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儿童期铅中毒：处理

Authors
Richard L Hurwitz, MD
Dean A Lee, MD, PhD
Section Editors
Donald H Mahoney, Jr, MD
Michele M Burns, MD, MPH
Jan E Drutz, MD
Deputy Editor
James F Wiley, II, MD, MPH
Translators
高雨松, 副主任医师

引言

减少儿童铅暴露是处理儿童铅中毒中单个的最重要因素。一旦铅已经被摄入或吸入，就会迅速融入骨骼系统并成为一个难以消除的铅暴露内源性储存库。螯合剂可以降低与急性摄入相关的即时毒性[1]，但不能逆转慢性铅摄入对神经认知的影响[2]。

儿童铅中毒的处理依据确认的血铅水平(blood lead level, BLL)的不同而变化，将总结在此。诊断、并发症和预防将单独讨论。(参见“儿童铅中毒：临床表现和诊断”和“儿童期铅中毒：暴露和预防”)

一级预防

因为铅毒性对认知和行为的影响是不可逆的，所以预防进一步的铅暴露(表 1)是治疗最为重要的方面。对已暴露于铅的新生儿、婴儿或儿童的识别必须被视为突发公共卫生事件，因为唯一有效的长期治疗就是根除环境铅污染。

产前暴露 — 在美国，推荐具有铅暴露重大危险因素的妊娠妇女进行血铅筛查。BLL升高的妊娠妇女的医生应确保管理新生婴儿的医生知晓母亲的BLL。母亲和婴儿的BLL都应记录在其病历中。妊娠期间和产后血铅筛查的指征将单独讨论。(参见“Adult occupational lead poisoning”)

根据美国疾病预防控制中心(Centers for Disease Control and Prevention, CDCP)，母亲BLL大于或等于5μg/dL(0.24μmol/L)的婴儿应在分娩时送检脐带血样本进行血铅检测或于出生后立刻进行静脉BLL检测[3]。对于最初静脉或脐带血BLL大于或等于5μg/dL(0.24μmol/L)的新生儿，还需进行其他检测。重复检测的频率以及其他干预的需要依据血铅升高的程度而异(表 2和图 1)。这些指南适用于年龄最多达6个月的婴儿。年龄较大的婴儿和儿童的筛查间期不同。(参见“儿童铅中毒：临床表现和诊断”，关于‘诊断’一节)

                            

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-22.
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