急性毒鼠强中毒血清炎性细胞因子动态变化及改良方案治疗的临床研究

Changes in serum contents of inflammatory mediators after tetramethylene- disulfo-tetramine poisoning and clinical study of a new treatment regime for the poisoning

目的评价“改良方案”治疗急性毒鼠强中毒的临床疗效。方法1对48例确诊的急性毒鼠强中毒患者,分别在入院后即刻及中毒后1、3、5、7、9、11、13、15、17和19d抽取静脉血2ml,测定β内啡肽(βEP)、内皮素(ET)、一氧化氮(NO)与肿瘤坏死因子(TNF);以30名健康献血者(乙对照组)为对照。2观察组采用“改良方案”治疗,并与36例既往采用“传统方案”治疗者(甲对照组)进行比较。结果148例“改良方案”治疗者中45例治愈,3例死亡。245例治愈者中,轻、中、重3组患者的βEP、ET、NO和TNF均于入院后即刻显著升高,于中毒后1d达高峰,随后缓慢下降。轻、中、重3组βEP恢复正常时间分别为中毒后9、13和17d;ET恢复正常时间分别为中毒后7、13和15d;NO恢复正常时间分别为中毒后7、11和11d;TNF恢复正常时间分别为中毒后9、11和17d。33例死亡者βEP、ET、NO和TNF在入院后即刻均显著升高,在治疗过程中继续升高。4观察组重度中毒者治愈率(84.2%)比甲对照组(41.7%)有显著提高(P<0.01),观察组中轻、中、重各组的安定和苯巴比妥用量、止惊时间均比甲对照组中各对应组显著减少(P均<0.01)。结论1血清βEP、ET、NO和TNF水平与急性毒鼠强中毒程度及病情转归相关。2血清βEP、ET、NO和TNF水平在治疗过程中稳定下降提示预后良好,持续升高提示预后不良。3采取相应措施降低βEP、ET、NO和TNF水平可改善毒鼠强的预后。4“改良方案”可作为急性毒鼠强中毒治疗的一种较为理想方案。

Objective To study the changes in serum contents of β- endorphin （β- EP）, endothelins （ET）, nitric oxide （NO）and tumor necrosis factor （TNF） after acute tetramethylene- disulfo- tetramine （TDT） poisoning and therapeutic effect of a new treatment regime. Methods ①Forty -eight patients with tetramethylene- disulfo- tetramine poisoning （experiment group） were enrolled in this study. The serum levels of β-EP, ET, NO and TNF were measured upon hospitalization and 1, 3, 5, 7, 9, 11, 13, 15, 17 and 19 days after poisoning, respectively, and compared with those of 30 healthy individuals （control group B）. ②They were treated with the improved regime and compared with patients treated with the conventional regime designated as control group A. Results ①In 48 patients treated with improved regime, 45 were cured and 3 died. ②The serum levels of β-EP, ET, NO and TNF from 45 patients who were cured were significantly higher at hospitalization compared with those of healthy individuals, with the peak values appeared on day 1 after poisoning in the mild, moderate and severe groups. β-EP levels returned to normal range on days 9, 13 and 17 after poisoning respectively in the mild, moderate and severe groups. ET levels returned to normal range on days 7, 13 and 15 after poisoning respectively in the mild, moderate and severe groups. NO levels returned to normal range on days 7, 11 and 11 after poisoning respectively in the mild, moderate and severe groups. TNF levels returned to normal range on days 9, 11 and 17 after poisoning respectively in the mild, moderate and severe groups. ③The serum levels of β- EP, ET, NO and TNF in 3 non- survivors were very high at hospitalization and continued to increase in the course of treatment. ④The cumulative doses of diazepam and phenobarbital, and the eclampsia time were significantly less in the experiment group than those of control group A. Conclusion ①The serum levels of β-EP, ET, NO and TNF are correlated with the severity of tetramethylene -disulfo -tetramine poisoning and general conditions of the patients. ②When the serum levels of β- EP, ET, NO and TNF decrease gradually in the course of treatment, prognosis is better. On the contrary ,the prognosis is poor when their levels increase gradually. ③ Measures to decrease levels of β- EP, ET, NO and TNF result in a better prognosis of patients with tetramethylene - disulfo - tetramine poisoning. ④The improved regime can be considered a better therapeutic strategy in tetramethylene -disulfo -tetramine poisoning