急性重症百草枯中毒40例救治体会

Experience in treatment of 40 cases of acute severe paraquat poisoning

目的总结急性重症百草枯中毒的救治体会。方法选取2017年1月至2018年4月急性重症百草枯中毒患者40例,男12例,女28例,年龄14~64岁,均因误服或自服20%百草枯原液而中毒,40例患者中1例因中毒严重,到院后死亡,余39例均进行积极抢救。分析救治结果,统计不同预后者的相关指标,如患者服毒剂量、洗胃时间及并发症。结果抢救39例中于抢救过程因多脏器功能衰竭死亡12例,因家属自愿放弃抢救而死亡3例,总死亡率为40.0%(16/40)。24例存活者经综合救治后临床症状明显缓解,10~40 d后出院,随访6个月,患者机体功能与日常生活均恢复正常。存活者服毒剂量、洗胃时间、急性呼吸窘迫综合征(ARDS)及消化道出血发生率少于死亡者(P<0.05)。结论急性重症百草枯中毒的死亡率较高,ARDS为其主要死亡原因。及时给予洗胃、导泻、抗过氧化、自由基清除、血液净化、对症治疗等综合措施,可在一定程度上抑制肺纤维化,提高患者远期生存率。

Objective To summarize the treatment experience of acute severe paraquat poisoning.Methods A total of 40 patients with acute severe paraquat poisoning from January 2017 to April 2018 were selected,including 12 males and 28 females,aged 14 to 64 years old,all of them were poisoned by mistreatment or self-administration of 20%paraquat original liquid.One case of 40 cases was seriously poisoned,died after arriving in hospital,and the other 39 cases were actively rescued.The results of treatment were analyzed,and the relevant indexes of the latter were statistically different,such as the dosage of poison,the time of gastric lavage and the complications.Results Among the 39 rescue cases,12 patiends died of multiple organ failure,and 3 cases died of the family gave up the rescue voluntarily.The total death rate was 40.0%(16/40).The clinical symptoms of 24 survivors were significantly relieved after comprehensive treatment.After 10-40 days,they were discharged from hospital and followed up for 6 months.The patient’s body function and daily life returned to normal.Survivor dose,gastric lavage time,acute respiratory distress syndrome(ARDS)ratio and digestive tract bleeding rate were lower than those of the deceased(P<0.05).Conclusions The mortality rate from acute severe paraquat poisoning is higher,and ARD is the leading cause of death.Timely treatment of gastric lavage,diarrhea,anti-oxidation,free radical removal,blood purification,symptomatic therapy and other comprehensive measures,can inhibit pulmonary fibrosis to a certain extent,and improve the long-term survival rate of patients.