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目的探讨铅中毒脑病的临床特点及预后。方法回顾分析衡阳市中心医院儿科2002～2003年26例铅中毒脑病患儿的临床资料及随访结果。结果26例铅中毒脑病患儿临床均表现为频繁的抽搐伴意识障碍,中度以上贫血。伴呕吐23例、腹泻21例、发热11例、肝大5例。26例患儿治疗前血铅平均为8.486μmol/L,尿铅平均为3.598μmol/L,Hb均低于90g/L,最低55g/L。血钙均低于1.86mmol/L,最低1.03mmol/L。脑脊液蛋白均增高,22例心肌酶谱增高,提示心肌损害明显。头颅CT/MRI仅1例脑室系统轻度扩张,全部病例经驱铅治疗后无一例死亡,1年后随访,继发性癫疒间4例,脑瘫4例。结论铅中毒脑病是铅中毒的严重类型,预后不良。对不明原因的无热惊厥者应注意及时行血铅检查,以便早期诊断,防止漏诊。
Objective To investigate the clinical characteristics and prognosis of lead poisoning encephalopathy. Methods The clinical data and follow-up results of 26 children with lead poisoning encephalopathy in Hengyang Central Hospital from 2002 to 2003 were retrospectively analyzed. Results 26 cases of lead poisoning encephalopathy in children with clinical manifestations of frequent convulsions associated with disturbance of consciousness, moderate to severe anemia. With vomiting in 23 cases, 21 cases of diarrhea, fever in 11 cases, 5 cases of liver. The mean blood lead level was 8.486μmol / L before treatment, 3.598μmol / L for urinary lead, Hb was less than 90g / L and the lowest was 55g / L. Blood calcium were less than 1.86mmol / L, the lowest 1.03mmol / L. Cerebrospinal fluid protein were increased, 22 cases of myocardial enzymes increased, suggesting that myocardial damage significantly. Only one case of cranial CT / MRI showed slight dilatation of ventricular system. All cases died of lead poisoning. One year later, 4 cases of secondary epilepsy and 4 cases of cerebral palsy were observed. Conclusion Lead poisoning encephalopathy is a serious type of lead poisoning with poor prognosis. For unexplained fever-free seizures should pay attention to prompt blood lead examination for early diagnosis, to prevent missed diagnosis.