探讨儿童毒蕈中毒的首发临床表现、治疗、预后及其相关影响因素。

选择2011年6月至2016年7月，于四川大学华西第二医院儿科住院治疗的符合毒蕈中毒诊断标准的21例患儿为研究对象。根据患儿预后情况，将这21例患儿分别纳入预后良好组(n＝18，治愈或好转)与预后不良组(n＝3，放弃治疗或死亡)。采用回顾性分析方法，收集21例患儿的性别、年龄、居住地、毒蕈中毒发生时间、临床症状、实验室检查结果、治疗方法及预后等临床资料，并对不同预后患儿的相关临床资料进行统计学比较。

①本研究21例毒蕈中毒患儿中，男性患儿为13例(61.9%)，女性为8例(38.1%)；中位年龄为8.1岁；2例(9.5%)来自于成都市主城区，19例(90.5%)来自成都市郊县或四川省内、外其他地区；16例(76.2%)患儿在进食毒蕈后6 h内发病(早发型毒蕈中毒)，5例(23.8%)在进食后6～24 h内发病(迟发型毒蕈中毒)，平均发病时间为进食后3.8 h(0.5～20.0 h)。首发临床症状以消化道症状为主，位于前3位的首发临床症状分别为呕吐(95.2%，20/21)，腹痛(42.9%，9/21)及腹泻(38.1%，8/21)。临床诊断：8例患儿诊断为肝功能损害，4例为肾功能损害，3例为心肌损害，3例为凝血功能障碍，2例为脑损害，1例为溶血性贫血。治疗措施：7例患儿接受了洗胃治疗，13例患儿接受了糖皮质激素治疗，10例患儿平均接受了3.9次(1～6次)血液净化治疗。治疗转归：17例患儿治愈，1例好转，1例放弃治疗，2例死亡。3例预后不良患儿均为迟发型毒蕈中毒。②相比于预后不良组患儿，预后良好组患儿的平均发病时间短，受累脏器数少，小儿危重症评分低，并且差异均有统计学意义(t＝－4.116，P＝0.001；t＝5.690，P<0.001；t＝－3.567，P＝0.002)。

儿童毒蕈中毒临床表现多样，可累及多个器官。毒蕈中毒后发病时间、受累脏器和小儿危重症评分与预后相关。迟发型毒蕈中毒患儿的预后较差，更应引起临床医师的重视。

To study the primary clinical symptoms, treatment and prognosis of mushroom poisoning in children and to explore the relevant influencing factors of its prognosis.

A total of 21 cases of children with mushroom poisoning from June 2011 to July 2016 in West China Second University Hospital were selected as research subjects. They were divided into good prognosis group (n=18, cured or improved) and poor prognosis group (n=3, giving up treatment or death) according to their prognosis. The genders, age, habitation place, the onset time of mushroom poisoning, clinical symptom, laboratory examination results, and prognosis of the 21 children were collected by retrospective method. The clinical data of two groups were statistically analyzed.

①Among the 21 cases of children with mushroom poisoning, 13 cases (61.9%) were male and 8 cases (38.1%) were female. The median age was 8.1 years old. And 2 cases were come from main urban zone of Chengdu, the other 19 cases (90.5%) were come from suburban towns of Chengdu or other cities of Sichuan Province. And 16 cases (76.2%) had clinical symptoms less than 6 h after ingesting toxicant (early-onset mushroom poisoning), 5 cases (23.8%) emerged manifestations between 6 h to 24 h after ingesting toxicant (delayed-onset mushroom poisoning). The median incubation was 3.8 h (0.5-20.0 h). The primary clinical symptoms of mushroom poisoning were diverse, the most common primary clinical symptom was vomiting (95.2%, 20/21), followed by abdominal pain (42.9%, 9/21) and diarrhea (38.1%, 8/21). Clinical diagnosis: liver dysfunction (8 cases), renal dysfunction (4 cases), cardiac damage (3 cases), coagulation disorders (3 cases), brain damage (2 cases) and hemolytic anemia (1 case). Treatment measures: 7 children received gastrolavage treatment, 13 children were treated with glucocorticoids and 10 children received 3.9 times (1-6 times) of blood purifications. Treatment outcomes: on the base of symptomatic and supportive treatment, 17 cases were cured, 1 case was turned better, 2 cases were died and 1 case gave up treatment. The 3 children in poor prognosis group all were with delayed-onset mushroom poisoning symptoms. ②Compared with the poor prognosis group, the median onset time in the good prognosis group was shorter, the numbers of damaged organs and pediatric critical illness scores were lower, and all the differences were statistically significant (t=-4.116, P=0.001; t=5.690, P<0.001; t=-3.567, P=0.002).

The symptoms are diverse in children with mushroom poisoning, which might lead to multiple organs dysfunction and serious consequences. The median onset time, damaged organs and pediatric critical illness scores can influence the prognosis of children with mushroom poisoning. Delayed-onset mushroom poisoning symptoms may lead to poor prognosis and need more attentions by clinicians.