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目的分析抗凝血杀鼠剂中毒的临床特征及误诊原因,提高确诊率。方法对我院2013年12月—2016年9月收治的曾误诊为其他疾病的抗凝血杀鼠剂中毒27例的临床资料进行回顾性分析。结果本组误诊时间1 d~7个月,平均24.8 d;临床表现为尿血(血尿)23例,牙龈(口腔)出血10例,耳鼻出血8例,肢体疼痛(或活动受限)5例,阴道出血(月经量多)4例,腰痛、腹痛各2例,便血、凝血功能异常各1例。误诊43例次14种疾病,居前4位的分别是肾输尿管结石、凝血功能障碍、泌尿系感染和牙龈出血。本组有不同程度的贫血21例,出现凝血功能障碍19例,血液中检测到溴鼠灵、溴敌隆各18例,同时检出溴鼠灵和溴敌隆9例。均确诊为抗凝血杀鼠剂中毒,予补液促排、补充维生素K1、输注血浆、血液灌流等治疗,预后良好。结论抗凝血杀鼠剂中毒起病隐匿,临床表现多样,对高度怀疑中毒者,及时行相关检查,减少误诊误治。
Objective To analyze the clinical characteristics and causes of misdiagnosis of anticoagulant rodenticide poisoning and improve the diagnosis rate. Methods The clinical data of 27 cases of anticoagulant rodenticide poisoning who had been misdiagnosed as other diseases in our hospital from December 2013 to September 2016 were analyzed retrospectively. Results The time of misdiagnosis in this group was 1 d ~ 7 months with an average of 24.8 days. The clinical manifestations were hematuria (hematuria) in 23 cases, gingival (oral) hemorrhage in 10 cases, otolaryngological bleeding in 8 cases, limb pain or limited mobility in 5 cases, Vaginal bleeding (menstrual flow) in 4 cases, back pain, abdominal pain in 2 cases, hematochezia, coagulation dysfunction in 1 case. Misdiagnosis of 43 cases of 14 kinds of diseases, the top 4 are renal ureteral calculi, coagulation disorders, urinary tract infections and bleeding gums. In this group, 21 cases of anemia and 19 cases of clotting dysfunction appeared. 18 cases of bromodecaryl and bromadiolone were detected in blood, and 9 cases of bromodecaryl and bromadiolone were detected at the same time. All were diagnosed as anticoagulant rodenticide poisoning, to promote fluid replacement, vitamin K1, infusion of plasma, hemoperfusion and other treatments, the prognosis is good. Conclusion anticoagulant rodenticide poisoning occult onset, clinical manifestations of diverse, highly suspected poisoning, timely and relevant checks to reduce misdiagnosis and mistreatment.