百草枯中毒长期存活并发COPD 2例报告

Two case reports:chronic obstructive pulmonary disease developed in long term survived patients after acute paraquat poisoning

急性百草枯中毒患者多因呼吸衰竭而死亡,幸存患者可遗留肺纤维化,但远期肺功能变化尚不明确。江苏省苏北人民医院急诊科对2例百草枯中毒存活7年以上患者进行随访,评估肺影像学和肺功能变化。例1患者中毒后8年胸部CT提示间质性肺炎、慢性支气管炎、肺气肿、支气管扩张;肺功能示极重度阻塞性通气功能障碍〔肺活量(VC)占预计值的百分比为63.7%,第1秒用力呼气容积(FEV1)占预计值的百分比为33.2%,用力肺活量(FVC)占预计值的百分比为64.7%,第1秒用力呼气容积与用力肺活量的比值(FEV1/FVC)52.5%,最大呼气中期流量(MMEF)占预计值的百分比为9.9%,单次呼吸一氧化碳弥散量(DLCO-SB)占预计值的百分比为49.3%〕。例2患者中毒后7年胸部CT示慢性支气管炎、肺气肿、肺大泡、胸腔积液;肺功能示重度混合性通气功能障碍,以阻塞性障碍为主(VC占预计值的百分比为47.8%,FEV1占预计值的百分比为35.6%,FVC占预计值的百分比为49.3%,FEV1/FVC 74.1%,MMEF占预计值的百分比为17.1%,DLCO-SB占预计值的百分比为21.8%)。急性百草枯中毒对患者肺结构和功能均有一定的远期影响,可能表现为慢性阻塞性肺疾病。

Patients with acute paraquat poisoning mostly die of respiratory failure,and the surviving ones may live with pulmonary fibrosis,but the long-term changes in lung function are still un-clear.Two patients with acute paraquat poisoning survived for more than 7 years were followed up in Northern Jiangsu People's Hospital to evaluate the imaging and spirometric changes.Eight years after poisoning,1 patient's chest computerized tomography(CT)revealed interstitial pneumonia,chronic bronchitis,emphysema,accompanied by bronchiectasis.Spirometric test showed very severe obstructive ventilatory dysfunction[percentage of vital capacity(VC)to predicted values was 63.7%,percentage of forced expiratory volume in one second(FEV1)to predicted values was 33.2%,percentage of forced vital capacity(FVC)to predicted values was 64.7%,forced expiratory volume in one second to forced vital capacity(FEV1/FVC)was 52.5%,percentage of maximal mid-expiratory flow(MMEF)to predicted values was 9.9%,percentage of diffusion capacity for carbon monoxide in single breath(DLCO-SB)to predicted values was 49.3%].The radiography of the other patient who survived over 7 years after poisoning also discovered chronic bronchitis,emphysema and bullae,along with pleural effusion.Spirometry identified severe mixed ventilatory dysfunction,mainly obstructive ventilatory disorder(percentage of VC to predicted values was 47.8%,percentage of FEV1 to predicted values was 35.6%,percentage of FVC to predicted values was 49.3%,FEV1/FVC was 74.1%,percentage of MMEF to predicted values was 17.1%,percentage of DLCO-SB to predicted values was 21.8%).These 2 cases indicate that acute paraquat poisoning had long-term effects on lung structure and pulmonary function,which may be manifested as chronic obstructive pulmonary disease.