杀鼠药中毒所致凝血功能障碍20例临床分析
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摘要
目的总结杀鼠药中毒导致的凝血功能障碍的临床诊断及治疗。方法对20例抗凝血杀鼠药中毒致凝血功能障碍患者予以维生素K_1治疗,比较患者治疗前后的凝血功能改变:凝血酶原时间(PT)、国际正常化比率(INR),活化部分凝血活酶时间(APTT)、凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ活性。结果 20例患者全部治愈,治疗前后凝血功能明显改变,PT治疗前后分别为:(103.2±20.3)s,(12.0±0.5)s。INR治疗前后分别为:4.2±2.4,1.4±0.2。APTT治疗前后分别为:(93.2±25.4)s,(30.2±3.4)s。凝血因子Ⅱ:活性成分治疗前后分别为:(6.2±2.5)%,(92.3±4.5)%。凝血因子Ⅶ:活性成分治疗前后分别为:(10.8±4.9)%,(86.2±3.4)%。凝血因子Ⅸ:活性成分治疗前后分别为:(22.5±6.8)%,(96.4±7.8)%。凝血因子X:活性成分治疗前后分别为:(14.2±3.2)%,(83.2±3.4)%,差异有统计学意义(P<0.001)。结论杀鼠药中毒致凝血功能障碍,容易误诊,维生素K_1是特效解毒药。
Objective To summarize the clinical diagnosis and therapeutic methods about disturbance of blood coaguation induced by rodenticide poisoning. Methods Twenty patients were treated with vitamin K_1,the changes of coagulation function before and after treatment including prothrombin time( PT),international normalization ratio( INR),activated partial thromboplastin time( APTT),and coagulation factor Ⅱ,Ⅶ,Ⅸ,Ⅹ activity were compared. Results All the patients were cured. There was obvious difference between before and after treatment in the blood clotting index( P < 0. 001). Before and after treatment,PT was( 103. 2 ± 20. 3) s,( 12 ± 0. 5) s respectively; INR was( 4. 2 ± 2. 4),( 1. 4 ± 0. 2),respectively; APTT was( 93. 2 ± 25. 4) s,( 30. 2 ± 3. 4) s,respectively; Ⅱ: C was( 6. 2 ± 2. 5) %,( 92. 3 ± 4. 5) %,respectively; Ⅶ: C was( 10. 8 ± 4. 9) %,( 86. 2 ± 3. 4) %,respectively; Ⅸ: C was( 22. 5 ± 6. 8) %,( 96. 4 ± 7. 8) %,respectively; Ⅹ: C was( 14. 2 ± 3. 2) %,( 83. 2 ± 3. 4) %,respectively,and the differences were statistically significant( P < 0. 001). Conclusions Coagulation disorder induced by rodenticide poisoning is easy to misdiagnose,the therapy with vitamin K_1 is a specific antidote.
Objective To summarize the clinical diagnosis and therapeutic methods about disturbance of blood coaguation induced by rodenticide poisoning. Methods Twenty patients were treated with vitamin K_1,the changes of coagulation function before and after treatment including prothrombin time( PT),international normalization ratio( INR),activated partial thromboplastin time( APTT),and coagulation factor Ⅱ,Ⅶ,Ⅸ,Ⅹ activity were compared. Results All the patients were cured. There was obvious difference between before and after treatment in the blood clotting index( P < 0. 001). Before and after treatment,PT was( 103. 2 ± 20. 3) s,( 12 ± 0. 5) s respectively; INR was( 4. 2 ± 2. 4),( 1. 4 ± 0. 2),respectively; APTT was( 93. 2 ± 25. 4) s,( 30. 2 ± 3. 4) s,respectively; Ⅱ: C was( 6. 2 ± 2. 5) %,( 92. 3 ± 4. 5) %,respectively; Ⅶ: C was( 10. 8 ± 4. 9) %,( 86. 2 ± 3. 4) %,respectively; Ⅸ: C was( 22. 5 ± 6. 8) %,( 96. 4 ± 7. 8) %,respectively; Ⅹ: C was( 14. 2 ± 3. 2) %,( 83. 2 ± 3. 4) %,respectively,and the differences were statistically significant( P < 0. 001). Conclusions Coagulation disorder induced by rodenticide poisoning is easy to misdiagnose,the therapy with vitamin K_1 is a specific antidote.
引文
[1]YU HY,LIN JL,FU JF,et al.Outcomes of patients with rodenticide poisoning at a far east poison center[J].Springerplus,2013,3(2):505-511.
