抗凝血杀鼠药中毒致鼻出血临床诊治分析

Clinical analysis of the diagnosis and treatment of nasal bleeding caused by anticoagulant rodenticide poisoning

摘要:

目的通过分析探讨抗凝血杀鼠药中毒致鼻出血的临床表现和诊治方法，减少临床对该类患者的误诊和漏诊。方法回顾性分析2012年9月～2018年4月兰州军区兰州总医院收治的20例抗凝血杀鼠药中毒致鼻出血患者，对其临床表现和诊治方法进行分析总结，所有患者均给予维生素 K1治疗，部分患者并结合鼻腔填塞、等离子等治疗，检测治疗前后患者的凝血酶原时间（PT）、国际正常化比率（INR）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）和凝血活酶时间（TT）等指标，比较分析检测结果。结果20例患者经维生素 K1 等方法治疗后鼻出血停止，凝血指标恢复正常，治疗后凝血指标分别为PT（14.06±2.55）s、APTT(27.48±4.77)s、INR 1.19±0.24，与治疗前患者的凝血指标PT(61.57±41.95)s、APTT(87.44±37.92)s、INR 6.11±4.41比较差异均具有统计学意义（P均＜0.01）。出院后所有患者继续口服维生素K1 2～3个月，均随访半年，其中18例未再次出血，2例患者在出院后自行停止服用维生素K1，１个月内再次出血入院治疗，经治疗后治愈出院。结论抗凝血杀鼠药中毒所致鼻出血主要表现为鼻腔黏膜弥漫性渗血，单纯前鼻孔填塞或等离子治疗不易止血，对于复杂的难治性鼻出血患者我们应该提高警惕，防止误诊漏诊；维生素K1对该类患者临床治疗效果显著，但需长疗程治疗。

关键词:鼻出血|抗凝血杀鼠药|中毒|维生素K1|临床疗效

Abstract:

ObjectiveTo explore the clinical manifestations, diagnosis and treatment of epistaxis caused by anticoagulant rodenticide poisoning, so as to reduce the clinical misdiagnosis and missed diagnosis of the disease.MethodsA retrospective analysis was performed on 20 patients with nasal bleeding caused by anticoagulant rodenticide poisoning, which were admitted to lanzhou general hospital of lanzhou military region from September 2012 to April 2018. The clinical manifestations, diagnosis and treatment methods of these patients were analyzed and summarized. All patients were treated with vitamin K1, and some of the patients were filled with nasal cavity and plasma treatment. The test results of pretreatment and posttreatment of nasal bleeding were compared and analyzed, including coagulation indexes prothrombin time (PT), activated partial thromboplastin enzyme time (APTT), international normalized ratio (INR), fibrinogen (FIB) and Thrombin time (TT).Resultsall patients stopped the nasal bleeding, and the coagulation indexes returned to normal after treatment with vitamin K1 and other methods. The coagulation indexes of pretreatment PT(61.57±41.95)s、APTT(87.44±37.92)s and INR 6.11±4.41; And the coagulation indexes of posttreatment were PT（14.06±2.55）s、APTT(27.48±4.77)s and INR 1.19±0.24. There was a significant difference in blood coagulation before and after the treatment (P<0.01). After their discharge, all patients continued to take vitamin K1 for 2~3 months. In the sixmonth followup(no loss of followup), no nasal bleeding presented in 18 cases after discharge, but 2 cases of them was rebleeding within 1 month because of their stopped taking vitamin K1, which got cured and discharged after treatment.ConclusionNasal bleeding caused by anticoagulant rodenticide poisoning shows diffuse osmotic bleeding from nasal mucosa, and anterior nostril packing or plasma treatment alone is not easy to stop bleeding. For patients with complicated refractory nosebleed, we should notice vigilantly in case of misdiagnosis and mistreatment. The effect of vitamin K1 on this kind of patients is remarkable, but it needs a long course of treatment.

Key words:Nasal bleeding| Anticoagulant rodenticide| poisoning| Vitamin K1| Clinical curative effect