持续补液成功抢救1例急性重度百草枯中毒患者经验总结

Experience of continuous fluid therapy in successfully rescuing a patient with acute severe paraquat poisoning

百草枯(PQ)中毒已经成为我国目前常见的农药中毒之一。PQ对人毒性极大,口服PQ中毒病死率高达90%以上,至今尚无特效解毒药。寻求PQ中毒的有效救治措施已成为临床医学研究的热点。2017年11月潍坊医学院附属寿光市人民医院重症医学科(ICU)收治了1例急性重度PQ中毒患者,在患者拒绝使用血液净化疗法的情况下,仅通过持续补液疗法加利尿排便及常规治疗抢救成功。本文通过介绍该病例的救治过程,希望能为基层医院PQ中毒的临床救治提供新的治疗思路,即:对于抢救PQ中毒患者,应在第一时间催吐、洗胃、导泻、口服蒙脱石散吸附毒物,对于无心、肺、肾功能障碍者,应立即大量补液利尿促进毒物排除。尽早尽快将体内PQ排出,才是目前提高PQ中毒抢救成功率的关键。

Paraquat(PQ)poisoning has become one of the common pesticide poisoning in China.PQ is extremely toxic to human beings.The fatality rate of oral PQ poisoning is more than 90%.So far,there is no specific antidote.Seek effective treatment measures for PQ poisoning has become the focus of clinical medical research.In November 2017,a patient with acute severe PQ poisoning was treated in the intensive care unit(ICU)of Shouguang People's Hospital Affiliated to Weifang Medical College.The patient refused blood purification therapy and was rescued successfully only by continuous fluid therapy,diuresis,catharsis and routine treatment.By reviewing the treatment process of this case,new treatment ideas for the clinical treatment of PQ poisoning in primary hospitals were provided.Patients with acute PQ poisoning should be rescued by immediate administration of emetic,gastric lavage,catharsis and oral montmorillonite powder.For those without dysfunction of heart,lung and and kidney,a large amount of fluid treatment and diuresis should be given immediately to promote the excretion of poison.The key to improve the success rate of rescue of acute PQ poisoning is to eliminate PQ from the body as soon as possible.