The Role of Abdominal CT in the Assessment of the Effectiveness of Gastric Lavage after Pesticide Poisoning

Pesticide poisoning is one of the most common diseases in the emergency department, characterized by rapid changes in condition, a high misdiagnosis rate, and a poor prognosis. Measures for early removal of poisons are crucial, and gastric lavage is one of the important measures. Regarding the post-gastric lavage effect, abdominal CT scanning has an important application value in the assessment of the gastric lavage effect after pesticide poisoning.

Paradoxical systemic toxicity by inhaled paraquat poisoning: A case report

Rationale:Multi-organ failure is a symptom of paraquat poisoning,resulting in high mortality and morbidity rates.Though paraquat is widely available,poisoning through inhalation is rare.Patient’s Concern:A 37-year-old male reported to the emergency department with complaints of vomiting after an alleged history of inhalation of paraquat while at work.Diagnosis:Paraquat poisoning.Interventions:Supportive management along with multiple sessions of hemodialysis.Outcomes:Renal complications caused by paraquat were improved after multiple sessions of hemodialysis.However,the patient developed respiratory complications and later due to persistent hypoxemia and non-responsive to supportive therapy,he succumbed to his illness.Lessons:Acute kidney injury is a complication of paraquat poisoning.However,kidney involvement with the inhalational mode is rare.It is caused by reduction and oxidation cycles,as well as the formation of reactive oxygen species,necessitating hemodialysis as the treatment.Without a clear history,a specific clinical trait,or a diagnostic test,diagnosis can be difficult.Our case thus highlights the inhaled paraquat poisoning,presenting with acute kidney injury with late respiratory impairment as a consequence.

Role of penehyclidine in acute organophosphorus pesticide poisoning

BACKGROUND:Penehyclidine is a newly developed anticholinergic agent.We aimed to investigate the role of penehyclidine in acute organophosphorus pesticide poisoning(OP)patients.METHODS:We searched the Pubmed,Cochrane library,EMBASE,Chinese National Knowledge Infrastructure(CNKI),Chinese Biomedical literature(CBM)and Wanfang databases.Randomized controlled trials(RCTs)recruiting acute OP patients were identifi ed for meta-analysis.Main outcomes included cure rate,mortality rate,time to atropinization,time to 60%normal acetylcholinesterase(AchE)level,rate of intermediate syndrome(IMS)and rate of adverse drug reactions(ADR).RESULTS:Sixteen RCTs involving 1,334 patients were identifi ed.Compared with the atropineor penehyclidine-alone groups,atropine combined with penehyclidine significantly increased the cure rate(penehyclidine+atropine vs.atropine,0.97 vs.0.86,RR 1.13,95%CI[1.07–1.19];penehyclidine+atropine vs.penehyclidine,0.93 vs.0.80,RR 1.08,95%CI[1.01–1.15])and reduced the mortality rate(penehyclidine+atropine vs.atropine,0.015 vs.0.11,RR 0.17,95%CI[0.06–0.49];penehyclidine+atropine vs.penehyclidine,0.13 vs.0.08,RR 0.23,95%CI[0.04–1.28]).Atropine combined with penehyclidine in OP patients also helped reduce the time to atropinization and AchE recovery,the rate of IMS and the rate of ADR.Compared with a single dose of atropine,a single dose of penehyclidine also signifi cantly elevated the cure rate,reduced times to atropinization,AchE recovery,and rate of IMS.CONCLUSION:Atropine combined with penehyclidine benefi ts OP patients by enhancing the cure rate,mortality rate,time to atropinization,AchE recovery,IMS rate,total ADR and duration of hospitalization.Penehyclidine combined with atropine is likely a better initial therapy for OP patients than atropine alone.

Acute Pesticide Poisoning in Jiangsu Province, China, from 2006 to 2015

This study aimed to investigate the characteristics of pesticide poisoning in Jiangsu Province, China, and to provide a scientific basis for developing effective interventional measures and preventive strategies. From 2006 to 2015, a total of 35,308 cases of pesticide poisoning were reported in Jiangsu Province. Non‐occupational poisoning accounted for 73.79% of all poisoning cases. A comparison of the data collected before（2006） and after（2015） this study showed a decrease in non‐occupational pesticide poisoning. Pesticide poisoning showed an age central tendency of 30 to 44 years, area central tendency for northern Jiangsu, and seasonal central tendency of occupational pesticide poisoning in autumn. Pesticide poisoning remains a major health concern in China. Government agencies together with scientists should focus their efforts on the prevention of potential threats to vulnerable groups such as the elderly, women, and children.

