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.

Risk factors and optimal predictive scoring system of mortality for children with acute paraquat poisoning

BACKGROUND There is no suitable scoring system that can be used to predict mortality in children with acute paraquat intoxication(APP).AIM To optimize a predictive scoring system for mortality in children with APP.METHODS A total of 113 children with APP from January 1,2010 to January 1,2020 were enrolled in this study.These patients were divided into survivors and nonsurvivors.We compared the clinical characteristics between the two groups and analyzed the independent prognostic risk factors.The survival rates of patients with different values of the pediatric critical illness score(PCIS)were assessed using kaplan-meier survival analysis.The best scoring system was established by using the area under the receiver operating characteristic curve analysis.RESULTS The overall mortality rate was 23.4%.All non-survivors died within 20 days;48.1%(13/27)died within 3 days,and 70.3%(19/27)died within 7 days.Compared to survivors,the non-survivors were older,had higher white blood cell count,alanine aminotransferase(ALT),aspartate aminotransferase,serum creatinine,blood urea nitrogen,glucose,and pediatric early warning score,and had lower platelet count,albumin,Serum sodium(Na+)and PCIS.ALT and PCIS were the independent prognostic risk factors for children with APP.The survival rate of children classified as extremely critical patients(100%)was lower than that of children classified as critical(60%)or noncritical(6.7%)patients.The specificity of ALT was high(96.51%),but the sensitivity was low(59.26%).The sensitivity and specificity of ALT combined with PCIS were high,92.59%and 87.21%,respectively.The difference in mortality was significantly higher for ALT combined with PCIS(area under the receiver operating characteristic:0.937;95%CI:0.875-0.974;P<0.05).CONCLUSION In our study,ALT and PCIS were independent prognostic risk factors for children with APP.ALT combined with PCIS is an optimal predictive mortality scoring system for children with APP.

Advances in molecular mechanism of lung injury induced by paraquat poisoning

Paraquat is a bipyridine dichloride non-selective herbicide,which was widely used in the world in the last century.Now,paraquat is banned in most countries because of the extremely high lethality and the lack of specific detoxification drugs.However,death due to paraquat poisoning still occurs frequently,thus it is of great clinical significance to explore the molecular mechanism of paraquat poisoning and the detoxification drugs.Paraquat poisoning causes multiple dysfunction of the lung,liver,kidney,heart,and brain through complex molecular mechanisms.About the mechanism there are excessive inflammatory reaction theory,REDOX reaction imbalance theory,oxidative stress free radical damage theory,calcium overload theory,NO molecular damage and cell apoptosis theory,etc.For the treatment of paraquat poisoning,paraquat antibody,pathway target blocker and related factor antibody have been developed in recent years.Although certain effects have been achieved,the treatment efficiency has not been significantly improved.This paper summarized the mechanism of signal transduction pathways involved in lung injury induced by paraquat poisoning in order to provide a theoretical basis for further research.

Ulinastatin suppresses endoplasmic reticulum stress and apoptosis in the hippocampus of rats with acute paraquat poisoning

Lung injury is the main manifestation of paraquat poisoning. Few studies have addressed brain damage after paraquat poisoning. Ulinastatin is a protease inhibitor that can effectively stabilize lysosomal membranes, prevent cell damage, and reduce the production of free radicals. This study assumed that ulinastatin would exert these effects on brain tissues that had been poisoned with paraquat. Rat models of paraquat poisoning were intraperitoneally injected with ulinastatin. Simultaneously, rats in the control group were administered normal saline. Hematoxylin-eosin staining showed that most hippocampal cells were contracted and nucleoli had disappeared in the paraquat group. Fewer cells in the hippocampus were concentrated and nucleoli had dis- appeared in the ulinastatin group. Western blot assay showed that expressions of GRP78 and cleaved-caspase-3 were significantly lower in the ulinastatin group than in the paraquat group. Immunohistochemical findings showed that CHOP immunoreactivity was significantly lower in the ulinastatin group than in the paraquat group. Terminal deoxynucleotidyl transferase-medi- ated dUTP nick end labeling staining showed that the number of apoptotic cells was reduced in the paraquat and ulinastatin groups. These data confirmed that endoplasmic reticular stress can be induced by acute paraqnat poisoning. Ulinastatin can effectively inhibit this stress as well as cell apoptosis, thereby exerting a neuroprotective effect.

