非消化道途径百草枯中毒2例

Paraquat poisoning by non-gastrointestinal pathway: Two cases report

百草枯(paraquat)是一种有效和广泛使用的除草剂,其对动物和人均有很强的致毒性,因意外或自杀摄入引起的百草枯中毒,死亡率高达50%~90%[1]。经消化道是百草枯最常见的中毒途径,常因自杀或误服、误食引起。皮肤接触途径的中毒多为职业暴露导致,也有通过皮肤接触谋杀的案例报道[2],而静脉途径多见于自杀或药物滥用患者。目前临床多关注口服引起的百草枯中毒,其他途径导致的中毒比较少见。

Paraquat poisoning can be caused by multiple pathways, and their major difference is clinical characteristic. We report two cases of paraquat poisoning by non-digestive pathway. After admission, patients were treated with glucocorticoid, antioxidant and viscera protection. One patient suffered progressive lung injury and secondary pulmonary infection after perineal derma contact with paraquat,and died of multiple organ failure. Another patient died of sudden changes in consciousness and respiratory failure after intravenous injection of paraquat, though hemoperfusion was performed immediately. We concluded that the dermal pathway, especially perineal skin, may cause severe poisoning after prolonged contact with paraquat, and the prevention and treatment of secondary infection should be concerned. Acute fulminant poisoning may be caused by intravenous paraquat.