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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 ,血铅水平才能稳定
To understand the common symptoms of children exposed to lead poisoning and the main causes of lead exposure, explore the medical history inquiry and diagnosis and treatment plan of outpatients with lead poisoning, and summarize the data of outpatients in Shanghai Xinhua Hospital and Shanghai Children’s Medical Center for six months sort out. The results showed that 102 cases of lead poisoning children, the geometric mean blood lead level 129μg / L, most children showed hyperactivity and attention deficit, the vast majority of school-age children showed distraction during the class, learning difficulties, grades Poor, some children with abdominal pain and constipation and other digestive symptoms, in addition to anemia and serum zinc levels lower; most children can find out the risk factors of lead exposure, common factors are not wash their hands before meals, daily intake of calcium 39 cases of referral children, out-patient guidance (including analysis of risk factors, environmental interventions, risk factors such as risk factors, Behavioral correction, nutritional guidance), and blood lead levels after hospitalization lead to varying degrees of decline, the geometric mean decreased from 148μg / L to 117μg / L, of which 1 case of extremely severe lead poisoning in children with lead poisoning after treatment lead Level decreased significantly, but withdrawal started 2 weeks rebound, suggesting that this case may require multiple courses of lead-driven treatment, blood lead levels can be stabilized