百草枯中毒患者肺功能变化的研究进展

Pulmonary function changes of paraquat poisoning

百草枯中毒可以引起多个重要器官脏器损害,其中以肺损伤为特征性改变,病理学特点主要表现为出血、水肿、弹性纤维增生等,最终形成肺纤维化;胸部影像学常表现为肺纹理增粗、磨玻璃样改变、肺实变、气胸、胸腔积液等,存活者最终形成肺纤维化改变。以上这些结构上的改变反映在功能上则肺功能检查可以出现阻塞性通气功能障碍、限制性通气功能障碍、混合通气功能障碍、弥散功能障碍等,表现为TLC、FRC、RV、VC、DLCO、VA、FEV1、FVC、FEV1/FVC异常,但肺功能改变与中毒程度明显相关,轻症病人可以没有任何异常表现;动脉血气分析可出现A-aDO2升高,伴或者不伴有低氧血症,且A-aDO2越高,肺损害越重。目前关于血气分析对百草枯中毒肺损害评价的研究较少,尚没有关于A-aDO2与百草枯肺损害程度关系的研究。

Paraquat poisoning is characterized by multiple-organ failure, involving mainly the lungs with the main pathological findings including hemorrhage, pulmonary edema, elastic fibers proliferation and pulmonary fibrosis finally.The radiological lung changes may include ground-glass attenuation, irregular lines, consolidation , pneumothorax, pleural effusion and finally honeycombing. These are matched by the development of obstructive, restrictive and sometimes mixed pulmonary dysfunctions, accompanied by progressive impairment of gaseous exchange （abnormal values of TLC, FRC, RV, VC, DLCO, VA, FEV 1, FVC, FEV 1/FVC）, although in mild cases the pulmonary functions can be normal.In most patients with paraquat poisoning, the A-aDO2 will increase, in the presence or absence of hyoxemia, with higher value of A-aDO2 being associated with more severe damage in the lungs. The study evaluating the arterial blood-gas analysis in paraquat poisoning is rare, and no study has investigated the A-aDO2 changes in patients with paraquat poisoning.