2019 年第 9 期 第 14 卷

急性甲醇中毒临床特征分析

Clinical features of acute methanol poisoning

作者：冉茂霞李莹林佳如吴蔚桦张丽玲刘琦欧三桃

英文作者：

单位：646000四川省泸州市，西南医科大学附属医院肾内科

英文单位：

关键词：甲醇；中毒；临床特征

英文关键词：

• 摘要：

• 【摘要】目的    分析急性甲醇中毒患者的临床特征，为临床诊治提供依据。方法    回顾性分析2017年2月至2018年2月就诊于西南医科大学附属医院的57例因误服醇基燃料致急性甲醇中毒患者的临床资料，包括性别、年龄、摄入量、住院时间、潜伏期、实验室检查和预后等，并分析各临床特征与急性甲醇中毒患者死亡的相关性。结果    57例急性甲醇中毒患者中男50例、女7例，年龄20～79岁，平均（49±12）岁，饮用醇基燃料50(40,150)ml，相当于甲醇摄入量32.95（26.36，98.85）g。49例（86.0%）患者出现中枢神经系统症状，39例（68.4%）出现胃肠道症状，29例（50.9%）出现眼部损害症状。57例患者根据预后分为存活组54例、死亡组3例。相关性分析显示，入院时出现谵妄昏迷、呼吸困难、胸闷/心悸等症状、醇基燃料摄入量、住院时间、白细胞计数、中性粒细胞计数、血细胞比容、动脉血氧分压、pH值、碱剩余、HCO-3、K+、二氧化碳结合力、阴离子间隙、丙氨酸转氨酶、天冬氨酸转氨酶、血尿素氮、血尿酸、血肌酐、胱抑素C、凝血酶原时间、凝血酶原时间活动度、心肌肌钙蛋白I、肌红蛋白、血淀粉酶、随机血糖与甲醇中毒患者死亡具有相关性（均P＜0.05）。结论    急性甲醇中毒可引起神经损伤、代谢性酸中毒及胃肠道损伤，经及时有效的综合治疗和血液净化大部分患者可以完全治愈，但部分患者因严重代谢性酸中毒预后不良。

• 【Abstract】Objective    To analyze the clinical features of acute methanol poisoning and to provide references for clinical diagnosis and treatment. Methods    A retrospective study was performed on 57 patients with acute methanol poisoning who had mistaken alcohol-based fuel and visited the Affiliated Hospital of Southwest Medical University from February 2017 to February 2018. Relation between clinical records and death was analyzed; relevant indicators including gender, age, intake of alcohol-based fuel， length of hospital stay, latency, laboratory indicators and prognosis were involved. Results    There were 50 males and 7 females with an average age of （49±12）years. Median intake of alcohol-based fuel was 50(40,150)ml, which was equivalent to methanol 32.95（26.36，98.85）g. Central nervous system damage, gastrointestinal symptoms and visual disturbance were present in 49(86.0%), 39(68.4%) and 29(50.9%) patients. Among them, 54 patients survived and 3 patients dead after comprehensive support therapies. Correlation analysis showed that delirium and coma, dyspnea, chest tightness/palpitation, intake of alcohol-based fuel, length of hospital stay, white blood cell count, neutrophil count, hematocrit, arterial partial pressure of oxygen, pH value, alkali residue, HCO-3, K+, carbon dioxide binding capacity, anion gap, alanine aminotransferase, aspartate aminotransferase, serum urea nitrogen, uric acid, creatinine, cystatin C, prothrombin time, prothrombin time activity, cardiac troponin I, myoglobin, blood hemodlastase and random blood sugar were related with risk of death(all P＜0.05). Conclusions    Nerve damage, metabolic acidosis and gastrointestinal injury are common manifestations of acute methanol poisoning. Most patients recover well after timely and effective comprehensive treatments and blood purification; severe metabolic acidosis may lead to poor outcomes.