铊中毒五例临床分析

目的总结铊中毒的临床特点及诊治方法。方法复习５例铊中毒患者的临床资料及有关文献,分析其临床表现、铊定量结果及治疗方法、效果和预后。结果５例患者急性中毒３例,慢性中毒２例,４例有铊接触史。临床表现以周围神经、颅神经、中枢神经损害等神经系统表现多见,其次为脱发、指甲白色横纹等皮肤损害和腹痛、呕吐等消化系表现,尚可有呼吸、循环、肝肾损害等。５例均经正规驱铊治疗,除１例合并感染死亡外,余４例临床症状明显改善,复查血、尿铊正常,其中１例病程长、病情重者遗留部分后遗症。结论铊中毒的诊断依靠明确的接触史、典型的临床表现及血尿铊定量结果并不困难。由于误服含铊物质所致的铊中毒接触史常不明确,给临床诊治带来一定困难,应提高警惕

Thallium poisoning a clinical analysis of 5 cases

OBJECTIVE: To sumarize the clinical features, diagnosis and treatment of thallium poisoning by analysis of clinical cases. METHODS: Five cases of thallium poisoning were reported. The clinical manifestations, quantitative-analysed thallium level, methods and effect of treatment, and prognosis were analysed. RESULTS: Three of the 5 cases were acute, and the other two chronic. Four of them had a history of poison contact. The clinical features included alopicia (4 cases), transverse white stripes in the nails (Mee's stripes, 2) polyneuropathy, cranial nerve and central nervous system impairments (5), and abdominal pain and other digestion disturbances (3). All of the 5 cases were treated with antidotes and other methods to increase thallium excretion. One case died of lung infection 3 days after diagnosis. The serum and urine thallium levels of the 4 survivors decreased to normal after treatment (3 recovered, one had neurologic sequelae). CONCLUSION: It is not difficult to diagnose thallium poisoning by definite poison contact history, classical manifestation, and serum or urine thallium quantitative analysis. Attention should be paid to those patients with indefinite exposure to thallium. For those suspected cases, it is necessary to measure the thallium level in blood and urine in order to verify the diagnosis.