早期大剂量甲泼尼龙联合环孢素A冲击治疗对口服百草枯中毒患者预后的影响

Effects of early pulse therapy with large dose of methylprednisolone associated with cyclosporine A on the prognosis of patients with paraquat poisoning

目的观察早期大剂量甲泼尼龙联合环孢素A冲击治疗对口服百草枯(PQ)中毒患者病死率、肺纤维化发生率的影响。方法38例口服PQ中毒患者除常规给予洗胃、血液灌流等治疗外,早期给予大剂量糖皮质激素联合免疫抑制剂(环孢素A)冲击治疗。定期监测动脉血气分析、胸部CT、肝肾功能等指标。分析口服PQ中毒患者的病死率、肺纤维化的发生率。结果38例PQ中毒患者中死亡13例,病死率为34.2%,其中12例患者在服毒后1周内死于多器官功能衰竭,另1例死于肺纤维化。25例存活者中,有18例在住院期间发生不同程度的氧合下降,其中17例胸部CT提示肺部间质性改变,13例出现两个以上脏器(肺、肝、肾)功能损伤。25例存活患者出院后随访1个月未诉特殊不适。结论早期大剂量甲泼尼龙联合环孢素A冲击治疗可改善PQ中毒患者的预后,但进一步明确此方法的疗效需开展大样本的随机、双盲对照研究。

Objective To observe the effects of early pulse therapy with large dose of methylprednisolone associated with cyclosporine A on mortality and incidence of pulmonary fibrosis in the patients with peroral paraquat poisoning.Methods Initial pulse therapy with large dose of methylprednisolone associated with cyclosporine A was given in early period,in addition to regular gastric lavage and hemoperfusion,after acute peroral paraquat poisoning in 38 patients.The indexes of arterial blood gas analysis,findings of lung CT,and the function of kidney and liver were all monitored periodically.At the same time,the data of mortality and incidence of pulmonary fibrosis of the patients with peroral paraquat poisoning were statistically analyzed.Results 13 of 38 patients died,the mortality was 34.2%.Among the dead,12 patients died of multiple organ failure within 1 week after paraquat poisoning,and the remaining one died of pulmonary fibrosis.During hospitalization of the other 25 patients who survived,blood oxygenation index declined in different degrees in 18 cases,the thoracic computed tomography showed interstitial changes in the lung in 17 cases,and dysfunction of more than two organs（lung,liver and kidney）was found in 13 cases.Conclusion The pulse therapy of large dose of methylprednisolone associated with cyclosporine A given in early period may markedly improve the prognosis of patients with acute peroral paraquat poisoning.But a large sample with randomized double blind study is needed in order to further evaluate the clinical efficacy.