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[目的]分析探讨急性铊中毒的临床症状及体征,为早期诊断治疗提供科学依据。[方法]总结分析我院近7年来收治的15例铊中毒患者的临床表现,实验室检查及诊治经过。[结果]分析研究发现临床表现以胃肠道不适,肌痛和毛发脱落为主,占总病例数的80%;其中束状脱发发生率为100%,出现时间晚于肌痛。实验室检查尿铊浓度均超标(浓度范围782~10,252μg/L),肌电图均出现双侧腓肠神经振幅下降。86.7%的患者均发生过误诊,仅2例为主动到中毒专科就诊。除1例延误诊治有后遗症外,治愈率为93.3%。6年追踪未发现发育及生育障碍。[结论]对胃肠不适、肌痛后出现毛发脱落的患者给予常规血铊、尿铊的检查,尽早识别铊中毒三联征,加强对非专科医师的培训是早期正确诊断铊中毒,减少后遗症及降低死亡率的重要途径。
[Objective] To analyze and discuss the clinical symptoms and signs of acute thallium poisoning and provide a scientific basis for early diagnosis and treatment. [Methods] To summarize and analyze the clinical manifestations, laboratory tests and diagnosis and treatment of 15 cases of thallium poisoning admitted to our hospital in the past 7 years. [Results] The study found that the main clinical manifestations of gastrointestinal discomfort, myalgia and hair loss, accounting for 80% of the total number of cases; the incidence of fascicular hair loss was 100%, appeared later than myalgia. Laboratory tests of urinary thallium concentrations were exceeded (concentration range 782 ~ 10,252μg / L), EMG showed bilateral sural nerve amplitude decreased. 86.7% of patients had misdiagnosis, only 2 cases were active to poisoning specialist treatment. Except for one case of delayed diagnosis and treatment with sequelae, the cure rate was 93.3%. 6-year follow-up found no developmental and reproductive disorders. [Conclusion] The routine examination of thallium and urinary thallium in patients with hair loss due to gastrointestinal discomfort and myalgia, early identification of the triple sign of thallium poisoning, and strengthening the training of non-specialists are the early correct diagnosis of thallium poisoning and the reduction of sequelae and An important way to reduce mortality.