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目的目的:通过对抗凝血类灭鼠剂中毒患者的临床特征分析,探讨抗凝血类灭鼠剂中毒的临床特征、治疗方案和再发出血的原因。方法方法:回顾性分析28例抗凝血类灭鼠剂中毒患者的病例资料及患者出院后进行电话随访,分析其中毒原因、临床表现、实验室检查、诊断、治疗及预后情况。结果结果:共有28例抗凝血类灭鼠剂中毒患者,男16例,女12例。3例为皮肤接触,23例为口服,2例不详。口服患者5例为敌鼠钠,15例为溴敌隆,3例为嗅鼠灵,口服患者中有10例为服用沾有灭鼠剂的食物。在首诊的28例中,急诊内科15例、儿科4例、精神病重症监护病房(PICU)1例、血液内科4例、耳鼻咽喉科2例、泌尿外科1例、妇科1例。其中发生误诊漏诊6例,儿科1例、PICU1例、耳鼻咽喉科2例、泌尿外科1例、妇科1例。(1)治疗前检测血常规:28例平均血红蛋白为87 g/L(52 g/L~133 g/L),血小板计数均在正常范围。(2)28例中26例出现凝血功能异常,对这些病例的凝血功能变化按照治疗前及治疗后进行比较。治疗前后凝血功能变化:经维生素K1治疗后第1天、第2天、第5天检测的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)与治疗前比较显著缩短,差异有统计学意义(P<0.01)。对所有患者进行维生素K110~40 mg/天静脉滴注治疗,2~5天后26例有出血症状的患者出血症状改善,凝血功能恢复正常。随访至患者出院后半年,4例失访,共6(6/24)例出院后再次出现凝血功能障碍就诊,复发率25%;其中4例在1月内再次出现凝血功能异常,1例在3月后出现凝血功能异常,1例在6月后出现出血,无死亡病例。结论结论:临床医师应提高对抗凝血类灭鼠剂中毒的认识。在治疗上,应予维生素K长期治疗。
Objective: To investigate the clinical characteristics of anticoagulant rodenticide poisoning in patients with anticoagulant clinical features, treatment options and causes of bleeding again. Methods and Methods: A retrospective analysis of 28 cases of anticoagulant rodenticide poisoning patients and patients after telephone follow-up, analysis of its causes of poisoning, clinical manifestations, laboratory tests, diagnosis, treatment and prognosis. Results: A total of 28 cases of anti-clotting rodenticide poisoning patients, 16 males and 12 females. 3 cases of skin contact, 23 cases were oral, 2 cases unknown. Five patients were oral sodium enemies of enemy mice, 15 cases of bromadiolone, 3 cases of olfactory signs, 10 cases of oral patients taking food stained with rodenticide. In the first visit of 28 cases, 15 cases of emergency medicine, 4 cases of pediatrics, psychiatric intensive care unit (PICU) in 1 case, 4 cases of blood medicine, 2 cases of otolaryngology, 1 case of urology, 1 case of gynecology. Among them, 6 cases were misdiagnosed, 1 was pediatrics, 1 was PICU, 2 was ENT, 1 was urology and 1 was gynecology. (1) Pretreatment blood test: 28 patients with average hemoglobin of 87 g / L (52 g / L ~ 133 g / L), platelet counts were in the normal range. (2) Among the 28 cases, 26 cases showed coagulation abnormalities, and the changes of coagulation function in these cases were compared according to pre-treatment and post-treatment. Changes of coagulation function before and after treatment: Prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR) and treatment on the 1st, 2nd and 5th days after vitamin K1 treatment Before shortening significantly, the difference was statistically significant (P <0.01). All patients were treated with vitamin K110 ~ 40 mg / day for intravenous drip. After 2 ~ 5 days, 26 patients with hemorrhagic symptoms improved hemorrhagic symptoms and blood coagulation returned to normal. Followed up to six months after discharge from the hospital, 4 patients were lost to follow-up, a total of 6 (6/24) cases of coagulation dysfunction again discharged after treatment, the recurrence rate was 25%; 4 of them again in 1 month clotting dysfunction, 1 in 3 months after coagulation abnormalities, 1 case of bleeding in June, no deaths. Conclusions: Clinicians should raise awareness of anticoagulant poisoning. In the treatment, should be long-term treatment of vitamin K.