
586例急性中毒住院患儿临床特征分析
Clinical features of acute poisoning in hospitalized children: an analysis of 586 cases
目的 对急性中毒住院患儿的临床特征进行分析,为儿童急性中毒的预防和治疗提供参考。方法 回顾性分析重庆医科大学附属儿童医院2006年1月至2015年12月出院并确诊为中毒的586例住院患儿的临床资料。结果 586例患儿中,男354例,女232例;年龄24 d至15.8岁;婴幼儿和学龄前期患儿450例(76.8%);农村患儿463例(79.0%);意外中毒551例(94.0%)。药物、农药、鼠药中毒分别221例(37.7%)、167例(28.5%)和175例(29.9%)。中毒物质在城市和农村患儿的分布差异有统计学意义(P < 0.01),其中城市中毒患儿以药物为主要中毒物质,农村患儿中农药中毒所占比例最高。药物、农药、鼠药中毒患儿的主要临床表现差异有统计学意义(P < 0.01),分别以神经系统、消化系统、循环系统症状为主;不同物质中毒患儿治疗总有效率差异无统计学意义。结论 儿童急性中毒主要发生在婴幼儿和学龄前儿童;多发生在农村;多为意外中毒;药物中毒是造成急性中毒的主要原因;不同物质所致中毒患儿主要的临床表现不同,但临床治疗的总有效率无明显差异。
Objective To investigate the clinical features of acute poisoning in hospitalized children. Methods A retrospective analysis was performed on the clinical data of 586 hospitalized children who were diagnosed with poisoning and discharged from the Children's Hospital of Chongqing Medical University between January 2006 and December 2015. Results The patients included 354 males and 232 females (age:24 days to 15.8 years). Of the 586 cases, 450 (76.8%) were infants and preschool children; 463 (79.0%) came from rural areas; 551 (94.0%) were hospitalized because of unintentional poisoning. The drug poisoning, pesticide poisoning, and rodenticide poisoning accounted for 221 cases (37.7%), 167 cases (28.5%), and 175 cases (29.9%) respectively. There was a significant difference in the distribution of the poisoning toxins between urban and rural children (P < 0.01), and drugs and pesticides were the most common toxins for urban and rural children respectively. There were significant differences in main clinical manifestations between the children with drug poisoning, pesticide poisoning, and rodenticide poisoning (P < 0.01), who presented with main clinical symptoms of the nervous system, digestive system, and circulatory system respectively. There was no significant difference in overall response rate between the children poisoned by different toxins. Conclusions Acute poisoning is most common in infants and preschool children. The majority of the patients are from rural areas. The majority of acute poisoning is unintentional. Poisoning by drugs is the main type of acute poisoning. There is no significant difference in overall response rate between the children poisoned by different toxins, but their clinical manifestations are different.
[1] World Health Organization. Public health impact of chemicals:knowns and unknowns[EB/OL]. (2016). http://www.who.int/ipcs/publications/chemicals-public-health-impact/en/.
[2] Ferrari AJ, Norman RE, Freedman G, et al. The burden attributable to mental and substance use disorders as risk factors for suicide:findings from the Global Burden of Disease Study 2010[J]. PLoS One, 2014, 9(4):e91936.
[3] Liu J, Lewis G. Environmental toxicity and poor cognitive outcomes in children and adults[J]. J Environ Health, 2014, 76(6):130-138.
[4] World Health Organization. Protecting our children[EB/OL]. (2003). http://www.who.int/features/2003/en/04_gallery_3_en.html.
[5] 国家食品药品监督管理总局南方医药经济研究所, 广州标点医药信息股份有限公司. 2016年儿童用药安全调查报告白皮书[R]. 北京:首届儿童安全用药传播与发展大会, 2016.
[6] 孙莹, 王丽杰. PICU收治的181例儿童急性中毒的警示[J]. 中国小儿急救医学, 2014, 21(2):106-108.
[7] Hoikka MH, Liisanantti JH, Dunder T. Acute poisoning in children under the age of six:a two-decade study of hospital admissions and trends[J]. Acta Paediatr, 2013, 102(7):e329-e333.
[8] 彭庆明, 邹卫红, 郭毅, 等. 206例小儿急性中毒的临床分析[J]. 中国当代医药, 2014, 26(16):152-153.
[9] Z'gambo J, Siulapwa Y, Michelo C. Pattern of acute poisoning at two urban referral hospitals in Lusaka, Zambia[J]. BMC Emerg Med, 2016, 16(1):1-8.
[10] Edelu BO, Odetunde OI, Eke CB, et al. Accidental childhood poisoning in Enugu, South East, Nigeria[J]. Ann Med Health Sci Res, 2016, 6(3):168-171.
[11] Mancini F, Jiggins JL, O'Malley M. Reducing the incidence of acute pesticide poisoning by educating farmers on integrated pest management in South India[J]. Int J Occup Environ Health, 2009, 15(2):143-151.
[12] Bakhaidar M, Jan S, Farahat F, et al. Pattern of drug overdose and chemical poisoning among patients attending an emergency department, western Saudi Arabia[J]. J Commun Health, 2015, 40(1):57-61.
[13] Woo JH, Ryoo E. Poisoning in Korean children and adolescents[J]. Pediatr Gastroenterol Hepatol Nutr, 2013, 16(4):233-239.
重庆市卫计委医学科研重点项目(2016ZDXM017);重庆市科委民生项目(cstc2016shmszx130048)。