Prognostic value of plasma C-reactive protein in the evaluation of paraquat poisoning patients

Objective: To investigate the prognostic value of plasma C-reactive protein(CRP) level in patients with paraquat poisoning.Methods: This study included 162 patients with paraquat poisoning. The data of plasma paraquat, CRP level and arterial blood gas were analyzed. Cox regression analysis was applied to evaluate the risk factors of prognosis. Receiver operating characteristics curve analysis and area under curve were used to calculate the predictive power of significant variable. Differences in patient survival were determined using the Kaplan–Meier method and a log-rank test.Results: Plasma CRP level was significantly increased in non-survival patients compared with survival patients(P < 0.05), and positively correlated with plasma paraquat level(P < 0.05). Cox regression analysis revealed that plasma CRP level was an independent prognostic marker of mortality within 30 days. The receiver operating characteristics curve analysis indicated that area under curve of plasma CRP level was0.867(95% CI: 0.81–0.93), and the cut-off value was 18 mg/L, and patients with CRP level over this value had a poor survival time compared with those with less than this value.Conclusions: These results suggest that plasma CRP level is distinct increased in patients with paraquat poisoning, and the plasma CRP level may be useful for the prediction of prognosis in paraquat poisoning.

Discernment scheme for paraquat poisoning: A five-year experience in Shiraz, Iran

AIM To evaluate various schemes for paraquat poisoning and different variables that influence the outcome of acute paraquat poisoning.METHODS In a cross-sectional study, the information about all cases of acute paraquat poisoning who were admitted to teaching hospitals affiliated to Shiraz University of Medical Sciences, in a five year period(September 2010 to September 2015) were evaluated. The variables included: Demographic data, medical assessment, therapeutic options, laboratory findings, and the outcomes. Data were analyzed using SPSS, version 22. Significant difference between groups was tested using t-test for continues outcomes and χ~2 test for categorical. The significance level was considered to be P < 0.05. RESULTS A total of 104 patients(66.3% male) were evaluated. The mean age of the female patients was 22.81 ± 9.87 years and the male patients' was 27.21 ± 11.06 years. Ninety seven(93.3%) of all the cases were suicide attempts with mortality rate of 43.2%. Despite the necessity for emergency hemodialysis during the first 6 h of intoxication, none of the patients had dialysis during this time. Immunosuppressive and corticosteroid medications were not administrated in adequate dosage in 31.1% and 60% of the patients, respectively. Ingestion of more than22.5 cc of paraquat and increase in creatinine level were the most important predictors of mortality.CONCLUSION Treatment should start immediately for these patients.Moreover, creating a clinical guideline according to the findings can have an impact on the treatment procedure which seems to be necessary.

Anthrahydroquinone-2,6-disulfonate alleviates paraquat-induced kidney injury via the apelin-APJ pathway in rats

