血液净化联合乙酰半胱氨酸对急性百草枯中毒患者肺纤维化的影响

吴超; 孙明; 姚成洲; 陆永姝; 孙小龙

doi:10.13201/j.issn.1009-5918.2021.01.002

血液净化联合乙酰半胱氨酸对急性百草枯中毒患者肺纤维化的影响

- 徐州医科大学附属宿迁医院南京鼓楼医院集团宿迁市人民医院急诊科(江苏宿迁, 223800)
基金项目:
江苏省“333工程”培养资金资助项目(No:BRA2018262)

宿迁市科技计划项目(No:Z 2 0 1 9 1 8 1)

详细信息

通讯作者: 孙明,E-mail:wch7992475@163.com

中图分类号: R595

收稿日期: 2020-06-14

Effect of blood purification combined with acetylcysteine on pulmonary fibrosis in patients with acute paraquat poisoning

- Department of Emergency, Suqian Hospital Affiliated to Xuzhou Medical University, Suqian People's Hospital of Nanjing Drum-Tower Hospital Group, Suqian, Jiangsu, 223800, China

More Information

Corresponding author: SUN Ming, E-mail: wch7992475@163.com

Received Date: 14 June 2020

摘要

摘要: 目的:分析并讨论血液净化联合乙酰半胱氨酸在急性百草枯中毒治疗中的实际效果,同时研究该治疗方法对患者肺纤维化的影响。方法:随机抽取2015年1月—2019年12月期间我院急诊中心收治的56例急性百草枯中毒患者进行课题研究。采取随机数字表法将56例患者分为对照组(28例)和观察组(28例),所有患者均给予全胃肠灌洗,静脉应用甲泼尼龙、环磷酰胺、乌司他汀、大剂量维生素C等治疗,同时口服普萘洛尔及对症支持治疗。对照组选择常规血液净化治疗,观察组选择血液净化联合乙酰半胱氨酸治疗。动态监测两组患者肝肾功能、动脉血气分析等指标变化,记录两组患者的急性生理和慢性健康评分(APACHEⅡ)、序贯器官衰竭评估(SOFA)评分。对患者定期进行胸部CT检查,对比两组患者第1、7、14、28天肺纤维化程度及病死率。结果:观察组在第7、14天的APACHEⅡ、SOFA评分显著低于对照组患者,氧合指数、氧分压显著高于对照组;观察组患者第7、14、28天相同时间点的肺纤维化程度显著低于对照组患者,远期随访观察组患者的治愈率显著高于对照组,病死率显著低于对照组,组间对比差异具有统计学意义(P<0.05)。结论:采用血液净化联合乙酰半胱氨酸对急性百草枯中毒患者进行临床治疗,不仅能降低患者的病死率,还能减少肺纤维化的发生率,有效改善预后,值得在治疗工作中进一步推广和采纳。
- 血液净化 /
- 乙酰半胱氨酸 /
- 急性百草枯中毒 /
- 临床效果 /
- 肺纤维化 /
- 病死率
Abstract: Objective: To analyze and discuss the actual effect of blood purification combined with acetylcysteine in the treatment of acute paraquat poisoning, and to study the effect of this treatment on patients with pulmonary fibrosis.Methods: Fifty-six patients with acute paraquat poisoning admitted to the emergency center of Suqian Hospital Affiliated to Xuzhou Medical University from January 2015 to December 2019 were randomly selected for this study.According to random number table method, 56 patients were divided into the control group(28 cases) and the observation group(28 cases).All patients were given whole bowel irrigation, intravenous methylprednisolone, cyclophosphamide, ulinastatin, high dose of vitamin C, and oral propranolol and symptomatic support therapy.The control group was treated with conventional blood purification, while the observation group was treated with blood purification combined with acetylcysteine.The changes of liver and kidney function, arterial blood gas analysis and other indicators of patients in the two groups were dynamically monitored, and acute physiological and chronic health scores(APACHE Ⅱ) and sequential organ failure assessment(SOFA) scores of patients were recorded in the two groups.Regular chest CT examinationwere performed on the patients, and the degree of pulmonary fibrosis and mortality were compared between the two groups on day 1, day 7, day 14 and day 28.Results: the scores of APACHE Ⅱ and SOFA in the observation group on day 7 and day 14 were significantly lower than those in the control group, and the oxygenation index and oxygen partial pressure were significantly higher than those in the control group.At the same time point of 7 d, 14 d and 28 d, the degree of pulmonary fibrosis in the observation group was significantly lower than that in the control group, the cure rate of patients in the long-term follow-up observation group was significantly higher than the control group, and the mortality rate was significantly lower than that of the control group, with statistically significant difference between the groups(P<0.05).Conclusion: The use of blood purification combined with acetylcysteine in the clinical treatment of acute paraquat poisoning patients can not only reduce the mortality of patients, but also reduce the incidence of pulmonary fibrosis and effectively improve the prognosis, which is worthy of further promotion and adoption in the treatment.
- blood purification /
- acetylcysteine /
- acute paraquat poisoning /
- clinical effect /
- pulmonary fibrosis /
- case fatality rate