Safety of gastric lavage using nasogastric ryle’s tube in pesticide poisoning

Objective: Gastric lavage is mandatory irrespective of nature in all patients with acute poisoning in India. Present study was undertaken with aim whether lavage done using nasogastric Ryle’s tube and small aliquots of water or normal saline is safe. Patients and Methods: All the patients above 12 years of age admitted consecutively with pesticide ingestion or exposure between July 2004 to June 2005 were studied with respect to complications associated with lavage using Ryle’s tube. Forty five patients were admitted directly to our hospital and lavage was undertaken using Ryle’s tube (16F ) with 100 - 200 mL of aliquots till 1 - 1.5 liters of fluid was lavaged, with prophylactic endotracheal intubation in patients with Glasgow coma scale ( GCS) < 10 (group I). The incidence of complications related to lavage in group I was compared to that in 53 patients admitted during same period with pesticide poisoning but lavaged outside using nasogastric Ryle’s tube and referred to our institute (group II). Results: The significant complications observed in group I were significant drop in SaO2 (6 patients) laryngospasm, tachycardia, electrolyte imbalance and tube getting struck in throat (one each). In one patient in group I (had no prophylactic intubation though GCS 3) In group II, 7 had aspiration pneumonia (no prophylactic intubation). Other significant complication was drop in SaO2 during lavage. None of them had any serious life threatening complication. Conclusion: Gastric lavage carried out using nasogastric Ryle’s tube and small aliquots of water or normal saline is relatively safe in patients with pesticide poisoning when combined with prophylactic endotracheal intubation in patients with GCS < 10. In absence of prophylactic intubation, risk of aspiration is there. However aspiration pneumonia is generally mild and not life threatening.

Trends in Suicide by Poisoning in China 2000-2006: Age, Gender, Method, and Geography

Objective This study analyzed patterns of suicide and suicide attempts by poisoning as reported through a national poison control system for the purpose of improving intervention and prevention. Methods During the period of 2000 to 2006, 6440 cases of poisoning suicide were reported to the telephone consultation service system of The National Center for Poisoning Control （Chinese Center for Disease Control and Prevention）. Among these records, 4728 cases had completed data for this analysis in terms of age, sex, trend of time and location, and type of poisons. Results There were 60.6% female cases with the age from 10 to 90 years old. The age of cases from 20 to 39 years accounted for 54.5% of all age groups. Both the numbers and percentage in record related to poisoning consultation of oral poisoning suicide showed an increasing tendency during the 7 years. In particular, there was a drastic increase from 2004 to 2006. In addition, the high frequency of cases occurred from May to October. Hebei, Shandong, Henan, and Anhui Provinces had the highest number of cases. Pesticide poisonings were the most common method in these cases of consultation for suicide and suicide attempts. Conclusion This study describes epidemiological characteristics in the oral poisoning suicide cases and provides scientific basis for suicide prevention interventions.

Small-Scale Tomato Cultivators’ Perception on Pesticides Usage and Practices in Buea Cameroon

It has been shown that farmers with limited knowledge of the use and safe handling of pesticides may suffer exposure which results in adverse health effects. In Buea, Cameroon, small-scale tomato farmers commonly use pesticides for pest control. Information was obtained from these tomato farmers to determine the extent and types of their pesticide use, their knowledge of pesticide use and effectiveness, and their perception of potential harm resulting from pesticide use. A standardized questionnaire, interviews, field observations and an analytical ranking game were used to describe the pesticide use of 93 tomato farmers. Many farmers (47.6%) used pyrethiod and organophosphorus insecticides and identified these chemicals as the most effective in pesticide control;these are WHO Class II pesticides which are the most hazardous to humans. Most farmers (83.8%) used knapsack sprayers to apply pesticides, with 76.3% using no or partial personal protective equipment (PPE). It was notable that 55.5% of farmers expressed no concern regarding the wind direction (pesticide drift) during spraying. The results showed a significant association between the method of pesticides application and farm size (P < 0.001). Most farmers (85.0%) reported at least one symptom of acute pesticide poisoning following spraying. This study revealed that the tomato farmers have a high exposure to pesticides secondary to inadequate knowledge of the safe and judicious use of pesticides. Strategies that provide training on the appropriate use of pesticides, how to reduce exposure to and health risks of pesticides and alternative options of pest management and control are required. The study also raised concerns that further control of the sale and distribution of pesticides may be indicated.

