analysis of hospital episode statistics data identified 83 hospital cases (124 admissions) over 3 years with any mention of lead poisoning, excluding two with admissions dating from 1965 and 1969. For these 83 cases the median hospital stay per admission was 3 days (range 0-115 days). Five were coded as having received intravenous treatment. Further clinical details of these cases beyond what is routinely recorded on the hospital episode statistics database were not available, except for blood lead concentrations in cases also identified on the Medical Toxicology Unit database. Eighteen cases (22%) were below 5 years of age of whom 10 (56%) came from the most deprived quintile of electoral wards. There was evidence to suggest spatial clustering of cases (p = 0.02). Six occupational cases were reported under RIDDOR in England during the period of study, two of whom were identified on the hospital episode statistics database. One further occupational case was identified on hospital episode statistics. Blood lead analyses for 4424 people carried out by the Medical Toxicology Unit (estimated at about 5% of such analyses in England over 7 years) found that among 547 children aged 0-4, 45 (8.2%) had a blood lead concentration in excess of 25 micrograms/dl, the action level in the United Kingdom for investigation, or removal of environmental sources of lead. At all ages, there were 419 (9.5%) such people, including 106 adults with no mention of industrial exposure. CONCLUSIONS: Both mortality and hospital admission ascribed to lead poisoning in England are rare, but cases continue to occur and some, at least, seem to be associated with considerable morbidity. Lead poisoning was confirmed as a probable cause of clinical signs and symptoms in only a small proportion of those in whom a blood lead concentration was requested. Where indicated, appropriate remedial action for the safe removal of environmental sources of lead should be taken.

 

     

2007—2018年我国报告155例铅中毒误诊分析

目的 分析临床工作中铅中毒误诊的原因,为采取有效的预防措施提供依据。
方法 查询中国知网、万方数据库、维普数据库2007—2018年铅中毒误诊相关文章,总结病例特点并进行综合分析。
结果 155例铅中毒误诊病例中生活性铅中毒115例（占74.84%）,职业性铅中毒39例（占25.16%）;误诊为消化系统疾病127例（占81.9%）,误诊为血液系统疾病15例（占10%）,误诊为神经系统疾病12例（占7%）,误诊为副肿瘤性天疱疮1例（占1%）。误诊为消化系统疾病的患者中,造成有创损伤26例（占20.5%）;误诊为其他系统疾病的患者中,造成有创损伤5例（占17.9%）。误诊为不同系统疾病给患者造成有创诊治的概率差异无统计学意义（P>0.05）。
结论 对不典型的铅中毒病例,经过全面检查才能得到正确诊断。临床医师需加强有关铅中毒知识的学习,对怀疑发生重金属中毒的患者,应尽早做相关检查,与其他疾病相鉴别,以免贻误治疗时机。
     

突发群体性氯气中毒1 539例临床救治

目的总结突发群体性氯气中毒的诊治体会并探讨其疾病特点与有效应对策略。 方法回顾性总结分析2009年6月至2017年5月,发生的4次突发性化工厂氯气泄漏事故所致的群体性氯气中毒抢救案例,总计1 539例,其中男性746例,女性793例;年龄7 d ～ 90岁,平均(43.8±0.69)岁。根据患者的症状、体征、影像学检查(胸部X线片及胸部CT)及动脉血气分析等实验室检查结果诊断并分级。对重症急性肺水肿患者,在综合治疗基础上,采用20AA复方氨基酸联用维生素B₆及短程山莨菪碱联用地塞米松冲击疗法,病情平稳后结合中药"柴黄参祛毒固本汤"辅助调理治疗。观察总结中毒初期及重症患者疾病进展过程中的临床表现、胸部X线片及胸部CT、实验室检查(血常规、血生化、动脉血气分析)的特点;计算抢救成功率,评价上述创新治疗方法对急性氯气中毒患者的治疗有效性。 结果1 539例急性氯气中毒患者中,1 041例(67.6%)出现轻度刺激反应,394例(25.6%)轻度中毒,79例(5.1%)中度中毒,25例(1.6%)重度中毒。重度氯气中毒患者治疗96 h内,症状开始好转,并逐渐进入恢复期,经2周左右持续治疗基本痊愈。1 539例患者均治愈,无1例死亡;对25例重症急性化学性肺水肿患者进行长期随访,未出现肺纤维化或肿瘤等远期效应。 结论氯气中毒病情发展快,防治肺水肿是治疗的关键。在综合治疗的基础上,采用20AA复方氨基酸联用维生素B₆、短程山莨菪碱联用地塞米松冲击疗法及柴黄参祛毒固本中药方剂有良好疗效。