摘 要: 目的 分析糖皮质激素(GC)治疗急性中重度1,2-二氯乙烷(1,2-DCE)中毒的影响因素,提出治疗建议。方法 对2005—2015年广东省职业病防治院收治的27例急性中重度病例进行回顾性研究,统计其预后和后遗症情况,选用秩和检验、Fisher’s卡方检验等方法,单因素分析其影响因素。结果 根据《职业性急性1,2-二氯乙烷中毒诊断标准》(GBZ39—2002)27例诊断为重度中毒而应用GC治疗,多见前期滴注甲泼尼龙,后期口服地塞米松;现根据《职业性急性1,2-二氯乙烷中毒诊断标准》(GBZ39—2002)进行27例病历回顾,重新分为中度、重度中毒,发现女性、非O型血、初诊不正确、感染、发生GC不良反应会降低治愈率,以抽搐震颤为典型表现、重度中毒、初诊不正确会增加神经系统后遗症的发生,重度中毒、无抽搐震颤表现、女性、年龄≥31岁、GC使用较迟(距发病≥5d)、感染、有GC不良反应是引起病例死亡的危险因素。结论 建议尽早(<5d) 治疗;中度、重度分级治疗,重度病例使用冲击疗法(甲泼尼龙500mg qd,5d),中度病例用药适当保守(首剂≤160mg qd,3d);长时间密切观察,尤其是重度、以非抽搐震颤为典型表现、非O型血、女性、年龄≥31岁的病例。 |
关键词: 糖皮质激素(GC) 1,2-二氯乙烷(1,2-DCE) 急性中毒 影响因素 |
中图分类号: R135.1
文献标识码: A
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基金项目: 国家卫生标准修订计划项目《职业性急性1,2-二氯乙烷中毒的诊断》(20130602);广东省化学中毒与核辐射突发事件医学救援应急技术研究中心(2016A020224005);广东省职业病防治重点实验室(2017B030314152);广东省医学科学技术研究基金(C2019061) |
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Analysis on prognostic factors of glucocorticoid treatment for acute moderate or severe 1,2-dichloroethane poisoning |
JIANG Jia-xin,FAN Chun-yue,LAN Li-zhu,WANG Yan-yan,HUANG Jia-wen,ZHOU Shan-yu,HUANG Yong-shun,CHEN Jia-bin
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Guangdong Provicial Occupational Disease Hospital,Guangdong Provicial Key Laboratory of Occupational Disease Prevention,Guangzhou 510300,China
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Abstract: Objective To analyze the prognostic factors of glucocorticoid(GC)therapy for acute moderate and severe 1,2-dichloroethane(1,2-DCE)poisoning, and make suggestions for the treatment.Method A retrospective cohort study was conducted on 27 cases of acute moderate or severe 1,2-DCE poisoning from 2005 to 2015 in our hospital, and the information on prognosis and sequelae was got. Then, the rank sum test,Fisher's Chi-square test and other methods were fused for single factor analysis on the infuence factor. Results It was showed that 27 cases diagnosed as severe cases according to GBZ39—2012 at that time and treated with GC(methylprednisolone i.v. drip. qd. at early stage,and mexamethasone p.o. qd at late stage)routinely. In this study, the cases were reclassified as moderate or severe cases according to GBZ 39—2016, and found that such factors as female,non type O blood,incorrect initial diagnosis,infection,GC adverse reactions, etc.would decrease cure rate;the factors such as convulsion & tremor as typical manifestation,severe poisoning and incorrect initial diagnosis, would increase the incidence of neurological sequelae;while those factors such as severe poisoning,non-convulsion & tremor as typical manifestation,female,age≥31y,delayed GC use(≥5d),infection,GC adverse reactions, etc. would be the risk factors of mortality. Conclusion The results suggested that early treatment(<5 d),grading therapy according to severity; GC pulse therapy(methylprednisolone 500 mg qd,5d)for severe cases,while low initial dose and shorter course(160 mg qd or less,3 d)for moderate cases,and longer close, observation on those cases such as female,age≥31y,non type O blood,severe poisoning,non-convulsive & tremor as typical manifestation. |
Keywords: glucocorticoid (GC) 1,2-dichloroethane (1,2-DCE) acute poisoning influencing factors |