草铵膦农药中毒致呼吸抑制患者的临床分析

Clinical analysis of respiratory depression caused by glufosinate poisoning

【目的】分析草铵膦农药中毒致呼吸抑制患者的临床特征、治疗和预后。【方法】分析2018年3月—2022年1月宁波市象山县第一人民医院医疗健康集团重症加强护理病房(ICU)收治的草铵膦中毒致呼吸抑制患者的临床资料。【结果】共有21例草铵膦中毒致呼吸抑制患者,摄入量中位数(四分位数Q1,Q3)为30(20,40)g,就诊时间为2.0(1.0,2.8)h。就诊初始症状主要为恶心呕吐16例(76.2%)、喉部疼痛8例(38.1%),摄入后6~48 h发生呼吸抑制、抽搐、休克和心动过缓症状,出现抽搐13例(61.9%)、休克10例(47.6%)、心动过缓5例(23.8%)。合并抽搐或休克患者中,先出现呼吸抑制,后出现抽搐、休克分别为10例(76.9%)和9例(90.0%)。所有患者均予洗胃、导泻、机械通气和对症支持治疗,行血液净化14例,机械通气时间5.0(4.0,7.0)d,无患者死亡。以有无行血液净化将21名患者分为血液净化组和常规治疗组,两组合并症、机械通气时间比较,差异均无统计学意义(P>0.05)。【结论】草铵膦中毒致呼吸抑制患者通常先出现呼吸抑制,后出现抽搐和休克症状,总体预后良好。预后主要取决于呼吸抑制的尽早识别和干预。

[Objective]To analyze the clinical features,treatment and prognosis of patients with respiratory depression caused by glufosinate poisoning.[Methods]The clinical data of patients with respiratory depression caused by glufosinate poisoning admitted to the ICU of Xiangshan first people’s hospital medical and health group from March 2018 to January 2022 were retrospectively analyzed.[Results]A total of 21 patients with respiratory depression caused by glufosinate poisoning were included.The median(interquartile)intake of glufosinate was 30(20,40)g,and the median(interquartile)visit time was within 2.0(1.0,2.8)h.The initial symptoms were nausea and vomiting in 16 cases(76.2%),and sore throat in 8 cases(38.1%).Respiratory depression,convulsions and shock occurred 6-48 hours after ingestion of glufosinate.Convulsion occurred in 13 cases(61.9%),shock in 10 cases(47.6%)and bradycardia in 5 cases(23.8%).Among the patients with convulsion or shock,respiratory depression occurred earlier than convulsion and shock in 10 cases(76.9%)and 9 cases(90.0%),respectively.All patients were treated with gastric lavage,catharsis,mechanical ventilation and symptomatic support.Blood purification was performed in 14 cases.The duration of mechanical ventilation was 5.0(4.0,7.0)d,and no patient died.The patients were divided into blood purification group and routine treatment group.There was no significant difference in complications and duration of mechanical ventilation between the blood purification group and the routine treatment group(P>0.05).[Conclusion]Respiratory depression caused by glufosinate poisoning usually occurs earlier than convulsion and shock.The overall prognosis of patients with respiratory depression caused by glufosinate poisoning is good,which mainly depends on the early recognition and intervention of respiratory depression.