摘要
目的分析黄盖鹅膏中毒患者的流行病学特点、临床表现及救治情况。方法选择楚雄彝族自治州人民医院急诊科2016年收治的8例黄盖鹅膏中毒患者的资料,回顾性分析毒蘑菇的鉴定、毒素检测、患者的临床表现及救治情况。结果毒蘑菇经形态学和分子生物学鉴定为黄盖鹅膏,蘑菇中检测出α-鹅膏毒肽(2.94μg/mg)、β-鹅膏毒肽(2.80μg/mg)、羧基三羟鬼笔毒肽(0.13μg/mg)、羧基二羟鬼笔毒肽(1.54μg/mg)、二羟鬼笔毒肽(1.08μg/mg),但由于患者入院为食毒蘑菇后5~6 d,故在中毒患者血尿标本中未检出毒素。患者表现为恶心、呕吐、腹痛、腹泻等消化道症状,伴头晕、听力下降及纳差,平均潜伏期(11.0±0.5)h。入院时实验室检查结果突出表现为肝功能和凝血功能异常,丙氨酸转氨酶(ALT)762~6544 U/L〔平均(2667±2554)U/L〕,天冬氨酸转氨酶(AST)368~3750 U/L〔中位数为589(389,3241)U/L〕,总胆红素(TBil)41.6~247.6μmol/L〔平均(117.4±76.7)μmol/L〕,乳酸脱氢酶(LDH)215~16165 U/L〔中位数为1709(905,13882)U/L〕,凝血酶原时间(PT)13.2~90.0 s〔中位数为23.7(15.4,89.0)s〕,活化部分凝血活酶时间(APTT)27.4~89.8 s〔平均(51.7±22.6)s〕。8例住院患者均采用活性炭、水飞蓟宾胶囊、青霉素-G注射液、N-乙酰半胱氨酸及灵芝煎剂治疗,其中6例进行了血液净化治疗,包括血液灌流(HP)、血浆置换(PE)、连续性静脉-静脉血液滤过/透析(CVVH/CVVHDF)、双重血浆分子吸附(DPMAS)。2例死亡患者出现胆-酶分离现象。结论这是一起黄盖鹅膏中毒事件,该类中毒器官损害以肝脏为主,胆-酶分离是该类中毒死亡的主要原因。
Objective To analyze the epidemiological characteristics,clinical manifestations and treatment of Amanita subjunquillea poisoning patients.Methods The data of eight patients with Amanita subjunquillea poisoning admitted to the department of emergency of the People's Hospital of Chuxiong Yi Autonomous Prefecture in 2016 were retrospectively analyzed,including the identification of poisonous mushrooms,toxin detection,clinical manifestations and treatment of patients.Results The poisonous mushroom was identified as Amanita subjunquillea by morphological and phylogenetic identification.α-amanitin(2.94μg/mg),β-amanitin(2.80μg/mg),phallisacin(0.13μg/mg),phallacidin(1.54μg/mg)and phalloidin(1.08μg/mg)were detected in mushrooms,but no toxin was detected in the poisoned patients'blood and urine samples,because the patients were admitted to the hospital 5-6 days after eating the poisonous mushrooms.The patients presented with gastrointestinal symptoms such as nausea,vomiting,abdominal pain and diarrhea,accompanied by dizziness,hearing loss and anorexia with the average latency period(11.0±0.5)hours.On admission,the laboratory results of the patients highlighted abnormal liver function and coagulation function,alanine aminotransferase(ALT)762-6544 U/L[the average was(2667±2554)U/L],aspartate aminotransferase(AST)368-3750 U/L[the median was 589(389,3241)U/L],total bilirubin(TBil)41.6-247.6μmol/L[the average was(117.4±76.7)μmol/L],lactic dehydrogenase(LDH)215-16165 U/L[the median was 1709(905,13882)U/L],prothrombin time(PT)13.2-90.0 s[the median was 23.7(15.4,89.0)s],activated partial thromboplastin time(APTT)27.4-89.8 s[the average was(51.7±22.6)s].Eight patients were treated with activated carbon,silybin capsule,penicillin-G injection,N-acetylcysteine and Ganoderma lucidum decoction.Six of them received blood purification treatment including hemoperfusion(HP),plasmapheresis(PE),continuous veno-venous hemofiltration/continuous veno-venous hemodiafiltration(CVVH/CVVHDF),and dual plasma molecular adsorption(DPMAS).Biliary-enzyme isolation occurred in two dead patients.Conclusions This is a case of mushroom poisoning caused by accidental ingestion of Amanita subjunquillea.Liver was the main damaged organ and biliary-enzyme isolation was the main cause of death.
作者
钟加菊
余成敏
张曙光
杨庭周
李朝宏
姚群梅
Zhong Jiaju;Yu Chengmin;Zhang Shuguang;Yang Tingzhou;Li Chaohong;Yao Qunmei(Department of Emergency,the People's Hospital of Chuxiong Yi Autonomous Prefecture,Chuxiong 675000,Yunnan,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2022年第4期454-458,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
云南省地方高校联合专项(202001BA070001-046)
云南省科技计划项目重大科技专项(2018ZF009)。
关键词
蘑菇中毒
黄盖鹅膏
肝损伤
临床特征
Mushroom poisoning
Amanita subjunquillea
Liver injure
Clinical characteristic
