抗凝血杀鼠剂中毒6例报道并文献复习

Anticoagulant rodenticide poisoning: A report of 6 cases and literature review

  • 摘要: 目的 总结抗凝血杀鼠剂中毒的临床表现、诊断和治疗方法。 方法 回顾性分析我科2012年2月-2014年3月收治的6例抗凝血杀鼠剂中毒患者的病历资料,并结合文献进行回顾性分析。 结果 6例以血尿、口鼻腔出血为主要表现,出血不易自止。3例以血尿为首发临床表现,其中1例伴发口鼻腔出血;2例以口鼻腔出血为主要表现,其中1例伴皮肤瘀点、瘀斑及头痛;1例无出血症状。3例白细胞计数增高,5例血红蛋白水平降低;5例凝血酶原时间、活化部分凝血酶原时间、凝血酶时间延长,凝血酶原活动度降低。凝血因子Ⅱ、Ⅶ、Ⅸ、Ⅹ活性下降。补充维生素K1或新鲜冷冻血浆(或凝血酶原复合物)后出血控制。 结论 以广泛性多部位出血为主要表现的患者要注意抗凝血杀鼠剂中毒的可能,治疗以补充维生素K1为主。

     

    Abstract: Objective To analyze the mechanism, clinical characteristics, diagnoses and treatments of anticoagulant rodenticides poisoning. Methods Six cases diagnosed with anticoagulant rodenticides poisoning in our department since 2012 were enrolled in this study and its related literatures were reviewed. Results Poisoning was characterized by hematuria, bleeding of oral and nasal cavities in 6 patients. Of the 6 cases, 3 patients presented with hematuria as primary clinical manifestation and one of them was accompanied by bleeding of oral and nasal cavities; 2 were accompanied by oral mucosal bleeding and 1 by skin petechiae or ecchymoses; 1 without bleeding symptom. The white blood count (WBC) elevated mildly in 3 patients, hemoglobin level decreased in 5 cases; prothrombin time, activated partial prothrombin time and thrombin time were prolonged and activity of thrombinogen reduced in 5 patients. Coagulation factor Ⅱ Ⅶ, Ⅸ, Ⅹdecreased. Hemorrhage was effective after supplementary of vitamin K1or fresh frozen plasma (or prothrombin complex). Conclusion Primary manifestation being hemorrhage of multiple sites should be taken into account the possibility of anticoagulant rodenticides poisoning, which is mainly treated by supplementary of vitamin K1.

     

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