Objective:To explore the protective effects of anthrahydroquinone-2,6-disulfonate(AH_(2)QDS)on the kidneys of paraquat(PQ)poisoned rats via the apelin-APJ pathway.Methods:Male Sprague Dawley rats were divided into four experimental groups:control,PQ,PQ+sivelestat,and PQ+AH_(2)QDS.The PQ+sivelestat group served as the positive control group.The model of poisoning was established via intragastric treatment with a 20%PQ pesticide solution at 200 mg/kg.Two hours after poisoning,the PQ+sivelestat group was treated with sivelestat,while the PQ+AH_(2)QDS group was given AH_(2)QDS.Six rats were selected from each group on the first,third,and seventh days after poisoning and dissected after anesthesia.The PQ content of the kidneys was measured using the sodium disulfite method.Hematoxylin-eosin staining of renal tissues was performed to detect pathological changes.Apelin expression in the renal tissues was detected using immunofluorescence.Western blotting was used to detect the expression levels of the following proteins in the kidney tissues:IL-6,TNF-α,apelin-APJ(the apelin-angiotensin receptor),NF-κB p65,caspase-1,caspase-8,glucose-regulated protein 78(GRP78),and the C/EBP homologous protein(CHOP).In in vitro study,a PQ toxicity model was established using human tubular epithelial cells treated with standard PQ.Twenty-four hours after poisoning,sivelestat and AH_(2)QDS were administered.The levels of oxidative stress in human renal tubular epithelial cells were assessed using a reactive oxygen species fluorescence probe.Results:The PQ content in the kidney tissues of the PQ group was higher than that of the PQ+AH_(2)QDS group.Hematoxylin-eosin staining showed extensive hemorrhage and congestion in the renal parenchyma of the PQ group.Vacuolar degeneration of the renal tubule epithelial cells,deposition of crescent-like red staining material in renal follicles,infiltration by a few inflammatory cells,and a small number of cast formation were also observed.However,these pathological changes were less severe in the PQ+sivelestat group and the PQ+AH_(2)QDS group(P<0.05).On the third day after poisoning,immunofluorescence assay showed that the level of apelin in the renal tissues was significantly higher in the PQ+AH_(2)QDS group than in the PQ group.Western blotting analysis results showed that IL-6,TNF-α,NF-κB p65,caspase-1,caspase-8,GRP78,and CHOP protein levels in the PQ group were higher than in the PQ+AH_(2)QDS group(P<0.05).The expression of apelin-APJ proteins in the PQ+AH_(2)QDS group was higher than in the PQ+sivelestat and PQ groups(P<0.05);this difference was significant on Day 3 and Day 7.The level of oxidative stress in the renal tubular epithelial cells of the PQ+AH_(2)QDS group and the PQ+sivelestat group was significantly lower than in the PQ group(P<0.05).Conclusions:This study confirms that AH_(2)QDS has a protective effect on PQ-poisoned kidneys and its positive effect is superior to that of sivelestat.The mechanism of the protective effects of AH_(2)QDS may be linked to reduction in cellular oxidative stress,PQ content of renal tissue,inflammatory injury,endoplasmic reticulum stress,and apoptosis.AH_(2)QDS may play a role in the treatment of PQ poisoning by upregulating the expression of the apelin-APJ.

Edaravone attenuates paraquat-induced lung injury by inhibiting oxidative stress in human type Ⅱalveolar epithelial cells

BACKGROUND:Edaravone(3-methyl-1-penyl-2-pyrazolin-5-one) is a potent free-radical scavenger and has the antioxidant ability to inhibit lipid peroxidation.The study aimed to examine the effect of edaravone on protecting the acute injury of human type II alveolar epithelial cells(A549cells) induced by paraquat(PQ) and the change of production of reactive oxygen species(ROS),malondialdehyde(MDA),superoxide dismutase(SOD).METHODS:A549 cells were cultured and divided into PQ group(group P),edaravone-treated group(group E) and normal control group(group C).The cells in group P were exposed to paraquat(600 umol/L),and the cells in group E were treated with edaravone(100 umol/L) additionally,and no drug intervention was given to the cells in group C.Real-time monitoring by LSCM was used to detect the cell response and the intracellular dynamic change of ROS level in A549 cells after administration of PQ and edaravone.And the levels of SOD and MDA were detected respectively by biochemistry colorimetry.Data were expressed as mean ± standard error of the mean.Statistical analysis was carried out with the soft SPSS 16.0.RESULTS:The concentration of intracellular ROS significantly increased when PQ was given to A549 cells.But after administration of edaravone,the concentration of intracellular ROS was decreased.Compared to the PQ group,the levels of SOD in the edaravone group were significantly increased while the levels of MDA were markedly decreased.CONCLUSIONS:Paraquat can increase the oxidative stress,and induce the lipid peroxidation of A549 cells.Edaravone has the effect to scavenge reactive oxygen species,and to protect against the PQ-induced lung toxicity.

