以循证医学方法为百草枯中毒制定治疗方案

An evidence-based treatment design for paraquat （PQ） poisoning

目的根据循证医学理论和原则，为急性百草枯（PQ）中毒患者制定循证治疗方案并实施相应的循证治疗，以期在目前现有证据的支持下，达到最佳化治疗的目的。方法选择1例PQ中毒患者，根据患者的临床情况，提出血液净化治疗和免疫抑制剂治疗的临床问题。检索Cochrane临床试验数据库（2010年第1期）、MEDLINE（1950年至2010年1月）和中国生物医学文献数据库（CBM，1978年至2010年），纳入PQ中毒治疗的系统评价、Meta分析和临床随机对照试验（RCT），根据所获证据为该例患者制定循证治疗的方案。治疗结束并随访1年。结果根据检索结果分析，共纳入7篇PQ中毒相关文献。证据显示，血液净化可延长患者的存活时间，但不能降低病死率；糖皮质激素与环磷酰胺联合冲击疗法可提高患者的生存率。结合该例患者的病情和意愿，给予相应循证治疗，治疗结束后好转出院，随访1年无并发症出现。结论以目前循证医学最佳证据、结合患者情况制定治疗方案，能提高PQ中毒患者的近期疗效，但远期预后尚需更长时间的随访观察。

Objective To optimize the treatment of PQ poisoning by a therapeutic regimen designed on the presently available clinical research reports following the principles of evidence-based medicine. Methods A treatment plan for a randomly chosen PQ poisoned patient was designed, with regard to the application of blood purification and immunosuppressor, following the suggestions in literatures adopted through computer aided search of Cochrane library （issue 1, 2010）, MEDLINE （1950- 2010.1） and China Biomedicine Literature Database （CBM, 1978- 2010）. The systematic evaluations, Meta-analysis and the randomized controlled trials （RCT） on treatment for PQ poisoning were collected to guide the design. A one year follow-up was conducted after the discharge of the patient. Results 7 articles matching the adoption criteria were analyzed. These reports demonstrate that blood purification and glucocorticoid combined with cyclophosphamide are effective against PQ poisoning. Blood purification can prolong the survival, but has little effect on mortality, whereas immunosuppressants increase the survival rate. With adjustment to the patient＇s condition, an evidence-based treatment plan was used for the patient upon her consent. The patient showed significant improvement throughout the hospitalization with no complication found during the follow-up. Conclusion With guidance from the latest research, an evidence-based treatment plan tailored to the patient＇s specific needs may benefit patient with PQ poisoning at least in short term. However, the long term effect of such measure still requires further studies with longer follow-up.