儿童鱼胆中毒的临床分析

doi:10.3877/cma.j.issn.1673-5250.2013.03.016

目的

探讨儿童鱼胆中毒的临床特征、救治方法和治疗效果。

方法

选择2008年1月至2012年8月于本院就诊的18例误服鱼胆中毒患儿为研究对象。按照治疗方法不同将其分为血液净化组(n＝14)和非血液净化组(n＝4)，并将血液净化组继续分为血液灌流亚组(n＝5)、血浆置换亚组(n＝5)和连续性肾替代治疗(CRRT)亚组(n＝4)。对两组患儿中毒发病时间、临床症状、实验室检查结果及治疗方法进行回顾性分析，比较血液净化组中3个亚组患儿疗效(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人的知情同意，并与之签署临床研究知情同意书)。两组患儿年龄、性别等一般情况比较，差异无统计学意义(P>0.05)。

结果

两组患儿误服鱼胆后中毒发病时间为(0.5～5.0) h，平均为(0.64±0.32)h。两组患儿均出现消化道症状及不同程度肝、肾功能异常(100%)。两组患儿住院时间比较，差异无统计学意义(P>0.05)。血液净化组患儿初次血液净化治疗前、后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)结果比较，差异有统计学意义(P<0.05)，尿素氮(BUN)、肌酐(Cr)、血红蛋白(Hb)、血小板(PLT)及纤维蛋白原比较，差异无统计学意义(P>0.05)。血液净化组中3个亚组患儿初次治疗前、后肝、肾功能变化比较，差异无统计学意义(P>0.05)。

结论

儿童鱼胆中毒易导致多器官功能衰竭(MOF)，临床应根据患儿中毒时间和器官受损程度，进行早期或预防性血液净化治疗，提高鱼胆中毒患儿的救治成功率。

关键词: 鱼胆中毒, 多器官功能障碍综合征, 血液净化, 儿童

Objective

To explore the characteristics and the most effective treatments of fish bile poisoning in children.

Methods

From January 2008 to August 2012, a total of 18 children with fish bile poisoning were included in the study, and divided into blood purification group(n=14) and non-blood purification group(n=4) according to their treatment strategies. The blood purification group was continued to be divided into hemoperfusion subgroup(n=5), plasma exchange subgroup (n=5) and continuous renal replacement therapy(CRRT) subgroup (n=4). The time of appearing toxicity, symptoms, lab results and treatment methods were analyzed in both groups. The clinical effects were compared among three subgroups. There was no significant difference in age between two groups(P>0.05). The study protocol was approved by the Ethical Review Board of Investigation in Human Being of West China Second University Hospital.Informed consent was obtained from each parent.

Results

The time of appearing toxicity was (0.5~5.0)h after taken fish bile. Gastrointestinal symptoms, abnormal liver and kidney function were found in all patients(100%). There was no significant difference in hospital stay between two groups(P>0.05). In blood purification group, there had significant differences in alanine aminotransferase(ALT) and aspartate aminotransferase(AST) between before and after primary treatment(P<0.05). Meanwhile there was no significant difference in urea nitrogen(BUN), creatinine(Cr), hemoglobin(Hb), platelet(PLT) and fibrinogen between before and after primary treatment(P>0.05). No significant difference were found in clinical effect of treatment among three subgroups(P>0.05).

Conclusions

Fish bile poisoning in children may lead to multiple organ failure(MOF), and the blood purification treatment can benefit their rehabilitation.

Key words: fish bile poisoning, multiple organ dysfunction syndrome, blood purification, child

表1 两组患儿平均住院时间比较(d，±s)

Table 1 Comparison of average hospital stay between two groups(d，±s)

	n	平均住院时间
血液净化组	14	11.20±3.82
非血液净化组	4	7.50±0.70
F		4.57
P		0.218

表1 两组患儿平均住院时间比较(d，±s)

Table 1 Comparison of average hospital stay between two groups(d，±s)

	n	平均住院时间
血液净化组	14	11.20±3.82
非血液净化组	4	7.50±0.70
F		4.57
P		0.218

表2 血液净化组患儿初次血液净化治疗前、后实验室检查结果比较(±s)