口服敌草快和百草枯中毒患者靶器官损害情况分析

目的 分析敌草快和百草枯中毒患者的靶器官损害特点,为进一步提高临床救治水平提供科学依据。方法 回顾性收集88例单纯经口服敌草快中毒患者(敌草快组)和80例百草枯中毒患者(百草枯组)的临床资料,包括年龄、性别、中毒剂量、中毒到入院时间、中毒催吐导泻情况、中毒到洗胃时间、临床表现、中毒到第一次血液灌流时间、血液灌流次数、住院天数、肝肾功能[丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、肌酐(Cr)]、凝血功能[凝血酶原时间(PT)]、白细胞计数(WBC)、肺损伤指标[氧合指数(PO2/FiO2)]、心肌损伤指标[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)]、血乳酸(Lac)、pH值及最终预后等指标。比较敌草快组和百草枯组患者的临床资料差异及不同中毒剂量死亡率与存活率及总体存活率;比较敌草快组和百草枯组死亡患者靶器官功能受损情况;比较死亡患者与存活患者敌草快和和百草枯的中毒剂量。结果 敌草快组年龄最大73岁,最小15岁;百草枯组年龄最大59岁,最小14岁;敌草快组男性34例(38.64%),女性54例(61.36%);百草枯组男37例(46.25%),女43例(53.75%);两组中毒后均以咽喉部疼痛、恶心、呕吐、上腹疼痛为主要临床表现,少部分中毒剂量少的患者可没有任何症状;百草枯组中毒剂量>50 ml的患者出现胸闷气促症状,敌草快组中毒剂量>50 ml的患者出现意识烦躁、嗜睡、谵妄甚至抽搐、昏迷等症状。两组性别、平均年龄、平均中毒剂量、平均中毒到入院时间、中毒催吐导泻率、平均中毒到洗胃时间、平均中毒到第一次血液灌流时间、平均血液灌流次数比较无明显差异(P>0.05);敌草快组的平均住院天数(4.86±1.81)d明显短于百草枯组的(7.85±1.13)d(P<0.05)。中毒剂量21~50 ml和51~100 ml时,敌草快组存活率均高于百草枯组(P<0.05);敌草快组总体存活率78.41%明显高于百草枯组的37.50%(P<0.05)。入院后第3天,敌草快组死亡患者ALT(109.26±63.88)U/L、TBIL(40.29±10.39)μmol/L、PT(12.24±1.56)s、Lac(1.54±1.09)mmol/L及WBC(13.24±3.43)×109/L均低于百草枯组死亡患者的(327.12±127.86)U/L、(68.38±48.55)μmol/L、(17.39±2.73)s、(4.53±1.54)mmol/L、(23.32±4.56)×109/L,Cr(308.44±156.87)μmol/L、PO2/FiO2(207.32±76.10)mm Hg(1 mm Hg=0.133 kPa)、CK(456.56±101.39)U/L、CK-MB(63.29±21.39)U/L、cTnI(11.56±1.31)ng/ml均高于百草枯组死亡患者的(201.93±87.01)μmol/L、(153.25±64.25)mm Hg、(50.29±21.39)U/L、(47.21±12.22)U/L、(4.29±4.21)ng/ml(P<0.05)。死亡患者敌草快和百草枯中毒剂量均明显高于存活患者(P<0.05);死亡患者敌草快中毒剂量大于百草枯(P<0.05);存活患者敌草快和百草枯中毒剂量无明显差异(P>0.05)。结论 敌草快和百草枯中毒患者的年龄以40岁以下中青年女性多见,所有口服中毒患者均出现咽痛、恶心、呕吐等消化道症状;敌草快口服中毒剂量大者会出现意识改变,包括烦躁、嗜睡、抽搐、昏迷等,而百草枯中毒剂量大者会出现胸闷气促等症状;服用同等剂量除草剂,敌草快存活率高于百草枯;敌草快以肾、心肌及神经系统损伤最为显著,且与患者预后密切相关;百草枯中毒以肺、肝和肾脏损伤为主;敌草快中毒患者总体死亡率低于百草枯中毒死亡率。

