【摘要】 目的 总结以鼻出血为主要临床表现的溴敌隆中毒的诊治方法。方法 回顾分析我院诊治的16例以鼻出血为主要表现的溴敌隆中毒病例的临床资料，梳理其诊断、治疗过程及预后，进而总结最佳诊疗方案。16例患者均因鼻出血就诊于急诊，多数患者伴有牙龈出血、结膜出血、皮肤淤点、淤斑等其他部位出血表现。实验室检查显示：所有患者部分凝血活酶时间(APTT)、凝血酶原时间(PT)均明显延长，纤维蛋白原(FIB)水平无明显异常，且血液标本中均检出溴敌隆成分。结果 患者就诊后遂行鼻内镜下鼻腔填塞纳吸绵止血，确诊后给予维生素K1持续静脉滴注，逐步减量，鼻出血得到有效控制，复查凝血功能指标恢复至正常范围。出院1个月后复查凝血系列，发现3例患者指标再次出现异常，但不伴有出血相关症状，遂继续口服维生素K1治疗，逐步减量治疗1个月后康复。结论 对于以鼻出血为主要表现的溴敌隆中毒患者，需结合毒物接触史、发病经过、临床表现、凝血功能检查及毒物检测结果综合诊断；治疗以鼻内镜下鼻腔填塞止血联合序贯性维生素K1补充为主，且治疗后需定期复查凝血系列。更多还原

【Abstract】 Objective To summarize the diagnostic and therapeutic methods for bromadiolone poisoning with epistaxis as the main manifestation. Methods Data of 16 cases of bromadiolone poisoning with epistaxis as the primary symptom admitted to our hospital were analyzed retrospectively. The diagnostic and therapeutic processes, and the prognosis were analyzed to identify the optimal therapeutic approach. All the 16 patients presented at the emergency department primarily due to epistaxis, and most of whom also had other symptoms such as gingival, conjunctival hemorrhage, skin ecchymosis, and petechiae. Laboratory tests showed that their blood routine was basically normal; however, both the partial thromboplastin time(APTT) and the prothrombin time(PT) were significantly prolonged in all the 16 cases. Fibrinogen(FIB) levels were generally normal, but bromadiolone components were detected in all blood samples. Results After admission, endoscopic nasal packing with absorbable sponge was performed for hemostasis. Upon confirmative diagnosis, continuous intravenous vitamin K1 infusion was initiated and gradually tapered off once nasal bleeding was effectively controlled and subsequent coagulation series tests returned to normal levels. The one-month followup coagulation tests revealed abnormalities in three patients without accompanying bleeding symptoms; therefore who continued oral vitamin K1 therapy which was gradually reduced until recovery one month later. Conclusions The diagnosis of bromadiolone poisoning with epistaxis as a primary manifestation requires comprehensive assessment based on history of toxic exposure, medical history, clinical presentation, coagulation series testing, and toxicological analysis. Treatment mainly involves nasal cavity packing for hemostasis along with sequential supplementation of Vitamin K1; regular monitoring of coagulation series is necessary.更多还原