长效抗凝血灭鼠剂致隐匿性中毒12 例临床分析

目的:探索长效抗凝血灭鼠剂致隐匿性中毒的特点及其诊断与治疗。方法:对2008 年7 月至2011 年4月在外院误诊后转入中南大学湘雅医院的抗凝血灭鼠剂隐匿性中毒12 例患者临床表现、血浆凝血酶原时间(PT) 、活化部分凝血酶时间(APTT)、首诊医院误诊情况及我院诊治效果进行回顾性分析。结果:抗凝血灭鼠剂中毒临床表现隐匿,可表现为皮肤瘀斑、血尿、阴道流血、消化道出血等;实验室检查显示PT 和APTT 明显延长;每日补充维生素K₁治疗,止血效果明显。治疗前后PT 和APTT 差异均有统计学意义(P<0.01)。结论:长效抗凝血灭鼠剂中毒患者为获得性维生素K依赖的凝血因子减少导致的凝血功能异常,由于病史隐匿,中毒症状推后出现,并累及多个器官,容易导致误诊并危及生命。因此,详细的病史收集,全面体查,可提高诊断准确性。一旦确诊为抗凝血灭鼠剂中毒,维生素K₁应尽早使用。

Clinical analysis of 12 patients caused by long-acting anticoagulant rodenticide occult poisoning

Objective: To explore the clinical characteristics and diagnosis and treatment of occult poisoning caused by long-acting anticoagulant rodenticides. Method: Records of 12 patients from July 2008 to April 2011 diagnosed as anticoagulant rodenticide occult poisoning, who had been misdiagnosed initially at other hospitals were analyzed retrospectively. Elements from the records included clinical symptoms and signs, laboratory findings for prothrombin time (PT) and activated partial prothrombin time (APTT), and initial misdiagnosis and treatment outcome at our hospital. Results: The clinical presentations of patients were insidious and serious, often presented as skin ecchymose, hematuria, menorrhagia and gastrointestine bleeding. Laboratory examinations showed prolonged PT and APTT; bleeding was controlled effectively by administoring vitamin K1 daily. There were statistical difference between PT and APTT before and after the treatment (P<0.01). Conclusion: Coagulation disorders might be caused by the reduced acquisition in vitamin K dependent coagulation factors, which tends to be neglected due to a hidden medical history, delayed signs of poisoning, and various organs involved. A detailed patient history and systematic review may improve the diagnostic accuracy. Once diagnosed is made, vitamin K1 should be given as soon as possible.