摘要
为了解目前铅中毒门诊患儿的常见症状 ,造成铅暴露的主要原因 ,摸索铅中毒门诊患儿的病史询问及诊疗方案 ,对上海新华医院和上海儿童医学中心半年中门诊患儿的资料进行归纳整理。结果发现铅中毒患儿102例 ,血铅水平几何均数129μg/L ,多数患儿表现为多动和注意力不集中 ,学龄儿童中绝大多数表现为上课时注意力分散、学习困难、成绩差 ,部分患儿伴腹痛和便秘等消化系统症状 ,此外还有贫血及血清锌水平降低等 ;多数患儿能找出铅暴露的危险因素 ,常见因素有饭前洗手不认真 ,日钙摄入量低于DRI的50 % ,常有手 -口动作如啃咬指头、铅笔或玩具 ,父亲吸烟或有被动吸烟史等 ;39例复诊患儿 ,经门诊指导 (包括高危因素分析、环境干预、行为矫正、营养指导 )及住院驱铅后血铅水平均呈不同程度下降 ,几何均数由148μg/L下降到117μg/L ,其中1例极重度铅中毒患儿经住院驱铅治疗后血铅水平显著下降 ,但停药2周开始反跳 ,提示这种病例可能需要多个疗程的驱铅治疗 。
The purpose of these analyses was to assess the common symptoms of lead poisoning,high_risk factors of lead exposure,medical histories,and to characterize the diagnosis and treatment of the children with lead poisoning at clinics in Shanghai.The authors collected and analyzed the clinical data which was from patients at the lead clinics in both Xinhua Hospital and Shanghai Children's Medical Center during last half year.102patients were diagnosed with lead poisoning.In these patients,the geometrical mean blood lead level was129μg/L.Most of the patients had symptoms of hyperactivity,attention deficits in classroom,and poor academic achievement in school.Some patients had abdominal pain,constipation,anemia and low levels of serum zinc.Most patients had high_risk factors of lead exposure,such as hand washing was infreˉquent before meals,calcium intake was lower than the50%of DRI,hand_mouth activity was common(nail biting)and these were substantial histories of passive smoking exposure from cigarettes.The blood lead level(BLL)decreased significantly(geometrical mean from148μg/L drop to117μg/L)of39patients who were followed in the clinic prospectively,and guidance education were provided relating to high_risk factors,enviˉronmental intervention and behavior correct,and nutrition guidance.One of the patients with BLL of784μg/L was chelated with two medications,DMSA and EDTA_Na 2 _ Ca,in the hospital.The child may need additional courses of chelation in the future.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2003年第4期235-238,共4页
Journal of Clinical Pediatrics
基金
国家自然科学基金资助 (项目编号30070665)
关键词
儿童
铅中毒
临床分析
诊断
治疗
children lead poisoning high_risk factors environmental intervention chelation
