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目的报告1例服用中药所致严重砷、铅中毒病例的发病情况、临床表现及治疗转归。方法回顾性分析本院近期收治的1例急性重度砷中毒、急性中度铅中毒病人的临床资料和治疗结果。结果病人服用含朱砂中药后出现消化道、皮肤、造血等器官严重损伤;入本院后进行实验室检查,用二巯基丙磺钠0.125 g肌内注射后留取24 h尿,查尿砷值为14.8μmol/L、尿铅值为12.8μmol/L,立即采用络合剂二巯基丙磺钠,后用依地酸钠钙驱砷、铅,同时进行抑酸、止血、防治感染对症支持等治疗,治疗4 d后患者症状明显减轻,住院29 d后好转出院,患者出院半年后症状消失,各项实验室检查恢复至正常,达到治愈标准。结论服用含朱砂等中药时因药物杂质可能发生砷、铅中毒,在络合剂的选择上,先采用对砷、铅中毒均有络合作用的二巯基丙磺钠进行治疗,后用依地酸钙钠进行驱铅治疗。
Objective To report the incidence, clinical manifestation and treatment outcome of one case of severe arsenic and lead poisoning caused by taking traditional Chinese medicine. Methods The clinical data and treatment results of one case of acute severe arsenism and acute moderate lead poisoning admitted to our hospital were retrospectively analyzed. Results After taking cinnabar traditional Chinese medicine, the patients suffered serious damage to the organs such as digestive tract, skin and hematopoietic cells. After entering the hospital, they were subjected to laboratory tests. After taking 0.125 g sodium dimercaptopropane sulpate intramuscularly for 24 hours, the urinary arsenic 14.8μmol / L, the urinary lead value of 12.8μmol / L, the immediate use of complexing agent DTPA sodium, followed by sodium edetate calcium arsenic, lead, at the same time to inhibit acid, stop bleeding, symptomatic prevention and treatment of infection support After 4 days of treatment, the symptoms of the patients were significantly relieved. After 29 days of hospitalization, the patients were relieved and discharged. After six months, the symptoms disappeared and the laboratory tests returned to normal, reaching the standard of cure. Conclusions Arsenic and lead poisoning may occur due to drug impurities when taking cinnabar and other traditional Chinese medicines. In the choice of complexing agent, sodium dimercaptopropane sulfonate, which has complexation with arsenic and lead poisoning, is firstly used for treatment. After that, Calcium and sodium acid for lead treatment.