敌草快混合百草枯中毒的急救与护理

目的分析敌草快混合百草枯中毒患者的急救方案与护理措施,为今后临床工作提供参考.方法采用回顾性研究方法,选择2019年1月1日至2023年12月31日温州医科大学附属第一医院急诊科收治的53例敌草快混合百草枯中毒患者作为研究对象.将患者按预后分为生存组和死亡组,收集临床资料,比较不同预后两组患者器官功能受损情况,以及使用血液灌流(HP)比例、使用灌流器平均数、血液净化比例、平均血液净化时间和HP串联连续性肾脏替代治疗(CRRT)比例的差异.结果53例敌草快混合百草枯中毒患者中男性27例(50.94%),女性26例(49.06%);年龄14~86岁,平均(38.13±19.68)岁.52例为自行口服中毒,1例为误服.检测出的敌草快血药浓度57.38~119762.00μg/L,百草枯血药浓度60.12~71244.89μg/L.40例患者出现了不同程度的多器官功能障碍综合征(MODS),其中38例最终进展为多器官衰竭,以消化道、肾脏、肝脏等靶器官损伤为主;经积极救治和护理后,13例(24.53%)患者两种药物血药浓度均下降至<50μg/L,最终好转出院,住院4~34 d;32例患者家属放弃治疗自动出院,随访后确认死亡,住院1~4 d;8例患者院内死亡,住院1~3 d,共死亡40例(75.47%).与生存组比较,死亡组患者神经系统、肾脏、呼吸系统、肝脏损伤率均明显升高[神经系统:90.00%(36/40)比15.38%(2/13),肾脏:95.00%(38/40)比69.23%(9/13),呼吸系统:97.50%(39/40)比30.77%(4/13),肝脏损伤:85.00%(34/40)比46.15%(6/13),均P<0.05];与生存组比较,死亡组使用灌流器平均数、平均血液净化时间均明显降低[使用灌流器平均数(个):4.35±2.42比6.62±1.17,平均血液净化时间(d):1.53±1.09比5.23±3.90,均P<0.05].结论敌草快混合百草枯中毒病情凶险,病死率高,实施系统性治疗的同时给予个体化、动态化护理支持,密切观察受累器官系统的表现与检验指标,优化死亡高峰期流程,以期降低敌草快混合百草枯患者病死率.

青少年百草枯中毒后肺移植1例并文献复习

目的总结百草枯中毒患者中毒后移植时机以及相关处理措施对预后的影响。方法回顾性分析1例百草枯中毒行双肺移植术治疗患者的临床资料,总结分析该例患者的临床表现、辅助检查以及诊治经过。结果1例17岁青少年在摄入25%百草枯20~30 mL后出现恶心、呕吐、咳嗽伴全身乏力入院。患者经对症支持治疗后,氧饱和情况无改善,肺部纤维化持续进展,遂在体外膜肺氧合(ECMO)辅助下行序贯双侧肺移植。经术后康复治疗,并积极防治并发症,患者于术后50 d出院。结论百草枯中毒后的移植时机可选择在肝肾功能开始恢复时,围手术期主动、有针对性地预防潜在致病性细菌感染,以及早期康复训练有助于改善肺移植受者的预后。

基于机器学习决策树模型对急性百草枯中毒患者预后的预测价值

目的探讨基于机器学习的决策树模型对急性百草枯(PQ)中毒(APP)患者预后的预测价值。方法采用回顾性研究方法。收集2012年5月至2021年8月沧州市中心医院急诊医学部救治的APP患者的临床数据,包括性别、年龄、服毒至洗胃的时间、血液灌流比例、血PQ浓度、生化指标[白细胞计数(WBC)丙氨酸转氨酶(ALT)血肌酐(SCr)血淀粉酶及血钾]以及血气指标[动脉血乳酸(Lac)、剩余碱和动脉血氧分压(PaO_(2))]。根据中毒后90d预后将患者分为生存组(56例)和死亡组(74例),比较不同预后两组患者临床指标的差异。通过多因素Logistic回归分析影响APP患者预后的危险因素,将危险因素作为变量构建含血PQ浓度及不含血PQ浓度的两种决策树模型。绘制受试者工作特征曲线(ROC曲线)评估决策树模型对APP患者预后的预测价值,通过Hanley&McNeil法对两种决策树模型的ROC曲线下面积(AUC)进行比较。结果患者90d的生存率为43.1%(56/130)。与死亡组比较,生存组WBC[×10^(9)/L:8.9(7.0,11.6)比17.4(11.9,23.1)]、ALT[U/L:25.3(21.2,31.8)比29.3(23.2,40.3)]、SCr[μmol/L:64.0(53.0,74.0)比91.0(72.5,141.5)]、Lac[mmol/L:2.5(1.4,4.0)比7.1(3.7,11.0)]和血PQ浓度[ng/L:0.3(0.10.9)比2.9(1.9,8.1)]均较低,差异均有统计学意义(均P<0.05),剩余碱[mmol/L:-2.5(-4.2,-1.1)比-7.2(-10.9,-4.7)]和血钾[mmol/L:3.7(3.5,4.0)比3.2(2.83.7)]均较高,差异均有统计学意义(均P<0.05),患者更年轻[岁:33.5(26.0,47.8)比42.5(26.0,58.0),P<0.05]。单因素Logistic回归分析结显示,年龄、WBC、ALT、SCr、血钾、Lac、剩余碱和血PQ浓度是影响APP患者90d预后的独立危险因素[优势比(0R)和95%可信区间(95%CI)分别为1.03(1.01~1.05)1.30(1.18~1.44)1.04(1.01~1.07)、1.02(1.01~1.04)、7.59(3.25~17.70)、1.64(1.35~1.99)、1.51(1.29~1.76)、7.00(3.41~14.37),P值分别为0.018、<0.001、0.011、<0.001、<0.001、<0.001、<0.001、<0.001]。含血PQ浓度的多因素Logistic回归分析结果显示,WBC、血钾和血PQ浓度是影响患者90d生存的独立危险因素[OR和95%CI分别为1.17(1.03~1.33)、7.29(1.66~32.01)、5.49(2.48~12.13),P值分别为0.014、0.008、<0.001]。不含血PQ浓度的多因素Logistic回归分析显示,年龄、WBC、血钾和剩余碱是影响患者90d生存的独立危险因素[OR和95%CI分别为1.05(1.01~1.08)、1.20(1.07~1.34)3.12(1.01~9.66)1.41(1.16~1.72),P值分别为0.008、0.002、0.049、0.001]。基于血PQ浓度和血钾决策树模型的AUC为0.94,95%CI为0.89~0.98,敏感度为91.9%,特异度为89.3%,准确率为90.0%。基于WBC、剩余碱和年龄决策树模型的AUC为0.89,95%CI为0.84~0.95,敏感度为86.5%,特异度为91.1%,准确率为88.5%。Hanley&McNeil法比较显示,两种决策树模型的AUC差异无统计学意义(Z=1.34,P=0.180)。结论基于机器学习的决策树模型可为临床早期评估APP患者的预后提供定量、直观的预测工具。

