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目的探讨二巯基丙磺酸钠(DMPS)对尿汞增高患者驱汞治疗的疗效和安全性。方法采用随机抽样的方法,以68例尿汞增高患者为研究对象,其中汞作业观察对象61例,职业性慢性轻度汞中毒7例。采用肌内注射DMPS进行驱汞治疗,观察治疗前后患者尿汞水平变化情况,分析疗效。结果 68例患者自然排尿汞中位数和第25、75百分位数[M(P_(25),P_(75))]为36.6(28.4,55.6)μmol/mol肌酐,第1疗程驱汞治疗后24 h尿汞总量M(P_(25),P_(75))为1 074.7(608.0,1 646.3)μg/d。经1~8个疗程驱汞治疗后,68例患者的24 h尿汞总量均低于驱汞治疗正常参考值(45.0μg/d);出院前一次性晨尿尿汞水平M(P_(25),P_(75))为2.7(1.8,4.0)μmol/mol肌酐,低于驱汞治疗前的自然排尿汞水平(P<0.05)。第1和2疗程驱汞治疗之间尿汞水平下降最快,其后疗程的尿汞水平下降趋于平缓。汞作业观察对象驱汞治疗疗程数少于慢性轻度汞中毒患者[(4.0±1.3)vs(5.6±1.1)个,P<0.05)。驱汞治疗疗程数与自然排尿汞水平及第1疗程24 h尿汞总量均呈正相关(P<0.01),与性别、工龄及年龄均不相关(P>0.05)。1例患者肌注DMPS后有头晕伴面色苍白,对症治疗后症状消失;68例患者用药后均无其他不良反应。结论 DMPS驱汞治疗的疗效肯定,且较为安全;DMPS驱汞后尿汞变化情况可为制定慢性汞中毒患者临床路径标准提供基础。
Objective To investigate the efficacy and safety of sodium dimercaptopropane sulfonate (DMPS) in the treatment of excreted mercury in patients with elevated urinary mercury. Methods A random sample of 68 cases of patients with increased urinary mercury as the research object, including mercury observed in 61 cases, occupational chronic mild mercury poisoning in 7 cases. Using intramuscular injection of DMPS for mercury excretion treatment, the change of urinary mercury level in patients before and after treatment was observed, and the curative effect was analyzed. Results The median of urinary mercury excretion and the 25th and 75th percentiles [M (P_ (25), P_ (75)]] of 36 patients were 36.6 (28.4,55.6) μmol / The total amount of urinary mercury M (P_ (25), P_ (75)) at 24 h after treatment was 1 074.7 (608.0,1 646.3) μg / d. After excretion of 1 to 8 courses of mercury treatment, 68 patients with 24 h urinary mercury were lower than the normal reference value of excreted mercury treatment (45.0μg / d); discharge before the morning urine urinary mercury level M (P_ P (75)) was 2.7 (1.8, 4.0) μmol / mol creatinine, which was lower than that of the natural urinary mercury excretion before excretion of mercury (P <0.05). The level of urinary mercury dropped fastest between treatments 1 and 2, and the levels of urinary mercury after the course of treatment tended to decrease. Mercury-operated subjects were less likely to have mercury-treated regimens than those with mild mild mercury poisoning [(4.0 ± 1.3) vs (5.6 ± 1.1), P <0.05). The number of courses of excretion of mercury was positively correlated with the level of urinary mercury excretion and the total amount of urinary mercury in the first course of treatment (P <0.01), but not with gender, length of service and age (P> 0.05). One patient had dizzy and pale skin after intramuscular injection of DMPS, and symptoms disappeared after symptomatic treatment. All 68 patients had no other side effects after treatment. Conclusion The efficacy of DMPS with mercury excretion is safe and safe. The changes of urinary mercury after DMPS excretion of mercury can provide the basis for establishing the clinical pathological criteria of patients with chronic mercury poisoning.