论文部分内容阅读
目的分析严重肝病患者静脉误用二甘醇后中毒的临床特点,探讨其中毒的可能相关因素。方法使用病例分析方法,分析静脉注入二甘醇的64例患者的临床及病理特点;应用病例对照研究方法比较二甘醇中毒组与无中毒组临床特点的差异,分析发生中毒的可能相关因素。结果15例患者发生二甘醇中毒,且都出现少尿型急性肾功能衰竭。其中11例出现消化道症状或消化道症状加重;10例出现神经系统受损,以颅神经及外周神经为主;13例发生代谢性酸中毒;中毒后血WBC、RBC、Hb分别为(9.78±3.75)×10~9/L、(2.32±0.76)×10~(12)/L、(79.5±23.6)g/L,WBC明显升高(P=0.008),RBC和Hb降低(P值分别为0.014和0.018)。中毒患者肾组织活检表现为急性肾小管坏死及间质炎症。12例中毒患者死亡。两组患者用药前诊断为重型肝炎、治疗过程中合并使用利尿剂、腹水、存在肾脏基础疾病的比例差异有统计学意义(P<0.05);两组患者之间静脉注射二甘醇前血中性粒细胞计数、BUN、Cr、钙离子和磷离子水平差异有统计学意义(P<0.05)。结论静脉二甘醇中毒主要表现为少尿型急性肾功能衰竭、代谢性酸中毒、胃肠道症状以及外周神经系统损害,贫血和WBC增高;病死率高;用药前存在严重肝脏疾患、肾脏疾病、潜在肾损害、感染可能是发生静脉二甘醇中毒的相关因素。
Objective To analyze the clinical features of intravenous administration of diethylene glycol poisoning in patients with severe liver diseases and to explore the possible related factors of poisoning. Methods The clinical and pathological features of 64 patients with intravenous administration of diethylene glycol were analyzed using a case analysis method. The differences between the two groups were compared with those of the non-toxic group by a case-control study, and the possible related factors of the poisoning were analyzed. Results Diethylene glycol poisoning occurred in 15 patients and oliguric acute renal failure occurred. Among them, 11 cases had gastrointestinal symptoms or digestive symptoms aggravated; 10 cases showed nervous system damage, mainly cranial nerves and peripheral nerves; 13 cases had metabolic acidosis; WBC, RBC and Hb after poisoning were (9.78 WBC increased significantly (P = 0.008), RBC and Hb decreased (P value, P <0.01) 0.014 and 0.018 respectively). Toxic patients with renal biopsy showed acute tubular necrosis and interstitial inflammation. 12 cases of poisoning patients died. Two groups of patients diagnosed as severe hepatitis before treatment, the course of treatment combined diuretics, ascites, there is a significant difference in the proportion of kidney disease (P <0.05); between the two groups of patients before intravenous injection of blood The levels of BUN, Cr, Ca2 +, and Px were statistically different (P <0.05). Conclusion Intravenous diethylene glycol poisoning is mainly manifested as oliguric acute renal failure, metabolic acidosis, gastrointestinal symptoms and peripheral nervous system damage, anemia and WBC increased; high mortality; severe liver disease, kidney disease , Potential kidney damage, infection may be related to the occurrence of venous diethylene glycol poisoning.