血必净注射液联合乙酰半胱氨酸对急性百草枯中毒肝肾损伤的作用

目的探讨血必净注射液联合乙酰半胱氨酸(acetylcysteine,AC)对急性百草枯中毒(acute paraquat poisoning,APP)肝肾损伤的作用。方法回顾性分析救治的80例APP患者的临床资料,按治疗方式不同分为AC组(n=39,常规治疗联合AC)、联合组(n=41,在AC组治疗的基础上加用血必净注射液)。比较2组治疗前、治疗2周后呼吸指标[动脉血氧分压(PaO_(2))、氧合指数]、炎症因子水平[白细胞介素-6(interleukin-6,IL-6)、转化生长因子β_(1)(transforming growth factor-β_(1),TGF-β_(1))]和肝肾功能指标[丙氨酸氨基转移酶(glutamic pyruvic transaminase,GPT)、天冬氨酸氨基转移酶(glutamic oxaloacetic transaminase,GOT)、血肌酐(serum creatinine,Scr)和肾小球滤过率(estimated glomerular filtration rate,eGFR)],并观察预后。结果治疗后,2组PaO_(2)、氧合指数和eGFR均较治疗前明显升高(P<0.05),且联合组均明显高于AC组(P<0.05);治疗后,2组血清IL-6、TGF-β_(1)水平和GPT、GOT、Scr均较治疗前明显降低(P<0.05),且联合组均明显低于AC组(P<0.05);联合组1个月内脏器功能衰竭发生率(32.56%vs.56.41%)、病死率(60.98%vs.82.05%)均明显低于AC组(P<0.05)。结论血必净注射液联合AC治疗APP,可明显减轻肝肾损伤,有效抑制炎症反应,显著提高患者的存活率。

急性百草枯中毒患者成功救治的循证实践

目的应用循证医学理念治疗百草枯中毒患者,探讨百草枯中毒的诊治方案及护理措施。方法选择2022年2月4日河北省衡水市第四人民医院急诊科收治的1例百草枯中毒患者作为研究对象。通过循证实践策略,检索国内外有关百草枯中毒患者救治的相关文献,查找临床证据,制定并实施诊治方案,观察患者预后。结果患者女性,54岁,主因空腹口服百草枯农药约100mL中毒后1.5h就诊于当地医院,紧急行洗胃、补液促排泄等处理,服毒后4h为进一步诊治入住本院。入院后在循证实践支持下进行治疗及护理,最终患者成功治愈出院。结论在百草枯中毒患者的治疗护理过程中,采取早期识别、早期快速减少毒物吸收、早期促进毒物排泄、早期实施器官功能支持与保护、严密监护,能遏制百草枯中毒患者病情进展,提高救治成功率。

