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目的 了解三邻甲苯磷酸酯 (TOCP)暴发中毒患者的临床特征 ,并探讨其诊断的敏感指标。方法 对 70例TOCP中毒患者 4年的临床资料进行了分析。结果 患者临床表现符合迟发性中枢 -周围远端型轴索病。食入TOCP的面粉后有一段无症状期 ,平均 46d ,其间无任何胃肠道症状和毒蕈碱样症状。麻痹前突出的症状为腓肠肌疼痛 (95 .7% ) ,是本组患者的首发症状。 3～ 7d后 ,出现由下肢远端开始的多发性周围神经病表现 ;重度中毒患者 (2 0例 )于发病 1个月左右开始出现上运动元麻痹的表现。所有神经损害的表现下肢均早于并重于上肢 ,远端重于近端。 7个月左右时 ,轻度中毒患者肢体功能大多基本恢复到病前水平 ;而重度中毒患者锥体束损害的表现却更加突出 ,10 0 %有肢体残疾。在第 1个月和第 48个月 ,对 10例中毒患者作神经肌电和诱发电位 (EP)检查 ,结果表明 ,下肢肌电图 (EMG)、运动神经传导速度 (MCV)均异常 ;下肢运动诱发电位 (MEP)异常 4例 ,均为中枢运动通路传导时间 (CMCT)延长 ;上肢体感诱发电位 (SEP)异常 2例 ,下肢SEP全部异常。TOCP中毒尚无特效疗法 ,常用B族维生素、ATP等治疗。恢复期针灸、按摩等有助于肢体功能的恢复。结论 腓肠肌疼痛对TOCP中毒具有诊断价值 ,EMG、神经传导速度、EP检查可作为诊断的?
Objective To understand the clinical characteristics of patients with tocopherol triphosphate (TOCP) outbreak and to explore the sensitive indicators of the diagnosis. Methods The clinical data of 70 patients with TOCP poisoning for 4 years were analyzed. Results The patient’s clinical findings were in line with the late-onset central-distal type of axonal disease. After ingestion of TOCP flour, there is a period of asymptomatic period, an average of 46d, during which there is no gastrointestinal symptoms and muscarinic symptoms. Symptoms of paralysis before the gastrocnemius pain (95.7%), is the first symptom of this group of patients. After 3 ~ 7 days, the appearance of multiple peripheral neuropathy started from the distal end of the lower extremity. The patients with severe poisoning (20 cases) started to show paralysis of upper limbs after about 1 month of onset. The performance of all nerve damage lower limbs are both earlier than the upper limbs, the distal heavier than the proximal. At about 7 months, most patients with mild poisoning basically recovered to their pre-morbid limb function. However, the performance of pyramidal tract damage was more prominent in patients with severe poisoning, and 10% had physical disability. In the first month and the 48th month, 10 cases of poisoning patients for neuromuscular and evoked potential (EP) examination showed that lower extremity electromyography (EMG), motor nerve conduction velocity (MCV) were abnormal; lower limbs There were 4 cases of abnormalities of motor evoked potentials (MEP), both of which were prolonged CMCT; 2 cases of abnormal somatosensory evoked potential (SEP) of upper limbs and all of abnormalities of SEP of lower limbs. TOCP poisoning no effective therapy, commonly used B vitamins, ATP and other treatment. Convalescent acupuncture, massage, etc. help to restore limb function. Conclusion Gastrocnemius muscle pain has diagnostic value for TOCP poisoning. EMG, nerve conduction velocity and EP can be used as diagnosis.