Can kissing cause paraquat poisoning: A case report and review of literature

BACKGROUND Paraquat is an effective,broad-spectrum,highly toxic quaternary ammonium herbicide.Paraquat poisoning has been reported frequently in recent years.It has severe lung,kidney,liver,and nervous system toxicity,and there is currently no specific antidote.Paraquat poisoning may follow ingestion,inhalation,and skin contact.There have been no previous reports of paraquat poisoning that resulted from kissing.This rare case provides a new reference for the prevention of paraquat poisoning.CASE SUMMARY A 27-year-old man came to the emergency department complaining that he had come into contact with paraquat by kissing his girlfriend,who had taken 80-120 mL 20%paraquat.After admission,his lung computed tomography(CT)showed increased lung markings.Redness and a burning sensation developed on his tongue,which progressed to painful erosions and coalescent ulcers.The final diagnosis was mild paraquat poisoning.Anti-inflammatory,antioxidant,and symptomatic treatment were initiated and continued for 7 d.Dyspnea did not occur,subsequent lung CT showed no significant changes,and the tongue pain was slightly improved.One month after discharge,the tongue injury was resolved.CONCLUSION This case indicated that the tongue and lung tissues are particularly vulnerable to paraquat toxicity,even after a limited exposure.

The advantages of penehyclidine hydrochloride over atropine in acute organophosphorus pesticide poisoning:A meta-analysis

Background:Penehyclidine hydrochloride(PHC)has been used for many years as an anticholinergic drug for the treatment of acute organophosphorus pesticide poisoning(AOPP).The purpose of this meta-analysis was to explore whether PHC has advantages over atropine in the use of anticholinergic drugs in AOPP.Methods:We searched Scopus,Embase,Cochrane,PubMed,ProQuest,Ovid,Web of Science,China Science and Technology Journal Database(VIP),Duxiu,Chinese Biomedical literature(CBM),WanFang,and Chinese National Knowledge Infrastructure(CNKI),from inception to March 2022.After all qualified randomized controlled trials(RCTs)were included,we conducted quality evaluation,data extraction,and statistical analysis.Statistics using risk ratios(RR),weighted mean difference(WMD),and standard mean difference(SMD).Results:Our meta-analysis included 20,797 subjects from 240 studies across 242 different hospitals in China.Compared with the atropine group,the PHC group showed decreased mortality rate(RR=0.20,95%confidence intervals[CI]:0.16–0.25,P<0.001),hospitalization time(WMD=-3.89,95%CI:-4.37 to-3.41,P<0.001),overall incidence rate of complications(RR=0.35,95%CI:0.28–0.43,P<0.001),overall incidence of adverse reactions(RR=0.19,95%CI:0.17–0.22,P<0.001),total symptom disappearance time(SMD=-2.13,95%CI:-2.35 to-1.90,P<0.001),time for cholinesterase activity to return to normal value 50–60%(SMD=-1.87,95%CI:-2.03 to-1.70,P<0.001),coma time(WMD=-5.57,95%CI:-7.20 to-3.95,P<0.001),and mechanical ventilation time(WMD=-2.16,95%CI:-2.79 to-1.53,P<0.001).Conclusion:PHC has several advantages over atropine as an anticholinergic drug in AOPP.