百草枯中毒患者外周血对氧磷酯酶1、程序性死亡因子-1、γ干扰素诱导蛋白-10水平检测的意义

目的探讨百草枯中毒患者外周血对氧磷酯酶1(PON1)、程序性死亡因子-1(PD-1)、γ干扰素诱导蛋白-10(IP-10)水平对预后的价值。方法对2017年5月—2023年4月中国人民解放军联勤保障部队第九八〇医院120例百草枯中毒患者进行前瞻性研究,统计百草枯中毒患者30 d内死亡与生存情况,比较不同预后患者临床资料及外周血PON1、PD-1、IP-10水平。采用Pearson相关性分析探讨外周血PON1、PD-1、IP-10水平与中毒剂量、序贯器官衰竭估计(SOFA)评分、急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)评分的相关性;采用受试者工作特征(ROC)曲线评价外周血PON1、PD-1、IP-10水平预测百草枯中毒患者预后的价值。结果随访期间共35例患者死亡(29.17%)。死亡患者中毒剂量、SOFA评分、APACHEⅡ评分及外周血IP-10、PD-1水平均高于生存患者,外周血PON1水平低于生存患者,差异有统计学意义(P<0.05)。相关性分析显示,百草枯中毒患者外周血PON1水平与中毒剂量、APACHEⅡ评分及SOFA评分均呈负相关,PD-1、IP-10水平与中毒剂量、APACHEⅡ评分及SOFA评分均呈正相关(P<0.05);PON1、PD-1、IP-10预测百草枯中毒的曲线下面积(AUC)分别为0.738、0.774、0.770,三者联合预测的AUC为0.922,三者联合预测效能高于各指标单独预测。结论百草枯中毒患者外周血PON1、PD-1、IP-10联合检测对判断患者预后具有较高价值。

早期多次血液灌流与血液透析对百草枯中毒病人的血气分析和预后效果分析

目的探讨早期多次血液灌流联合血液透析对百草枯中毒患者的治疗效果。方法回顾性分析我院2021年2月至2023年1月治疗的124例百草枯中毒患者资料,其中50例接受常规治疗与早期多次血液灌流作为对照组,74例在对照组治疗基础上加用血液透析作为观察组。比较两组患者临床疗效、肝肾功能、血气指标变化及90天生存情况。结果与对照组相比,观察组临床疗效明显增强,总有效率分别为93.24%和76.00%(P<0.05);肝功能指标AST、ALT和ALP较对照组显著降低(P<0.05);肾功能指标BUN和Cr较对照组显著降低(P<0.05);PaO_(2)、PaO_(2)/FiO_(2)较对照组显著升高,PaCO_(2)较对照组显著降低(P<0.05);90天生存率显著升高,死亡率分别为25.68%和66.00%(P<0.001)。结论早期多次血液灌流联合血液透析可显著提高百草枯中毒患者临床疗效、改善肝肾功能和血气指标,并提高患者短期生存率。

血必净注射液治疗急性百草枯中毒的实验

目的探讨血必净注射液对急性百草枯大鼠中毒脏器损害的治疗保护机制。方法成年Wistar大鼠随机分为百草枯250 mg/kg剂量染毒对照组、百草枯250 mg/kg剂量染毒+血必静注射液高剂量治疗组(1.72 g生药/kg)、百草枯250 mg/kg剂量染毒+血必静注射液低剂量治疗组(0.86 g生药/kg)3组。取原液加蒸馏水稀释至1 ml灌胃染毒。治疗组于染毒后1 h经鼠尾静脉给予相应剂量的血必静注射液缓慢注射,观察染毒组和治疗组动物表现。染毒8 h后处死动物,留取动静脉血及大鼠肺组织,行动脉血气分析、丙氨酸转氨酶(ALT)、碱性磷酸酶(AKP)、尿素氮(BUN)、肌酐(Cr)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6I、L-10I、L-1β、血小板衍生生长因子(PDGF)和胰岛素样生长因子-1(IGF-1)测定,同时行常规病理观察。结果血必净注射液治疗组大鼠动脉血气指标PaO2、PaCO2、pH值明显好于非治疗染毒组,差异有统计学意义(P<0.05或0.01)。治疗组肝肾损害减轻,表现为ALT升高幅度较小,差异有统计学意义(P<0.05),血肌酐变化治疗组明显小于非治疗组,差异有统计学意义(P<0.05)。细胞因子TNF-αI、L-6血必净治疗组与染毒组比较,差异无统计学意义(P>0.05),而IL-10I、L-1β、PDGF和IGF-1高剂量血必净治疗组均明显小于染毒组,差异有统计学意义(P<0.05),PDGF低剂量治疗组也明显小于染毒组,差异有统计学意义(P<0.05)。病理检查示百草枯染毒8 h后肺泡毛细血管的扩张充血,内皮细胞肿胀,出现大量以中性白细胞为主的炎性细胞浸润,肺泡腔内充血,有蛋白水肿液的渗出。血必净治疗组上述改变明显较轻。结论血必净注射液可抑制部分炎性因子的活力。对百草枯中毒脏器损害有治疗保护作用。

