不同剂量激素联用环磷酰胺治疗百草枯中毒

Different dosage of glucocorticoid plus cyclophosphamide in treatment of paraquat poisoning

目的:探讨不同剂量甲强龙联用环磷酰胺对百草枯中毒的疗效及安全性。方法:回顾性分析我院收治的百草枯中毒患者90例,分为冲击组(46例,大剂量甲强龙+环磷酰胺)和常规组(44例,常规剂量+环磷酰胺)。观察并比较两组病死率、低氧血症发生率、肝肾功能损伤、肺纤维化及多脏器功能衰竭等情况。结果:冲击组患者7 d内病死率、低氧血症发生率、ALT、Cre峰值明显低于常规组,且肝肾损伤时间延迟(P<0.05或P<0.01)。冲击组肺纤维化、多器官功能衰竭发生率亦低于常规组,但差异无统计学意义。结论:大剂量甲强龙联合环磷酰胺是一种更为有效的百草枯中毒治疗方案。

Objective： To compare the efficacy and safety of different dosage of methylprednisolone combined with cyclophosphamide for paraquat poison-ing.Methods：Ninety patients admitted to our hospital due to paraquat poisoning were divided into groups of shock therapy（n=46,treated with high dose of methylprednisolone ＋cyclophosphamide） and conventional therapy（ n=44,managed with conventional dose of methylprednisolone ＋cyclophospha-mide）.The two groups were observed regarding the mortality,incidence of hypoxemia,liver and kidney injury,pulmonary fibrosis and multiple organ fail-ure.Results：The patients received shock therapy significantly had lower mortality in 7 days,incidence of hypoxemia,levels of serum alanine transarninase （ALT） and creatinine（Cre） as well as delayed liver and kidney injury as compared with those managed with conventional dosage （P 〈0.05 or P 〈0.01）.Although the incidence of pulmonary fibrosis and multiple organ failure in shock group was lower,yet the difference was not significant. Conclusion：High-dose of methylprednisolone plus cyclophosphamide appears a more effective treatment regimen for paraquat poisoning .