糖皮质激素早期大剂量冲击联合小剂量长时间递减维持治疗对重度百草枯中毒的疗效观察

Effect of severe paraquat poisoning by the therapy of early high-dose pulse and lengthy tapered-dose maintenance of glucocorticoid

目的探讨糖皮质激素早期大剂量冲击联合小剂量长时间递减维持治疗重度百草枯中毒的疗效。方法实验选取2010年1月到2012年1月我院收治的重度百草枯中毒患者76例,实验组给予甲泼尼龙15mg.kg-1.d-1冲击治疗3天,后逐渐减量,每3天减为原来剂量的1/2,直到40mg/d,之后改为口服泼尼松片,每7天减少5mg,直至5mg/d;对照组给予现行临床上的常规治疗方案,8mg.kg-1.d-1,连续冲击3～5天,比较2周存活率,对存活超过2周的患者于2、4、6和12周行肺功能检查。结果实验组2周生存率为52.6%,对照组2周生存率为28.9%(log rank检验,χ2=5.902,P<0.05)。在2、4、6、12周,1秒用力呼气容积(FEV1)实验组为(76.40±5.54)%、(82.50±3.75)%、(83.30±4.22)%、(83.30±3.38)%,对照组为(64.80±3.90)%、(76.80±3.35)%、(77.20±3.75)%、(77.60±3.50)%;用力肺活量(FVC)在实验组为(69.60±5.74)%、(76.10±7.30)%、(75.00±6.04)%、(76.50±5.38)%,对照组为(62.40±1.52)%、(69.60±5.30)%、(68.60±5.32)%、(70.80±4.27)%;一氧化碳弥散量(DLco)在实验组为(64.20±6.76)%、(68.40±5.27)%、(68.90±4.70)%、(71.10±5.53)%,对照组为(56.00±4.30)%、(62.00±3.39)%、(62.60±2.41)%、(65.40±3.05)%。两组FEV1、FVC及DLco均呈逐渐增高趋势,FEV1、FVC及DLco在组间、不同时点差异有统计学意义(P<0.05或<0.01),但在组间与不同时点的交互作用差异无统计学意义(P>0.05)。结论糖皮质激素的早期大剂量冲击联合小剂量长时间递减维持方案救治重度百草枯中毒患者能够提高生存率,且对远期的肺功能有益。

Objective To observe effect of severe paraquat poisoning by the therapy of early high-dose pulse and lengthy tapered-dose maintenance of glucocorticoid. Methods The trial enrolled 76 patients with severe paraquat poisoning from January 2010 to January 2012. Experimental group received intravenous methylprednisolone 15 mg · kg^-1 · d ^-1 in the first three days,then reduced to half of the original every third day and until 40 mg/d,since then oral prednisone,reduced by 5 mg every seven days and until 5 mg/d. Control group received traditional dose 8 mg · kg^-1 · d ^-1 for 3--5 days as controls. 2-week survival rate was compared. Pulmonary function tests were conducted regularly at 2,4,6 and 12 weeks for survivors. Results 2-week survival rate was 52.6% in experimental group and 28.9% in control group（log rank= 5. 902, P 〈 0.05 ）. At 2,4,6 and 12 weeks, forced expiratory volume in one second （forced expiratory volume in one second, FEV1 ） was （ 76.40 ± 5.54） %, （ 82.50 ± 3.75 ） %, （ 83.30± 4.22 ） %, （ 83.30 ± 3.38）% in experimental group and （64.80±3.90）%,（76.80±3.35）%,（77.20±3.75）%,（77.60±3.50）% in control group; forced vital capacity（forced vital capacity, FVC） was （69.60± 5.74）%, （76. 10± 7.30）%, （75. 00± 6.04） %, （76.50± 5.38）% in experimental group and （62.40± 1.52） %, （69.60± 5.30） %, （68. 604-5.32） %, （70.80±4.27）% in control group;diffusing capacity of the lung for carbon monoxide（diffusing capacity of the lung for carbon monoxide,DLco） was （64. 209±6.76）%,（68.40±5.27）%, （68.90±4.70）%, （71.10±5.53） in experimental group and （56.00±4.30）%,（62. 00±3. 39）% ,（62.60±2.41）%,（65.40±3.05）% in control group FEV1 ,FVC and DLco of both groups showed an upward trend. The differences of interblock and time dissimilarity between the two groups had statistical significance（ P 〈0.05 or 〈0.01）, and interaction of interblock and with time dissimilarity had no statistical significance（ P 〈0.05）. Conclusion Therapy of early high-dose pulse and lengthy＇tapered-dose maintenance of glucocorticoid can decrease mortality and has a positive impact on long-term lung function.