HTML全文

参考文献(17)

[1]	闫永吉,叶俏.百草枯中毒致急性肺损伤多重机制的研究进展[J].中华劳动卫生职业病杂志,2018,36(11):877-880.
[2]	李国强,李国锋,李玉明.百草枯中毒的毒代动力学研究进展[J].中华劳动卫生职业病杂志,2014,32(6):473-476.
[3]	百草枯中毒诊断与治疗“泰山共识”专家组.百草枯中毒诊断与治疗“泰山共识”(2014)[J].中国工业医学杂志,2014,27(2):117-119.
[4]	Zhao X,Xiao Y,Zhu J,et al.Prognostic comparison of goal-oriented hemoperfusion and routine hemoperfusion combined with continuous venovenous hemofiltration for paraquat poisoning[J].J Int Med Res,2018,46(3):1091-1102.
[5]	Dinis-Oliveira RJ,Duarte JA,Sánchez-Navarro A,et al.Paraquat poisonings:mechanisms of lung toxicity,clinical features,and treatment[J].Crit Rev Toxicol,2008,38(1):13-71.
[6]	赵爽,李新华,范淑玲,等.血液灌流并连续性肾脏替代治疗和透析滤过治疗百草枯中毒疗效研究[J].中国实用内科杂志,2017,37(7):621-625.
[7]	Hong SY,Yang JO,Lee EY,et al.Effect of haemoperfusion on plasma paraquat concentration in vitro and in vivo[J].Toxicol Ind Health,2003,19(1):17-23.
[8]	Kang MS,Gil HW,Yang JO,et al.Comparison between Kidney and Hemoperfusion for Paraquat Elimination[J].J Korean Med Sci,2009,24(Suppl):S156-S160.
[9]	陈功雷,谢芬,郁毅刚,等.百草枯中毒临床治疗的回顾性分析[J].临床急诊杂志,2018,19(11):630-633.
[10]	Kumar A,Shukla S,Chauhan AK,et al.The manganese-salen compound EUK-134 and N-acetyl cysteine rescue from zinc-and paraquat-induced toxicity in rat polymorphonuclear leukocytes[J].Chem Biol Interact,2015,231:18-26.
[11]	赵承杰,徐佳.乙酰半胱氨酸、吡非尼酮联合激素对特发性肺纤维化患者的临床研究[J].中国临床药理学杂志,2019,35(18):2002-2005.
[12]	陈慧敏,姚梦雅,孙宝迪,等.N-乙酰半胱氨酸治疗急性百草枯中毒患者的临床研究[J].临床急诊杂志,2018,19(3):168-171.
[13]	Xiong G,Zhao L,Yan M,et al.N-acetylcysteine alleviated paraquat-induced mitochondrial fragmentation and autophagy in primary murine neural progenitor cells[J].J Appl Toxicol,2019,39(11):1557-1567.
[14]	李加贝,昌建祥,李忠贤.血液净化联合乙酰半胱氨酸治疗急性百草枯中毒的效果及对肺纤维化的影响[J].中国医药,2020,15(1):45-48.
[15]	黄铭,黄伟.大剂量氨溴索联合乙酰半胱氨酸在百草枯中毒肺纤维化患者早期应用中的疗效观察[J].中华全科医学,2018,16(12):2098-2101.
[16]	闫永吉,范亚丽,李双,等.百草枯中毒所致肺损伤的新药治疗研究进展[J].中国药理学与毒理学杂志,2018,32(12):959-965.
[17]	Chen HM,Guo HR,Yeh ST,et al.Protective effects of N-acetylcysteine treatment post acute paraquat intoxication in rats and in human lung epithelial cells[J].Toxicology:An International Journal Concerned with the Effects of Chemicals on Living Systems,2006,223(3):181-190.