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目的:探讨抗凝血杀鼠药溴敌隆中毒的临床特点和治疗措施。方法:对2011年1月—2012年12月入住我科符合纳入标准的56例溴敌隆中毒患者进行回顾性研究,分析抗凝血杀鼠药溴敌隆中毒发病时间,维生素K依赖凝血因子活性动态变化,以及血浆置换对纠正反复凝血功能异常的疗效。结果:口服溴敌隆后出现严重出血时间为(9.4±2.3)天。入院第1天凝血因子Ⅱ、Ⅶ、Ⅳ、Ⅹ活性分别为(1.10±0.91)%、(2.84±1.58)%、(4.19±1.74)%和(10.71±5.66)%,经维生素K1治疗后第5天凝血因子Ⅱ、Ⅶ、Ⅳ、Ⅹ活性分别为(76.69±15.07)%、(66.28±13.56)%、(56.17±19.25)%和(74.04±13.70)%,差异非常显著(P<0.01)。血浆置换组反复凝血功能障碍持续时间为(13.05±2.94)周,非血浆置换组为(26.12±5.68)周,差异非常显著(P<0.01)。结论:维生素K1可迅速纠正抗凝血杀鼠药抑制的维生素K依赖凝血因子活性。血浆置换明显缩短中毒后反复凝血功能异常的持续时间。
Objective: To investigate the clinical features and treatment of anticoagulant rodenticide bromadiolone poisoning. Methods: A retrospective study was performed on 56 cases of broronuron poisoning admitted to our department from January 2011 to December 2012. The incidence of bromadiolone-induced anticoagulant poisoning, vitamin K-dependent coagulation factor Dynamic changes in activity, and plasma exchange to correct the efficacy of repeated coagulation disorders. Results: Serious bleeding after oral bromadiolone was (9.4 ± 2.3) days. The activity of coagulation factors Ⅱ, Ⅶ, Ⅳ and Ⅹ on the first day after admission were (1.10 ± 0.91)%, (2.84 ± 1.58)%, (4.19 ± 1.74)% and (10.71 ± 5.66)%, respectively. The activities of coagulation factors Ⅱ, Ⅶ, Ⅳ and Ⅹ in the 5th day were (76.69 ± 15.07)%, (66.28 ± 13.56)%, (56.17 ± 19.25)% and (74.04 ± 13.70)%, . The duration of repeated coagulation disorders in the plasma exchange group was (13.05 ± 2.94) weeks compared with that in the non-plasma exchange group (26.12 ± 5.68) weeks, the difference was significant (P <0.01). Conclusion: Vitamin K1 can quickly correct the inhibition of vitamin K-dependent coagulation factor activity by anticoagulant drugs. Plasma exchange significantly shortened the duration of repeated coagulation abnormalities after poisoning.