儿童意外吸入磷化铝中毒55例临床分析及文献

目的:分析儿童意外吸入磷化铝中毒的临床特点、治疗方法及死亡原因。方法:对本院儿科2014年5月～2018年8月收治的55例意外吸入磷化铝中毒患者进行回顾性分析,根据病情严重程度将其分为轻度(31例)和重度(14例),统计患儿的年龄、性别、发病季节、中毒吸入时间、中毒就诊时间、临床症状、实验室及心电图检查。结果:55例吸入磷化铝中毒患儿中,死亡10例,存活45例,死亡患者均为重度中毒者,死亡原因为循环衰竭。轻度中毒毒素吸入时间平均为25.1 h,中毒后平均就诊时间14.6 h;重度中毒毒素吸入时间平均为185.4 h,中毒后平均就诊时间38.5 h;临床表现为恶心呕吐55例(100%),头晕、面色苍白14例(25%),心悸16例(29%),呼吸衰竭14例(25%),严重的心律失常8例(14.5%),低血压、心源性休克10例(18%);心电图检查:室上性心动过速1例,室性心动过速4例,II度II型房室传导阻滞1例,窦性心律不齐5例,窦性心动过速26例;实验室检查中心肌酶升高19例(34.5%);肝功能异常12例(21.8%);肾功能异常6例(10.9%);代谢性酸中毒14例(25%)。治疗上主要为对症支持治疗。结论:儿童意外吸入磷化铝中毒以重度中毒病例死亡率高,多为循环衰竭所致,目前无特效解毒药物,早期诊断和早期综合性治疗尤为重要。

Clinical Analysis and Literature Review of 55 cases of Children with Accidental Inhalation of Aluminum Phosphide Poisoning

ABSTRACT Objective: To analyze the clinical characteristics, treatment methods and cause of death of aluminium phosphide poi- soning in children. Methods: The clinical data of 55 cases of children with accidental inhalation of aluminum phosphide poisoning in our hospital from 2014 to 2018 (31 cases of mild poisoning and 14 cases of severe poisoning ) were analyzed, including the age, gender, onset seasons, poisoning inhalation time, visit time and examination results. Results: In the 55 cases, 10 cases died. The average inhalation time of mild poisoning was 25.1 hours, of which the severe poisoning was 185.4 hours, and the average visit time were 14.6 hours and 38.5 hours separately. The clinical manifestations were nausea and vomiting in 55 cases (100%), dizziness and pale in 14 cases (25%), palpita- tion in 16 cases (29%), respiratory failure in 14 cases (25%), severe arrhythmia in 8 cases (14.5%), hypotension and cardiogenic shock in 10 cases (18%). Electrocardiogram examination were analyzed: 1 case of supraventricular tachycardia, 4 cases of ventricular tachycardia, 1 case of grade 2 II atrioventricular block, 5 cases of sinus arrhythmia, and 26 cases of sinus tachycardia. Laboratory results followed: myocardial enzymes were elevated in 19 cases (34.5%), liver function were abnormal in 12 cases (21.8%), 6 cases (10.9%) had abnormal renal function and 14 cases (25%) had metabolic acidosis. Treatment is mainly symptomatic support treatment. All of them were severe poisoned and died from circulatory failure. Conclusion: The mortality of aluminium phosphide poisoning is very high and the cause of death is circulatory failure. There are no special detoxification drugs now, so it is important to diagnose early and treatment comprehen- sively.