摘要
目的 探讨抗凝血型灭鼠剂中毒误诊原因及防范误诊措施.方法 回顾性分析 2018 年 11 月—2022年9 月收治的抗凝血型灭鼠剂中毒29 例的临床资料.结果 29 例临床表现主要为不同程度的皮肤淤点淤斑19 例、肉眼血尿10 例、鼻出血9 例、牙龈出血7 例及口腔黏膜出血、便血各6 例等.误诊为凝血功能障碍19 例次,鼻出血7例次,牙龈出血6 例次,消化道出血5 例次,泌尿道感染和泌尿道结石各 3 例次,失血性休克 2 例次,肠梗阻、药物中毒、胸腔积液、脑出血、肢体活动异常、软组织血肿各1 例次.误诊时间1～60 d.入院后依据临床及相关医技检查、灭鼠剂成分检测(溴鼠灵、溴敌隆、塞鼠酮等),确诊为抗凝血型灭鼠剂中毒.29 例均予首剂静脉滴注维生素K1 制剂治疗后凝血功能好转.随访3 个月～1 年,3 例失访,余26 例预后良好.结论 抗凝血型灭鼠剂中毒病史不清楚,症状无特异性,容易漏诊误诊.临床应提高警惕,及时行血清灭鼠剂成分检测,以减少误诊.
Abstract
Objective To explore the causes of misdiagnosis of anticoagulant rodenticide poisoning and measures to prevent misdiagnosis.Methods The clinical data of 29 patients with anticoagulant rodenticide poisoning treated from Novem-ber 2018 to September 2022 were retrospectively analyzed.Results The main clinical manifestations of the 29 patients were different degrees of skin petechial ecchymosis(n =19),gross hematuria(n =10),epistaxis(n =9),gingival bleeding(n = 7),oral mucosal bleeding(n =6)and hematochezia(n =6).They were misdiagnosed as coagulopathy 19 times,nose bleed-ing 7 times,gum bleeding 6 times,digestive tract bleeding 5 times,urinary tract infection 3 times,urinary tract calculus 3 times,hemorrhagic shock 2 times,and intestinal obstruction,drug poisoning,pleural effusion,cerebral hemorrhage,abnor-mal limb movement,and soft tissue hematoma 1 time,respectively.Misdiagnosis lasted from 1 to 60 d.After admission,ac-cording to the clinical and relevant medical technical examination,and detection of rodenticide ingredients(bromurin,brodi-olone,and difethialone),the anticoagulant rodenticide poisoning was confirmed.The coagulation function of 29 patients was improved after the first dose of intravenous infusion of vitamin K1 preparation.After 3 months to 1 year of follow-up,3 patients were lost to follow-up,and the remaining 26 patients had a good prognosis.Conclusion The history of anticoagulant rodenti-cide poisoning is not clear,and the symptoms are not specific,which,therefore,are more likely to cause miss diagnosis and misdiagnosis.In order to reduce misdiagnosis,it is necessary to be vigilant and detect serum rodenticide components in time.
维普
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