189例儿童急性中毒的临床诊断与治疗

 目的 探讨儿童急性中毒的诊断与治疗评价,分析儿科临床急性中毒的原因。方法 应用荧光偏振免疫法(FPIA)或气相色谱-质谱联用方法(GC／MS)定性定量分析中毒物质,采用血液灌流法(HP)治疗中毒患儿,调查189例急性中毒儿童的年龄、中毒物质及其原因。结果 189例儿童急性中毒者,应用FPIA定量测定的20例(11％);应用GC／MS定性鉴别的101例(53％)。189例中抢救成功173例(92％),死亡16例(8％);必须采用HP治疗的17例。灭鼠药中毒的危重患儿全部抢救成功,有效率100％。1～7岁患儿130例(70％)为儿童急性中毒的高发期;引起儿童急性中毒的物质有化学药品68例(36％)、中药4例(2％)、有机物类121例(59％),其中农药和灭鼠药中毒的患儿101例(90％,101／112),以及食物源性5例(3％);急性中毒的原因是医源性药物中毒22例(12％)、患儿家属自行或不遵医嘱用药38例(20％)、患儿偷食家人药品或其它物质12例(6％)、食物源性5例(3％)、毒物污染环境或食物引起中毒112例(59％)。结论 FPIA定量测定和GC／MS定性鉴别,在儿童急性中毒的临床诊断和治疗评价中有非常的意义;HP为治疗灭鼠药中毒危重患儿的有效手段。预防儿童各种意外中毒应引起人们的高度重视。

Diagnosis and treatment of acute poisoning in 189 children

OBJECTIVE To study the diagnosis and treatments of acute poisoning in children, and to investigate their causes. METHODS The blood drug concentrations were monitored by fluorescence polarization immunoassay (FPIA) . The liquid of washing stomach were analyzed by gas chromatography - mass spectrometry (GS/MS). The patients were treated with hemoperfusion (HP) .The age, sex,poisoning substances and reasons, and diagnosis and treatments of the patients were analyzed.RESULTS Biosamples from 20 cases (11%) and 101 cases(53%) of the 189 cases were analyzed by FPIA and GC/MS, respectively. The rates of treatment effectiveness and mortality were 92%(173/189) and 8%(16/189) ,respectively. 17 severe cases were saued successfully by HP.The acute poisoning accident most frequently occurred in children aged 1-7 years (130/189) . The poisoning substances were pharmaceutics 36% (68/189), Chinese herb 2% (4/189),organic substances 59% (121/189) and food 3% (5/189) .The accidents were caused by medicine-toxication 12%(22/189) .self-medication or disobedience 20% (38/189) , taking drugs or other substance on the sly 6% (12/189), environment or food pollution 59% (112/ 189) or food 3%(5/189) .CONCLUSION The results showed that it is very important to qualitatively and quantitatively analyze the poisonous substances. HP is a safe and effective treatment for severe children with acute poisoning. Attention should be payed to take precautions a-gainst childhood injury.