University of Virginia School of Medicine and Family Medicine Residency Program, Charlottesville, VA, USA.
Am Fam Physician. 2010 Mar 15;81(6):751-7.
The prevalence and severity of childhood lead poisoning have been greatly reduced since the removal of lead from paint and gasoline in the 1970s. Despite these efforts, approximately 310,000 U.S. children younger than five years have elevated blood lead levels. Health care professionals should perform targeted screening for lead poisoning in children who are Medicaid-enrolled or -eligible, foreign born, or identified as high risk by the Centers for Disease Control and Prevention (CDC) location-specific recommendations or by a personal risk questionnaire. Venous sampling is the preferred method for measuring blood lead levels, but a carefully collected finger-stick sample is an acceptable alternative. Capillary samples of elevated levels should be confirmed by a venous sample. The CDC recommends that the threshold for follow-up and intervention of lead poisoning be a blood lead level of 10 microg per dL or higher. Recommendations for treatment of elevated blood levels include a thorough environmental investigation, laboratory testing when appropriate, iron supplementation for iron-deficient children, and chelation therapy for blood lead levels of 45 microg per dL or more. Prevention consists of education and avoidance of lead-contaminated products.
自 20 世纪 70 年代以来，由于从油漆和汽油中去除了铅，儿童铅中毒的流行率和严重程度已经大大降低。尽管做出了这些努力，仍有约 31 万名五岁以下的美国儿童血液中的铅含量升高。医疗保健专业人员应该对参加医疗补助计划或符合条件的儿童、外国出生的儿童或被疾病控制和预防中心（CDC）根据特定地点的建议或个人风险调查问卷确定为高风险的儿童进行有针对性的铅中毒筛查。静脉采样是测量血铅水平的首选方法，但精心采集的指血样也是一种可接受的替代方法。毛细血管中升高的血铅水平样本应通过静脉样本确认。CDC 建议，血铅中毒的随访和干预阈值为每分升 10 微克或更高。对于升高的血铅水平的治疗建议包括彻底的环境调查、在适当的情况下进行实验室检测、为缺铁的儿童补充铁、以及对每分升 45 微克或更高的血铅水平进行螯合疗法。预防包括教育和避免接触含铅产品。