早期大剂量甲泼尼龙联合环孢素A冲击治疗对口服百草枯中毒患者预后的影响

目的观察早期大剂量甲泼尼龙联合环孢素A冲击治疗对口服百草枯(PQ)中毒患者病死率、肺纤维化发生率的影响。方法38例口服PQ中毒患者除常规给予洗胃、血液灌流等治疗外,早期给予大剂量糖皮质激素联合免疫抑制剂(环孢素A)冲击治疗。定期监测动脉血气分析、胸部CT、肝肾功能等指标。分析口服PQ中毒患者的病死率、肺纤维化的发生率。结果38例PQ中毒患者中死亡13例,病死率为34.2%,其中12例患者在服毒后1周内死于多器官功能衰竭,另1例死于肺纤维化。25例存活者中,有18例在住院期间发生不同程度的氧合下降,其中17例胸部CT提示肺部间质性改变,13例出现两个以上脏器(肺、肝、肾)功能损伤。25例存活患者出院后随访1个月未诉特殊不适。结论早期大剂量甲泼尼龙联合环孢素A冲击治疗可改善PQ中毒患者的预后,但进一步明确此方法的疗效需开展大样本的随机、双盲对照研究。

内皮素与急性百草枯农药中毒后多器官功能障碍综合征的相关性研究

目的探讨内皮素(ET)与急性百草枯中毒(APP)后多器官功能障碍综合征(MODS)的关系及临床价值。方法应用放射免疫技术测定24例APP伴MODS患者与19名健康人血浆ET水平,分析APP后MODS患者血浆ET水平和急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、动脉血氧分压(PaO2)、心肌肌钙蛋白I(cTnI)、血清酶学、血生化等指标的关系。结果APP伴MODS患者血浆ET水平较正常对照组明显升高(P<0.01),而死亡组血浆ET水平明显高于存活组(P<0.01)。血浆ET含量与APACHEⅡ评分、cTnI、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血尿素氮(BUN)、血肌酐(SCr)呈正相关(P<0.05或P<0.01),与PaO2呈显著负相关(P<0.01)。结论ET参与了APP后MODS的发病过程,且与APACHEⅡ评分呈正相关;血浆ET含量水平可作为APP后MODS患者多器官功能损害程度的评估、指导治疗与预后判断的临床指标之一。

急性百草枯中毒后早期并发症的特点及其与预后的相关性分析

目的分析急性百草枯中毒患者早期并发症的特点并研究哪些并发症可影响中毒患者的预后。方法对南京军区南京总医院急救医学科2005-01～2011—12收治的87例百草枯急性中毒患者的资料进行回顾分析，在患者服毒一周内采集其病历资料，分析患者出现的各种并发症，并通过四格表∥检验分析中毒死亡组患者与中毒存活组患者之间并发症发生率的统计学差别。结果急性百草枯中毒患者早期的并发症发生率最多的依次为凝血功能障碍、呼吸系统功能损害、胰腺功能损害、肾功能损害、肝功能损害、肌肉损害以及胃肠道出血。而其中肝功能损害、凝血功能障碍、呼吸功能损害、胰腺功能损害、肌肉损害这5项并发症在中毒死亡组患者和中毒存活组患者比较差异有统计学意义（P〈0．05）。结论临床医师应对急性百草枯中毒患者的早期并发症予以关注，预防并治疗服毒患者的肝功能损害、凝血功能障碍、呼吸功能损害、胰腺功能损害、肌肉损害并发症可能对改善患者预后有帮助。