汞中毒92例临床分析

摘要

Objective To summarize the clinical features of mercury poisoning diagnosed by blood and urine tests for improving the diagnosis and treatment of the disease.Methods Poisoning causes,clinical manifestations,diagnosis,treatment and prognosis were retrospectively reviewed in 92 in-patients with mercury poisoning in our hospital from January 2000 to April 2010.Results Of the 92 patients,37 were male and 55 were female with an average age of 33.1(2-65)years old.The mercury poisoning was caused by occupational exposure and non-occupational exposure,such as iatrogenic exposure,life exposure and wrong intake or suicidal intake of mercury-containing substances,mainly through respiratory tract,digestive tract and skin absorption.The most common clinical symptoms were as the followings:nervous system symptom,such as memory loss in 50 eases(54.3%),fatigue in 34(37.0%),numb limb in 25 (27.2%),dizziness and headache in 22(23.9%),cacesthesia in 20(21.7%),fine tremor(finger tip,tongue tip,eyelids)in 15(16.3%),insomnia and more dreams in 12(13.0%);gastrointestinal symptoms:nausea in 16 (17.4%),abdominal pain in 14(15.2%),stomatitis in 5(5.4%);joint and muscle symptoms:muscle pain in 16(17.4%),joint pain in 5(5.4%);cardiovaseular system:chest tightness,hean palpitations in 6(6.5%);urinary system:edema in 9(9.8%);other system:hidrosis in 20(21.7%).After the treatment with sodium dimercaptopropane sulfonate (DMPS),the symptoms were gradually alleviated.Their gastrointestinal,cardiovascular symptoms were alleviated within 2 weeks;neurological symptoms were alleviated within 3 months;kidney damage showed a slower recovery and could be completely'alleviated within 6 months.Conclusions Because of its diverse clinical symptoms,the mercury poisoning was easy to misdiagnosis and missed diagnosis:therefore the awareness of the disease should be further enhanced.Leaving from the poisoning environment timely and giving appropriate treatment with DMPS will lead to a satisfactory prognosis.%目的 总结经血、尿毒检确诊为汞中毒的92例患者的临床诊治特点,以提高该病的诊治水平.方法 对2000年1月至2010年4月我院住院诊治的92例汞中毒患者的原因、临床表现、诊治及预后情况进行回顾性分析.结果 92例(男37例,女55例)患者平均发病年龄33.1(2～65)岁,因职业性接触、生活性接触(医源性、生活、误服或自杀)含汞物质所致,主要经呼吸道、消化道和皮肤吸收而中毒.其受累系统有神经系统,表现为记忆力减退50例(54.3%)、乏力34例(37.0%)、四肢麻木25例(27.2%)、眩晕头痛22例(23.9%)、感觉异常20例(21.7%)、细小震颤(指端、舌尖、眼睑)15例(16.3%)、失眠多梦12例(13.O%);消化系统:恶心16例(17.4%)、腹痛14例(15.2%)、口腔炎5例(5.4%);关节肌肉:肌痛16例(17.4%)、关节酸痛5例(5.4%);心血管系统:胸闷、心悸6例(6.5%);泌尿系统:水肿9例(9.8%);其他系统:多汗20例(21.7%).经驱汞治疗后,患者各系统症状、体征逐渐缓解,其消化系统和心血管系统症状2周内缓解;神经系统症状3个月内缓解;肾脏损害恢复较慢,在6个月内也可临床完全缓解.结论 汞中毒临床表现多样,易被误诊、漏诊,故需进一步提高对此病的认识.及时脱离汞中毒环境,并行驱求治疗,预后较好.