Role of hemoperfusion combined with hemodialysis in acute severe organophosphorus pesticide poisoning:a meta-analysis

Background:Acute severe organophosphorus pesticide poisoning is a common severe emergency in developing countries.Our meta-analysis aimed to clarify the efficacy of hemoperfusion combined with hemodialysis on acute severe organophosphorus pesticide poisoning.Methods:Several databases were searched.After formulating relevant inclusion and exclusion criteria,qualified studies were included,and the data were extracted.The outcome indicators were the success rate of rescue,the time of hospitalization,the incidence of com-plications,the time for the cholinesterase level to return to normal,the coma time,and the atropine dosage.The results were analyzed using risk ratios,weighted mean difference,standard mean difference,and 95%confidence interval.The Cochrane Collaboration tool was used to assess the risk of bias in all the included studies.In terms of statistical methods,we used RevMan software(version 5.3;The Nordic Cochrane Centre,The Cochrane Collaboration,Copenhagen,Denmark)and Stata(versions 14 and 16;StataCorp,College Station,TX,USA)for the data analysis.Results:We included 92 randomized controlled trials with 6899 participants.Compared with the conventional emergency treatment group(CET group),the hemoperfusion group(HP+CET group),and the hemodialysis group(HD+CET group),the use of hemoperfusion combined with hemodialysis based on CET(HP+HD+CET group)significantly increased the success rate of rescue and reduced hos-pitalization time,the incidence of complications,time for cholinesterase level to return to normal,coma time,and atropine dosage.Conclusion:Hemoperfusion combined with hemodialysis is effective in the treatment of acute severe organophosphorus pesticide poi-soning.In the future,more scientifically designed,large-scale,high-quality,multicenter randomized controlled trials are needed to validate this study further.

Toxicity Symptoms among Migrant Agropesticide Workers in Oman

The toxicity symptoms among 79migrant pesticide workers involved in open-field pesticide application in Oman were studied. Questionnaires addressing the workers＇ demographics, pesticide use and practices, use of protective devices, disposal of empty containers, storage of pesticides and self-reported poisoning symptoms were administered face-to-face to the workers before commencement of work, during break or at home. A total of 28 toxicity symptoms were reported, skin rash being the symptom reported by a majority of the workers （78%）, followed by increased salivation （68%）. The gravity of toxicity symptoms was attributed principally to the non-use of protective devices during pesticide spraying. Other factors contributing to poisoning were the workers＇ poor post-application sanitation habits, improper disposal of empty pesticide containers and storage of partially used pesticides in bedrooms. In order to reduce the incidents of poisoning among the agropesticide workers, there is a need to educate them about the benefits of using PPE （personal protective equipment） and ensuring that they adopt good hygiene and sanitation habits at all stages of pesticide handling.

由乐果导致的重度急性有机磷中毒合并脓毒性休克的治疗体会

目的描述1例重度急性有机磷中毒(AOPP)合并复发性呼吸衰竭、中间综合征(IMS)、多器官功能障碍综合征(MODS)和脓毒症的诊断、治疗及临床病程。方法云南省第一人民医院内科重症监护病房(MICU)于2021年5月8日收治了1例自服农药乐果AOPP患者,经过29d的治疗痊愈出院。介绍临床诊治过程。结果患者男性,78岁,因自服农药乐果导致AOPP。入院后迅速出现呼吸衰竭,经紧急气管插管接呼吸机辅助呼吸,并进行一系列针对性治疗,包括应用复能剂碘解磷定、阿托品和山若碱,以及抗菌药物、维持水电解质和酸碱平衡等。在治疗过程中,患者病情经历了多次反复,如脓毒症发作、胆碱酯酶(ChE)水平大幅波动、多重耐药菌感染、呼吸衰竭反复出现等情况。最终,经过29d的治疗,患者成功脱离呼吸机,各器官功能恢复正常出院。结论通过对该病例的分析,提示在AOPP救治过程中需密切关注调整药物剂量,防治感染、脓毒性休克和呼吸机相关性肺炎(VAP)的发生,并及时心理评估和干预的重要性。

恒温等渗冲洗液在急诊口服农药中毒洗胃中的应用效果评价

目的:探讨恒温等渗冲洗液在急性口服农药中毒患者洗胃中的应用效果。方法:选取52例口服农药中毒患者为研究对象,按随机数表法分为实验组(26例)和对照组(26例),实验组患者采用恒温等渗冲洗液进行洗胃,对照组患者采用传统温开水进行洗胃。比较两组患者发生低钾血症、低钠血症、黏膜出血等并发症发生率,以及两组患者洗胃液的平均准备时间。结果:实验组患者中发生低钾血症、低钠血症及黏膜出血并发症发生率均明显低于对照组,实验组患者洗胃液的平均准备时间明显低于对照组,满意度高于对照组,差异均具有统计学意义(P<0.01)。结论:采用恒温等渗冲洗液对口服农药中毒患者进行洗胃,可明显减少患者并发低钾血症、低钠血症、黏膜出血的发生率,同时也明显缩短了洗胃液的准备时间,提高患者的护理满意度。

