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目的分析总结急性铊中毒的临床表现及治疗方法。方法收集2009至2011年军事医学科学院附属医院收治的所有急性铊中毒患者病历资料进行回顾性分析。结果 2009至2011年共收治急性铊中毒患者14例,男性8例,女性6例,年龄9~68岁,平均42岁。1例自诉被他人投毒;1例疑似误服;2例与铊中毒者有共同生活史;10例中毒原因不明。铊中毒早期临床表现主要为恶心、呕吐、腹痛等胃肠道症状(5例)和四肢麻木、酸胀疼痛、记忆力减退等神经系统症状(13例),10例出现肝功能异常,8例出现毛发脱落,1例指甲出现Mees纹。治疗前患者血铊浓度为3764.0~19.7μg/L,尿铊浓度为29 100.0~0.2μg/L,给予单纯支持(1例)、口服普鲁士蓝(4例)和口服普鲁士蓝联合血液灌流(9例)等治疗后,血铊浓度降至68.0~2.4μg/L,尿铊浓度降至542.0~11.3μg/L。13例出现神经系统症状者在住院期间症状明显缓解,但出院时仍有轻度四肢麻木、疼痛等症状。5例出现胃肠道症状者在1周内症状缓解或消失。10例出现肝功能异常者的肝酶水平在2~4周内恢复正常。8例毛发脱落者中5例在住院期间好转,3例未见明显变化。出现Mees纹者体征无变化。结论患者出现不明原因胃肠道症状且同时伴有神经系统症状时,应考虑重金属中毒的可能。普鲁士蓝联合血液灌流治疗铊中毒安全有效。
Objective To analyze and summarize the clinical manifestations and treatment of acute thallium poisoning. Methods A retrospective analysis was performed on the medical records of all patients with acute thallium poisoning admitted to the Affiliated Hospital of Academy of Military Medical Sciences from 2009 to 2011. Results A total of 14 patients with acute thallium poisoning were admitted from 2009 to 2011, including 8 males and 6 females, aged from 9 to 68 years with an average of 42 years. One case of private prosecution was poisoned by others; one case was suspected to be mistaken; two cases had common life history with thallium poisoning; the cause of poisoning was unknown in 10 cases. The main clinical manifestations of thallium poisoning were nausea, vomiting, abdominal pain and other gastrointestinal symptoms (n = 5) and numbness, soreness and pain, memory loss and other nervous system symptoms (13 cases), 10 cases of liver dysfunction occurred in 8 cases Hair loss, nail nails appear Mees pattern. Blood thallium concentration was 3764.0-19.7 μg / L and thallium concentration was 29 100.0-0.2 μg / L before treatment in patients with simple support (1 case), oral Prussian blue (4 cases) and oral Prussian blue combined with blood perfusion Cases) After treatment, the blood thallium concentration dropped to 68.0 ~ 2.4μg / L, urinary thallium concentration dropped to 542.0 ~ 11.3μg / L. Thirteen patients with neurological symptoms were significantly relieved during hospitalization but were still experiencing mild numbness and pain when discharged from hospital. 5 cases of gastrointestinal symptoms in 1 week to alleviate or disappear symptoms. Liver enzymes in 10 patients with abnormal liver function returned to normal in 2 to 4 weeks. Of the 8 cases of hair loss, 5 cases improved during hospitalization and 3 cases showed no significant change. No signs of change Mees signs. Conclusion Patients with unexplained gastrointestinal symptoms accompanied by neurological symptoms should consider the possibility of heavy metal poisoning. Prussian blue combined hemoperfusion thallium poisoning safe and effective.