慢性正己烷中毒102例临床分析

目的探讨正己烷中毒的临床特点。方法102例中男30例,女72例,年龄17～29岁,平均(21±3)岁。所有病例进行病史采集、神经病学、神经-肌电图、心电图、生化和眼科检查,尿2,5-己二酮含量以及工作环境空气正已烷浓度测定。结果车间空气正己烷浓度188.0～7848.6mg/m3,均超过安全水平。潜伏期平均(8.3±2.6)个月,病程平均(12.1±4.2)个月。前驱症状有头昏头痛、食欲不振和体重减轻,临床表现主要为自四肢远端开始的感觉异常、感觉和运动障碍,患者出现肢体麻木、乏力、肌腱反射减弱或消失、肌萎缩等,神经-肌电图显示神经源性损害改变。用B族维生素、中药、理疗和体疗治疗后全部病例完全康复。结论此病以多发性周围神经病为主要表现,根据正已烷接触史、临床症状和体征以及神经-肌电图神经源性损害可作出诊断,预后一般较好。

A clinical analysis of 102 cases of chronic n-hexane intoxication

OBJECTIVE: Chronic n-hexane exposure can result in n-hexane intoxication which is mainly characterized by a series of manifestations of peripheral nerve lesions. The disease was sometimes misdiagnosed as "unknown multiple peripheral neuropathy". 102 cases of n-hexane intoxication were investigated and reported in order to call attention to the disease. METHODS: All the 102 cases, male 30, female 72; age 17 - 29, mean (21 +/- 3) were n-hexane workers. During the hospitalization the following data were collected: medical history, neurological check up, electromyogram, electrocardiogram, serum biochemical analysis, ophthalmologic study and the metabolite of n-hexane- the urinary 2, 5-hexanedione level. The airborne n-hexane levels of the working environment were also measured. RESULTS: The average incubation period of the 102 cases was (8.3 +/- 2.6) months. The average course of the disease was (12.1 +/- 4.2) months. Airborne n-hexane concentration of the working places ranged from 188.0 to 7,848.6 mg/m(3). The most common prodromes were headache, anorexia, dizziness and weight loss. The main clinical manifestations of the disease were ascending abnormal sensation. Sensory loss and dyskinesia began from the distant parts of the limbs. The patient had reduction or disappearance of tendon reflexes, weakness and muscle atrophy in the limbs. Electromyography showed a neuropathic pattern, which was parallel to the clinical symptoms and signs. Delayed worsening of symptoms and signs after cessation of n-hexane exposure was observed in some cases. All the 102 cases recovered totally after treatment with Vitamin B, Chinese traditional medicine, physical therapy and training. CONCLUSION: The main lesion of the disease is multiple peripheral neuropathy. Diagnosis should be made according to the history of n-hexane exposure, the typical clinical manifestations of peripheral neuropathy as well as the neuropathic changes on electromyography. Therapeutic measures for peripheral neuropathy of other etiologies may be used and the prognosis is optimistic if correct diagnosis is made and further exposure stopped.