摘要
目的探讨2例儿童误服复方地芬诺酯中毒后的临床表现、中枢系统影像学特点、治疗及预后,进而提高临床对该疾病的早期识别。方法对2例明确诊断为复方地芬诺酯中毒患儿的资料进行总结并复习相关文献,分析其临床特点及神经系统影像学的表现。结果 2例患儿均以急性中毒性脑病起病;临床表现为发热、昏迷、抽搐、呼吸抑制等,实验室检查肝功能转氨酶、心肌酶谱均有明显升高;均行头颅MR检查,提示大脑皮层、皮层下、脑干、小脑及基底节区广泛性损害;积极主动的对症和支持治疗是其影响存活的主要因素,包括洗胃、机械通气、早期应用足量的纳诺酮及维持水电解质平衡等;均预后不良,其中1例家属放弃治疗。结论儿童误服复方地芬诺酯后部分临床症状危重,神经系统影像学提示大脑弥漫性损害明显,治疗效果不佳。预防误服可以避免该类事件的发生。
Objective To report the clinical manifestations, imaging features of central nervous system, treatment and prognosis of compound diphenoxylate poisoning in children, and to improve the early identification of the disease. Methods Clinical data of 2 children diagnosed as compound diphenoxylate poisoning were summarized and the literature was reviewed. The clinical characteristics and imaging performance of nervous system were analyzed. Results The two children had the onset of acute toxic encephalopathy. Clinical manifestations of compound diphenoxylate poisoning included fever, coma, convulsion, respiratory depression, etc. Laboratory examination showed an obvious increase in liver transaminase and myocardial enzyme levels. Cranial MRI showed extensive damage in cerebral cortex, subcortex, brainstem, cerebellum and basal ganglia. Aggressive symptomatic and supportive treatments were the main factors affecting survival, including gastric lavage, mechanical ventilation, early application of adequate amounts of naloxone and maintenance of water and electrolyte balance. Poor prognosis occurred in both cases and family members of one of them abandoned treatment. Conclusion Clinical symptoms are severe and MRI features of nervous system show diffuse brain damage in children with compound diphenoxylate poisoning. Moreover, the treatment is associated with poor outcome. The effective prevention may be the best way to avoid compound diphenoxylate poisoning.
出处
《实用临床医学（江西）》
CAS
2014年第5期80-82,87,共4页
Practical Clinical Medicine
关键词
复方地芬诺酯
中毒
儿童
compound diphenoxylate
poisoning
children
