急性铊中毒4例临床救治分析

孙昌华; 任昊; 袁丁; 车璐; 段国宇; 徐志高; 李素娟; 闫改勤; 朱桂英; 高艳霞

doi:10.13201/j.issn.1009-5918.2023.12.07

急性铊中毒4例临床救治分析

- 郑州大学第一附属医院急诊医学科(郑州，450000)
基金项目:
国家自然科学基金(No.82172180)；河南省高等学校重点科研项目(No.23A320009)

详细信息

通讯作者: 高艳霞，E-mail：gaoyanxiazzu@163.com

中图分类号: R595.2

收稿日期: 2023-06-29

刊出日期: 2023-12-10

Four case studies with clinical treatments for acute thallium poisoning

- Department of Emergency Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China

More Information

Corresponding author: GAO Yanxia, E-mail: gaoyanxiazzu@163.com

Received Date: 29 June 2023

Publish Date: 10 December 2023

摘要

摘要: 本文对2011年9月—2019年9月郑州大学第一附属医院收治的4例铊中毒患者进行回顾性分析，以了解铊中毒患者的临床特征及救治方法。4例患者中位确诊时间38 d，其中2例患者在诊疗过程中均被误诊为格林巴利综合征，3例患者出现脱发，2例患者在治疗期间发现米氏纹。4例患者均出现不同程度的心动过速，1例患者出现声音嘶哑，1例出现胸背部疼痛，1例出现消化道出血，1例出现心脏骤停，2例出现呼吸衰竭。给予普鲁士蓝口服，二巯基丙磺酸钠肌注及血液净化等驱铊治疗。1例因中毒量大，病情迅速恶化，放弃治疗，其余3例患者均好转或治愈。铊中毒最易被误诊为吉兰巴雷综合征，鉴别除了毒物接触史外，下肢肌肉疼痛、脱发、米氏纹均为特征性的表现。铊中毒的患者应尽早给予二巯基丙磺酸钠、普鲁士蓝、血液净化联合治疗，迅速地降低患者体内的铊浓度。
- 铊中毒 /
- 临床特征 /
- 治疗 /
- 预后 /
- 尿铊浓度
Abstract: This paper reviews the clinical characteristics and treatment of 4 patients with thallium poisoning treated in our hospital from September 2011 to September 2019. The median diagnosis time of the 4 patients was 38 days, of which 2 patients were misdiagnosed as Guillain-Barre syndrome during diagnosis and treatment, 3 patients had alopecia, and 2 patients found Mees' lines during treatment. All 4 patients had tachycardia of varying degrees, 1 patient had hoarseness, 1 patient had chest and back pain, 1 patient had gastrointestinal bleeding, 1 patient had cardiac arrest, and 2 patients had respiratory failure. The treatment was given by oral Prussian blue, intramuscular injection of sodium dimercaptopropyl sulfonate and blood purification. Due to the large amount of poisoning, the condition of 1 patient deteriorated rapidly and gave up treatment, and the other 3 patients were improved or cured. Thallium poisoning is most commonly misdiagnosed as Guillain-Barre syndrome. In addition to the history of exposure to the poison, pain in the muscles of the lower extremities, alopecia, and Mees' lines are the characteristic manifestations in the differential diagnosis. Combined treatment with sodium dimercaptopropanesulfonate, Prussian blue and blood purification should be given to patients with thallium poisoning as soon as possible to rapidly reduce the concentration of thallium in the body and improve the prognosis of patients.
- thallium poisoning /
- clinical characteristics /
- therapy /
- prognosis /
- urinary thallium concentration

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图 1 3例铊中毒患者驱铊治疗后尿铊浓度变化情况

下载: 全尺寸图片幻灯片

表 1 4例铊中毒一般资料

一般资料	患者1	患者2	患者3	患者4
性别	男	男	男	女
年龄/岁	26	37	46	15
确诊时间/d	71	20	55	2
首发症状	双下肢乏力疼痛	双足麻木疼痛	双下肢麻木疼痛	昏迷
昏迷时间/d	否	否	40	2
下肢肌力	3级	5级	0级	0级
脱发出现时间/d	30	21	30	否
米氏纹	有	有	无	无
其他症状	声音嘶哑、小腿肌肉萎缩	发热、胸背部疼痛	呼吸衰竭、消化道出血	呼吸衰竭、心脏骤停
心律/心率	窦性心动过速(116次/min)	窦性心动过速(113次/min)	窦性心动过速(102次/min)	室性心动过速(110次/min)
肌电图	周围神经传导延迟	阴性	周围神经传导异常	未做
预后	治愈	治愈	好转	放弃

下载: 导出CSV

表 2 4例铊中毒患者主要实验室检查结果

实验室检查	患者1	患者2	患者3	患者4
治疗前尿铊浓度/(μg/L)	90	631.8	422	21 200
最高尿铊浓度/(μg/L)	500	631.8	422	21 200
出院前尿铊浓度/(μg/L)	20.5	3.8	< 2.5	未复查
ALT最高值/(U/L)	83	399	357	69
CK-MB最高值/(U/L)	42	19	43	14
注：正常参考值：尿铊≤5 μg/L；ALT 0~40 U/L；CK-MB 0~16 U/L。

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表 3 驱铊治疗后患者尿铊浓度变化情况

患者编号	不同时间点尿铊浓度/(μg/L)
患者编号	0 d	3 d	7 d	14 d
患者1	90.0	500.0	210.5	20.5
患者2	631.8	299.7	67.0	3.8
患者3	422.0	106.0	177.4	2.5

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