[2]杨旺,罗建明,林发全.临床分析23例抗凝血灭鼠剂中毒导致的凝血障碍[J].重庆医学,2016,45(15):2092-2094.
[3]王蕾,郭新红,江明,等.毒鼠药中毒致凝血异常19例临床分析[J].新疆医科大学学报,2013,36(7):962-964,969.
[4]詹玲玲,徐酉华.抗凝血灭鼠药中毒的研究现状[J].儿科药学杂志,2012,18(1):56-59.
[5]李蓓,冯聪,周璇,等.抗凝血杀鼠剂中毒6例报道并文献复习[J].解放军医学院学报,2015,36(4):333-336.
[6]金宝灿,广跃乾,王天昌,等.抗凝血杀鼠剂中毒21例误诊分析[J].贵州医药,2012,36(7):641-642.
[7]肖礼民.成人重度溴敌隆中毒27例临床分析[J].中国乡村医药,2014,,21(1):38-38.
[8] LEE HJ,YOU MR,MOON WR,et al. Evaluation of risk factors in patients with vitamin K-dependent coagulopathy presumed to be caused by exposure to brodifacoum[J]. Korean J Intern Med,,2014,29(4):498-508.
[9] KING N,TRAN MH. Long-acting anticoagulant rodenticide(superwarfarin)poisoning:A review of its historical development,epidemiology,and clinical management[J]. Transfus Med Rev,2015,29(4):250-258.
[10]龙剑海,孙亚威,邱泽武.影响抗凝血杀鼠剂中毒患者维生素K1维持剂量的多因素分析[J].中华危重症医学杂志(电子版),2016,9(2):87-90. DOI:10. 3877/cma. j. issn. 1674-6880.2016. 02. 003.
[11] SCHMEITS PC,PEQUERIAUX NC,VAN GEEST-DAALDEROP JH,et al. Investigating unexpected INRs:in search of the culpritadherence,interactions,genetics,and superwarfarin[J]. Neth J Med,2009,67(2):76-78.
[12] PARK J. Can we more efficiently save patients with vitamin K-dependent coagulopathy caused by superwarfarin intoxication[J].Korean J Intern Med,2014,29(4):430-433.
[2]杨旺,罗建明,林发全.临床分析23例抗凝血灭鼠剂中毒导致的凝血障碍[J].重庆医学,2016,45(15):2092-2094.
[3]王蕾,郭新红,江明,等.毒鼠药中毒致凝血异常19例临床分析[J].新疆医科大学学报,2013,36(7):962-964,969.
[4]詹玲玲,徐酉华.抗凝血灭鼠药中毒的研究现状[J].儿科药学杂志,2012,18(1):56-59.
[5]李蓓,冯聪,周璇,等.抗凝血杀鼠剂中毒6例报道并文献复习[J].解放军医学院学报,2015,36(4):333-336.
[6]金宝灿,广跃乾,王天昌,等.抗凝血杀鼠剂中毒21例误诊分析[J].贵州医药,2012,36(7):641-642.
[7]肖礼民.成人重度溴敌隆中毒27例临床分析[J].中国乡村医药,2014,,21(1):38-38.
[8] LEE HJ,YOU MR,MOON WR,et al. Evaluation of risk factors in patients with vitamin K-dependent coagulopathy presumed to be caused by exposure to brodifacoum[J]. Korean J Intern Med,,2014,29(4):498-508.
[9] KING N,TRAN MH. Long-acting anticoagulant rodenticide(superwarfarin)poisoning:A review of its historical development,epidemiology,and clinical management[J]. Transfus Med Rev,2015,29(4):250-258.
[10]龙剑海,孙亚威,邱泽武.影响抗凝血杀鼠剂中毒患者维生素K1维持剂量的多因素分析[J].中华危重症医学杂志(电子版),2016,9(2):87-90. DOI:10. 3877/cma. j. issn. 1674-6880.2016. 02. 003.
[11] SCHMEITS PC,PEQUERIAUX NC,VAN GEEST-DAALDEROP JH,et al. Investigating unexpected INRs:in search of the culpritadherence,interactions,genetics,and superwarfarin[J]. Neth J Med,2009,67(2):76-78.
[12] PARK J. Can we more efficiently save patients with vitamin K-dependent coagulopathy caused by superwarfarin intoxication[J].Korean J Intern Med,2014,29(4):430-433.