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 manifestation and influential factors in patients with acute arsenic poisoning

Objective To investigate the clinical characteristics of acute arsenic poisoning and its influential factors. Methods Clinical data of 47 cases of arsenic poisoning were collected and analyzed. Two cases of observation,40 cases of mild acute poisoning,and 5 severe acute poising were investigated in this group. Results Myocardial enzyme activity was correlated with age and urine arsenic concentrations. Myocardial enzyme,the liver ALT,total bilirubin (TBil) and indirect bilirubin (IBil) were negatively correlated with vomiting frequency,with statistical significance (P<0.05). Urine arsenic concentration was correlated with vomiting frequency and amount of soup drunk, with statistically significant difference(P<0.05 ). Despite no statistical significance in age and amount of soup drunk, the patients with more vomiting or diarrhea had less urine arsenic concentrations,cardiac enzymes and liver enzyme concentration. Conclusion Acute arsenic poisoning can lead to muhiple organ damage. The damage is relevant with amount of arsenic intake, vomiting,diarrhea and urinary frequency arsenic concentration. So early use of gastric lavage, vomiting, poison discharges, and adequate application of effective antidote (Na-DMPS)as soon as possible, symptomatic treatment and the reinforced monitoring, are the rescue key for patients with acute arsenic poisoning.