强化心理护理联合急救模式对有机磷农药中毒患者的影响

目的:分析强化心理护理联合急救模式对有机磷农药中毒的影响。方法:选取2021年3月—2023年3月滨州医学院附属医院收治的有机磷农药中毒患者72例作为研究对象,采取区组随机化法分组方式分为对照组(常规护理)、观察组(在对照组基础上给予强化心理护理联合急救模式),各36例。比较两组急救指标、转归指标、心理状态、家属满意度等。结果:观察组首次血液净化时间、留观时间短于对照组,抢救成功率高于对照组(P<0.05);观察组毒蕈碱样、烟碱样、中枢神经系统症状消失时间,胆碱酯酶恢复至60%时间及住院时间短于对照组(P<0.001);干预后,两组焦虑自评量表、抑郁自评量表评分低于干预前,观察组低于对照组(P<0.05);观察组服务态度、护理能力、配合协调性、急救及时性评分高于对照组(P<0.001);观察组并发症发生率低于对照组(P=0.024)。结论:针对有机磷农药中毒患者采取强化心理护理联合急救模式可获得较好的效果,可缩短急救时间,提高抢救成功率,减少并发症发生,调节心理应激水平,家属满意度较高。

有机磷农药中毒重症患者的呼吸衰竭急救措施及预后价值研究

分析急救措施对于有机磷农药中毒重症患者呼吸衰竭的影响以及预后价值。选取2022年1月—2023年1月贵港市人民医院收治的160例有机磷农药中毒重症患者进行研究,采用随机数字表法将患者分为对照组和救治组,每组各80例,对照组采用常规救治措施,救治组患者采用急救措施。比较两组患者的救治有效率、第一救治时长、血气分析指标、恢复情况以及并发症发生情况。结果显示,救治组患者救治总有效率高于对照组,第一救治时间短于对照组(P<0.05);救治后,救治组患者血氧分压高于对照组,动脉血二氧化碳分压低于对照组(P<0.05);救治组患者昏迷时长、下床活动时长、住院时长以及血胆碱酯酶上升时长均短于对照组(P<0.05);救治组患者并发症总发生率低于对照组(P<0.05)。研究发现,针对出现呼吸衰竭的有机磷农药中毒重症患者应及时采取急救措施抢救,以改善患者的临床症状。

2016—2022年荆州市农药中毒流行病学分析

目的分析荆州市农药中毒流行病学特征,为农药中毒的防控提供依据。方法导出“职业病及健康危害因素监测信息系统”中荆州市2016—2022年农药中毒报告病例,对中毒病例进行三间分布等描述性统计分析。结果2016—2022年荆州市累计报告农药中毒病例4961例,死亡1738例,死亡率为35.0%,以生活性中毒为主,其病例数占比为91.5%(4538/4961)。2016—2022年农药中毒报告病例数呈整体上升趋势;农药中毒高发于6—8月,其病例数占比为32.1%(1594/4961)。公安县报告病例数最多,其病例数占比高达68.8%(3412/4961),中毒病例男女性别比为1∶0.99,生产性中毒中男性多于女性。中毒病例平均年龄为64.2岁,≥66岁年龄组中毒病例数占比[55.3%(2744/4961)]和死亡率[47.7%(1310/1738)]均最高。中毒农药类型以有机磷等杀虫剂为主,其病例数占比为40.0%(1983/4961),但死亡率最高的农药类型为生物化学农药,为68.2%(533/781)。结论荆州市农药中毒以生活性中毒为主,有机磷等杀虫剂为高危毒物。建议管理部门根据农药中毒的高发时间、地区和人群特征制定针对性的防控措施,并加大农药监管力度。

