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目的探讨慈溪地区急性砷中毒后在神经精神障碍上表现,以及神经电生理情况。方法回顾性分析2010年2月至2014年1月103例急性砷中毒患者,对其临床表现和实验室检查等进行总结,分析在神经精神障碍表现,观察其脑电图、肌电图、诱发电位、心电图、肝功、腰椎穿刺指标情况,对所有患者及时采用二巯基丁二酸钠胶囊等治疗,观察治疗后疗效。结果在神经精神障碍上,可分成3种,神经型54例,精神型31例,混合型18例。神经型中临床表现上以四肢烧灼或麻木感、肢体自发疼痛、疲乏无力为主;精神型则以急性中毒性脑病表现为主,主要是烦躁不安、失眠多梦和恐怖性幻觉;混合型则以上表现均有。在神经电生理上,脑电图上表现为额颞部慢波增多,高波幅的棘波和α波。肌电图中表现为纤颤波和正锐波,运动和感觉神经传导速度减慢;诱发电位检查中表现为波幅低、波型消失、潜伏期延长。心电图表现为ST段下降、T波平坦和双相或倒置、QT时间延长。肝功能为谷丙转氨酶和谷草转氨酶升高,脑脊液检查中异常仅为25.24%,其他的均为正常。在疗效上,治愈91.27%,无效5.82%,死亡2.91%。结论急性砷中毒后神经精神障碍明显,在神经电生理上异常表现也较为明显,在临床上要加强防范,而治疗后预后较好。
Objective To investigate the neuropsychiatric disorders after acute arsenism in Cixi and the electrophysiological status of neurons. Methods A retrospective analysis of 103 patients with acute arsenism between February 2010 and January 2014 was performed. The clinical manifestations and laboratory tests were summarized. The neuropsychiatric disorders were analyzed. The changes of EEG, EMG, Potentials, electrocardiogram, liver function, lumbar puncture index, timely treatment of all patients with sodium dimercaptosuccinate capsules, observe the effect after treatment. Results Neuropsychiatric disorders can be divided into three kinds, neurological 54 cases, mental 31 cases, mixed 18 cases. Neurological clinical manifestations to limbs burning or numbness, limbs spontaneous pain, fatigue weakness; mental type is characterized by acute toxic encephalopathy, mainly irritability, insomnia and horror hallucinations; mixed type Above performance are. In neuroelectrophysiology, the EEG appears as frontotemporal slow wave increased, high amplitude spike and alpha wave. EMG showed fibrillation wave and positive sharp wave, motor and sensory nerve conduction slows; evoked potential test showed low amplitude, wave disappeared, the incubation period is prolonged. ECG showed ST segment decline, T wave flat and biphasic or inverted, QT prolonged. Liver function for alanine aminotransferase and aspartate aminotransferase increased cerebrospinal fluid abnormalities was only 25.24%, the other were normal. In the efficacy, cure 91.27%, invalid 5.82%, death 2.91%. Conclusions After acute arsenism, neuropsychiatric disorders are obvious, and neuroelectrophysiological abnormalities are more obvious. Clinical precaution should be strengthened, and the prognosis is good after treatment.