Brahmi Nozha, Blel Youssef, Abidi Nour, Kouraichi Nadia, Thabet Hafedh, Hedhili Abderrazek, Amamou Mouldi
Department of Intensive Care Medicine and Clinical Toxicology, (CAMU), Tunis, Tunisia. nozha
Clin Toxicol (Phila). 2007 Sep;45(6):717-20. doi: 10.1080/15563650701502600.
Methanol poisoning continues to be a public health problem in Tunisia in spite of the different legislative measures. We report a series of 16 cases of methanol poisoning admitted to our Intensive Care Unit between December 2003 and April 2004. The patients' median age was 21.5 years (range 16 to 53 years) with a median SAPS II of 14 (range 12 to 84) and an APACHE II of 8 (range 6 to 36). The median latent period was 9.5 hours (range 4 to 24 hours) with a delay to medical consultation of 36 hours (range 6 to 48 hours), and a median serum methanol concentration of 1.4 g/L (range 0.19 to 3.62 g/L). Clinical signs included central nervous system symptoms (69%), gastrointestinal complaints (87%), visual disturbances (69%) and metabolic acidosis (94%). Three patients (19%) required mechanical ventilation because of deep coma or shock and died within 6 hours. Hemodialysis was performed in eleven patients (69%) because of visual disturbances and/or metabolic acidosis. One patient developed irreversible bilateral blindness and another unilateral blindness secondary to optic neuropathy. Statistical significant risk factors for the developing of visual disturbances were found to be the ingested quantity of methanol, the latent period, acidosis and serum methanol concentration on admission.
尽管采取了不同的立法措施，但甲醇中毒在突尼斯仍然是一个公共卫生问题。我们报告了2003年12月至2004年4月期间收入我们重症监护病房的16例甲醇中毒病例。患者的年龄中位数为21.5岁（范围16至53岁），简化急性生理学评分系统II（SAPS II）中位数为14（范围12至84），急性生理与慢性健康状况评分系统II（APACHE II）为8（范围6至36）。潜伏期中位数为9.5小时（范围4至24小时），就医延迟时间为36小时（范围6至48小时），血清甲醇浓度中位数为1.4 g/L（范围0.19至3.62 g/L）。临床症状包括中枢神经系统症状（69%）、胃肠道不适（87%）、视觉障碍（69%）和代谢性酸中毒（94%）。3例患者（19%）因深度昏迷或休克需要机械通气，并在6小时内死亡。11例患者（69%）因视觉障碍和/或代谢性酸中毒接受了血液透析。1例患者发展为不可逆的双侧失明，另1例因视神经病变继发单侧失明。发现视觉障碍发生的统计学显著危险因素为甲醇摄入量、潜伏期、酸中毒和入院时的血清甲醇浓度。
