儿童汞中毒临床分析
摘要
目的总结儿童汞中毒的特点,提高对儿童汞中毒的诊治水平。方法对2013年1月至2018年5月收治的13例汞中毒患儿的中毒原因、临床表现、辅助检查、治疗及疗效情况进行回顾性分析。结果 13例患儿均为慢性生活性汞中毒,大多数症状轻微且不特异,仅1例有严重神经系统症状。所有患儿尿汞均升高(>20μg/L),血汞仅3例升高(>10μg/L)。2例经驱汞试验后,尿汞无明显增加(<150μg/L),未行驱汞治疗。其余11例均行螯合剂驱汞治疗,给予二巯丙磺钠2.5~5.0 mg/(kg·d),肌内注射,连用3 d,间隔4 d为1个疗程,疗程视尿汞而定,为1~10个疗程,疗程间隔0~4个月,治疗后症状减轻或消失,尿汞下降,治疗前后比较,差异有统计学意义(P <0.01)。结论儿童汞中毒多为慢性生活性汞中毒,症状隐匿。应加强汞暴露的防范意识及措施。在慢性汞中毒时尿汞检测更有意义,儿童驱汞治疗尚无标准方案,二巯丙磺钠治疗安全有效。
引文
[1]钱素云,丁宗一.金属中毒//江载芳,申昆玲,沈颖.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2014:2637-2639.
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[6]Wang Y,Wang D,Wu J,et al.Cinnabar-induced subchronic renal injury is associated with increased apoptosis in rats[J].Biomed Res Int,2015,2015:278931.
[7]Burch JB,Wagner Robb S,Puett R,et al.Mercury in fish and adverse reproductive outcomes:results from South Carolina[J].Int J Health Geogr,2014,13:30.
[8]Geier DA,Carmody T,Kern JK,et al.A significant dose-dependent relationship between mercury exposure from dental amalgams and kidney integrity biomarkers:a further assessment of the Casa Pia children's dental amalgam trial[J].Hum Exp Toxicol,2013,32:434-440.
[9]Rafati-Rahimzadeh M,Rafati-Rahimzadeh M,Kazemi S,et al.Current approaches of the management of mercury poisoning:need of the hour[J].Daru,2014,22:46.
[10]McKay CA Jr.Public health department response to mercury poisoning:the importance of biomarkers and risks and benefits analysis for chelation therapy[J].J Med Toxicol,2013,9:308-312.
[11]胡晓亮,宋丽红.二巯丙磺酸钠治疗汞中毒引起肾损伤一例[J].中华劳动卫生职业病杂志,2015,33:290.
[2]Lorenzo Dus MJ,Cases Viedma E,Bravo Gutiérrez J,et al.Pulmonary embolism caused by elemental mercury[J].Arch Bronconeumol,2007,43:585-587.
[3]Mahajan VK,Sharma NL.Metallic mercury vapour poisoning revisited[J].Australas J Dermatol,2011,52:e5-e7.
[4]Oz SG,Tozlu M,Yalcin SS,et al.Mercury vapor inhalation and poisoning of a family[J].Inhal Toxicol,2012,24:652-658.
[5]Tezer H,Erko?o?lu M,Kara A,et al.Household poisoning cases from mercury brought from school[J].Eur J Pediatr,2011,170:397-400.
[6]Wang Y,Wang D,Wu J,et al.Cinnabar-induced subchronic renal injury is associated with increased apoptosis in rats[J].Biomed Res Int,2015,2015:278931.
[7]Burch JB,Wagner Robb S,Puett R,et al.Mercury in fish and adverse reproductive outcomes:results from South Carolina[J].Int J Health Geogr,2014,13:30.
[8]Geier DA,Carmody T,Kern JK,et al.A significant dose-dependent relationship between mercury exposure from dental amalgams and kidney integrity biomarkers:a further assessment of the Casa Pia children's dental amalgam trial[J].Hum Exp Toxicol,2013,32:434-440.
[9]Rafati-Rahimzadeh M,Rafati-Rahimzadeh M,Kazemi S,et al.Current approaches of the management of mercury poisoning:need of the hour[J].Daru,2014,22:46.
[10]McKay CA Jr.Public health department response to mercury poisoning:the importance of biomarkers and risks and benefits analysis for chelation therapy[J].J Med Toxicol,2013,9:308-312.
[11]胡晓亮,宋丽红.二巯丙磺酸钠治疗汞中毒引起肾损伤一例[J].中华劳动卫生职业病杂志,2015,33:290.