优化急救流程对急性重度有机磷农药中毒患者的影响分析

目的探讨优化急救流程对急性重度有机磷农药中毒患者的影响。方法以2021年11月南京医科大学第一附属医院优化急救流程为分界线,将2019年10月—2021年10月实施常规急救模式的67例急性重度有机磷农药中毒患者归为对照组,2021年11月—2023年11月实施优化后急救流程的69例急性重度有机磷农药中毒患者归为观察组。比较两组救治时间,临床症状消失时间,并发症发生率,预后评分[格拉斯哥昏迷指数(GCS)评分、急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分]和患者护理满意度。结果观察组胆碱酯酶活力恢复时间、应用呼吸机时间和住院时间显著低于对照组(P<0.05),但两组间阿托品化时间和清洁肠道时间差异无统计意义(P>0.05);观察组恶心呕吐、瞳孔异常、全身抽搐、昏迷和呼吸紧促时间显著低于对照组(P<0.05);观察组并发症发生率为2.90%,显著低于对照组的11.94%(P<0.05);观察组GCS评分显著高于对照组,APACHEⅡ评分显著低于对照组(P<0.05);观察组护理满意度评分显著高于对照组(P<0.05)。结论优化急救流程可以缩短急性重度有机磷农药中毒患者救治时间和临床症状消退时间,减少并发症发生率,改善预后,提高护理满意度。

急性有机磷农药中毒患者并发毛细血管渗漏综合征的危险因素分析

目的探索急性有机磷农药中毒(acute organophosphorus pesticide poisoning,AOPP)患者并发毛细血管渗漏综合征(capillary leak syndrome,CLS)的危险因素,为早期预防及诊断AOPP并发CLS提供参考。方法前瞻性收集2020年11月—2022年6月阜阳市人民医院急诊科连续收治的AOPP患者临床资料,包括临床表现、辅助检查及预后情况等,根据是否并发CLS将其分为CLS组和非CLS组。以患者入院为观察起点,以死亡或出院为观察终点,采用多因素Logistic回归分析探索AOPP并发CLS的危险因素。结果共纳入38例AOPP患者,其中17例(44.7%)并发CLS;非CLS组与CLS组患者在年龄(P=0.015)、敌敌畏血药浓度(P=0.001)、敌百虫血药浓度(P<0.001)、肌酐(P<0.001)、APACHEⅡ评分(P<0.001)等方面存在统计学差异。多因素Logistic回归分析显示,敌百虫血药浓度≥0.44μg/mL、APACHEⅡ评分≥10.5分是AOPP并发CLS的独立危险因素。CLS组患者的死亡率明显高于非CLS组(P<0.001)。结论AOPP患者较易并发CLS,且死亡率较高,临床上可通过敌百虫血药浓度、APACHEⅡ评分早期识别高风险患者,及早进行干预,以改善患者预后。

血液灌流对重度有机磷农药中毒伴心肌损伤患者心肌酶谱和炎症指标变化的影响

目的探讨血液灌流对重度有机磷农药中毒伴心肌损伤患者心肌酶谱和炎症指标变化的影响。方法回顾性分析本院2018年1月—2022年12月接诊的重度有机磷农药伴心肌损伤的80例患者,按照实际治疗期间是否进行血液灌流治疗分为对照组30例与观察组50例,对照组采用常规救治,观察组在对照组的基础上加以血液灌流进行治疗。对比分析两组患者治疗前后格拉斯哥昏迷指数(GCS)评分、血清胆碱酯酶(ChE)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌动蛋白(cTnⅠ)以及降钙素原(PCT)、C反应蛋白(CRP)水平以及临床疗效。根据临床疗效,将观察组分为治愈组、有效组、无效组3个亚组,比较不同疗效患者血清ChE、LDH、CK、CK-MB、cTnⅠ、PCT、CRP水平。结果治疗后,两组患者血清LDH、CK、CK-MB、cTnⅠ、PCT、CRP水平均显著低于治疗前,ChE水平以及GCS评分显著高于治疗前(P<0.05),观察组患者血清LDH、CK、CK-MB、PCT、CRP水平显著低于对照组,ChE水平显著高于对照组(P<0.05);且随着临床疗效增加,血清LDH、CK、CK-MB、cTnⅠ、PCT、CRP水平逐渐降低,ChE水平逐渐升高,两两比较差异均存在统计学意义(P<0.05)。结论血液灌流治疗重度有机磷农药中毒伴心肌损伤患者疗效显著,可显著降低心肌酶谱(LDH、CK、CK-MB、cTnⅠ)和炎症指标(PCT、CRP)水平,对心肌损伤及炎症反应具有积极影响,且疗效越显著,其血清水平下降越快。