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目的总结汞中毒致周围神经病变的诊治经验,并分析误诊原因。方法对1例先后误诊为糖尿病末梢神经炎、腰椎管狭窄并腰椎失稳症、颈延交界处颈1神经鞘瘤、复杂区域性疼痛综合征及神经病理性疼痛的汞中毒致周围神经病变的临床资料进行回顾性分析。结果患者以双下肢麻木、疼痛伴足底烧灼感为主要临床表现,有糖尿病病史,曾在外院就诊,诊断为糖尿病末梢神经炎、腰椎管狭窄并腰椎失稳症、颈延交界处颈1神经鞘瘤,并行腰5~骶1椎板减压加椎间植骨融合术、腰3~骶1椎弓根钉内固定术、后正中入路颈延髓交界处神经鞘瘤切除术,术后腰骶部疼痛及双下肢麻木症状无明显改善。1个月前患者上述症状加重,并出现性格改变,先后就诊于当地人民医院疼痛科及解放军总医院疼痛治疗科,分别诊断为复杂区域性疼痛综合征、神经病理性疼痛,给予相应治疗,疼痛缓解不明显或稍有改善。为排除中毒,于我院行毒物检测示血汞29.0μg/L,尿汞25.0μg/L,诊断为汞中毒、周围神经病变,行二巯基丙磺酸钠驱汞等综合治疗共7个疗程,患者肢体麻木、疼痛等症状基本缓解,睡眠良好,出院。结论临床接诊不明原因出现腰骶部及四肢麻木、疼痛等患者时,应认真鉴别诊断,警惕汞中毒。汞中毒致周围神经病变患者给予驱汞等综合治疗,效果良好。
Objective To summarize the diagnosis and treatment of peripheral neuropathy caused by mercury poisoning and to analyze the causes of misdiagnosis. Methods The clinical data of 1 peripheral neuropathy misdiagnosed as diabetic peripheral neuritis, lumbar spinal stenosis and lumbar vertebral instability, cervical neurinoma at neck junction 1, complex regional pain syndrome and neuropathic pain were analyzed. Retrospective analysis. Results The patients had numbness of both lower extremities and pain associated with cauterization of the foot as the main clinical manifestations. They had a history of diabetes mellitus, had seen in the outpatient department, diagnosed peripheral neuropathy of diabetes, lumbar spinal stenosis and lumbar instability, Tumor, parallel lumbosacral vertebral 5 ~ lumbar decompression plus interbody fusion, lumbar 3 ~ sacral pedicle screw fixation, posterior median neck medulla oblongata junction schwannoma resection, postoperative lumbar Sacral pain and numbness of both lower extremities no significant improvement. One month earlier, the above symptoms were aggravated and his personality changed. He successively visited the pain department of the People’s Hospital of People’s Liberation Army and the Department of Pain Management of the General Hospital of People’s Liberation Army and was diagnosed with complex regional pain syndrome and neuropathic pain respectively. The patients were given corresponding treatment and pain relief Not obvious or slightly improved. In order to rule out poisoning, toxic substances in our hospital showed 29.0μg / L of blood mercury and 25.0μg / L of mercury, diagnosed as mercury poisoning, peripheral neuropathy, mercaptosodium mercapto-prophylactic and other comprehensive treatment of a total of seven courses , Patients with numbness, pain and other symptoms were basically relieved, good sleep, discharged. Conclusions Clinical admissions for unknown reasons lumbosacral and limb numbness, pain and other patients, the diagnosis should be carefully identified to guard against mercury poisoning. Mercury poisoning caused peripheral neuropathy patients given mercuric complex treatment, the effect is good.