Table 2 Comparison of lab results between before and after primary treatment in blood purification group(±s)

组别	ALT(U/L)	AST(U/L)	BUN(mmol/L)	Cr(μmol/L)	Hb(g/L)	PLT(×10⁹/L)	纤维蛋白原(mg/dL)
治疗前	2266.29±2665.77	1574.79±2060.71	31.23±13.06	467.00±329.06	108.79±18.94	177.36±68.71	370.50± 93.23
治疗后	488.71± 138.34	325.85± 724.55	23.02±15.30	289.07±296.43	99.50±24.44	160.14±51.82	338.50±101.74
t	2.604	2.753	2.047	2.135	1.941	1.116	0.864
P	0.022	0.016	0.061	0.052	0.074	0.285	0.334

表2 血液净化组患儿初次血液净化治疗前、后实验室检查结果比较(±s)

Table 2 Comparison of lab results between before and after primary treatment in blood purification group(±s)

组别	ALT(U/L)	AST(U/L)	BUN(mmol/L)	Cr(μmol/L)	Hb(g/L)	PLT(×10⁹/L)	纤维蛋白原(mg/dL)
治疗前	2266.29±2665.77	1574.79±2060.71	31.23±13.06	467.00±329.06	108.79±18.94	177.36±68.71	370.50± 93.23
治疗后	488.71± 138.34	325.85± 724.55	23.02±15.30	289.07±296.43	99.50±24.44	160.14±51.82	338.50±101.74
t	2.604	2.753	2.047	2.135	1.941	1.116	0.864
P	0.022	0.016	0.061	0.052	0.074	0.285	0.334

表3 血液净化组3个亚组患儿初次治疗前、后肝、肾功能水平比较(±s)

Table 3 Comparison of lab tests results before and after primary treatment among three subgroups of blood purification group(±s)

组别	n	ALT(U/L)		AST(U/L)		BUN(mmol/L)		Cr(μmol/L)
组别	n	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
血液灌流亚组	5	1810.80±1579.53	757.00±780.53	1717.80±2200.67	636.20±1208.76	27.24±11.79	16.44±11.79	342.80±291.62	4116.60± 84.30
血浆置换亚组	5	3884.40±3832.07	249.00±211.99	926.20±1135.08	83.00±　55.66	33.30± 9.90	19.44± 9.53	509.20±233.20	412.80±428.39
CRRT亚组	4	813.00± 601.73	453.00±267.33	2206.75±2993.13	241.50± 233.05	33.62±19.54	35.73±19.98	569.50±490.53	350.00±215.80
F		1.779	1.267	0.407	0.735	0.325	2.407	0.550	1.464
P		0.214	0.320	0.675	0.501	0.729	0.136	0.592	0.273

表3 血液净化组3个亚组患儿初次治疗前、后肝、肾功能水平比较(±s)

Table 3 Comparison of lab tests results before and after primary treatment among three subgroups of blood purification group(±s)

组别	n	ALT(U/L)		AST(U/L)		BUN(mmol/L)		Cr(μmol/L)
组别	n	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
血液灌流亚组	5	1810.80±1579.53	757.00±780.53	1717.80±2200.67	636.20±1208.76	27.24±11.79	16.44±11.79	342.80±291.62	4116.60± 84.30
血浆置换亚组	5	3884.40±3832.07	249.00±211.99	926.20±1135.08	83.00±　55.66	33.30± 9.90	19.44± 9.53	509.20±233.20	412.80±428.39
CRRT亚组	4	813.00± 601.73	453.00±267.33	2206.75±2993.13	241.50± 233.05	33.62±19.54	35.73±19.98	569.50±490.53	350.00±215.80
F		1.779	1.267	0.407	0.735	0.325	2.407	0.550	1.464
P		0.214	0.320	0.675	0.501	0.729	0.136	0.592	0.273

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Clinical Analysis of Fish Bile Poisoning in Children

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Clinical Analysis of Fish Bile Poisoning in Children