摘要
目的研究并分析百草枯中毒导致急性肺损伤的基本原理,并总结相关预防措施。方法对26例百草枯中毒致使急性肺损伤患者的基本临床资料、诊治过程进行回顾,总结其急性肺损伤发病机制,将其中接受一般治疗的18例患者设为对照组,另外采用血液净化、清除氧自由基以及免疫抑制剂等治疗方法的8例患者设为观察组。将两组的治疗效果进行比较。结果百草枯中毒致急性肺损伤以胃肠道不适、气胸、皮下气肿以及黑便为主要临床表现。入院当天至入院后第3天,患者的丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、血尿素氮(BUN)、血清肌酐(Scr)、动脉血氧分压(PaO2)、肌酸激酶-同工酶MB(CK-MB)、白细胞(WBC)均显著升高,PaO2与入院当日比较降低。出院当天除PaO2以外,所有生化指标项目检测数值均下降。观察组中毒病死率(22.2%)要低于对照组(75.0%),差异有统计学意义(P<0.05)。肺部影像学检查显示大部分患者存在肺间质病变、肺部毛玻璃样变,两种病变所占百分比要高于其他病变类型,渗出性病变所占百分比要高于纵隔病变和心包病变。结论炎性反应、基因表达异常和氧化损伤等是百草枯中毒导致急性肺损伤的基本原理,对患者进行催吐、灌肠和洗胃的同时,结合血液净化、清除氧自由基以及免疫抑制剂等多种治疗方法,有利于患者预后。
Objective To study and analyze the theory and preventive measures of acute lung injury caused by paraquat poison‐ing .Methods A total of 26 patients with acute lung injury caused by paraquat poisoning were selected .The basic clinical data ,diag‐nosis and treatment process were analyzed retrospectively .And the pathogenesis of acute lung injury was summarized .Eighteen pa‐tients were divided into control group ,which accepted the general treatment ,the other 8 cases which used the treatment of blood purification ,elimination of oxygen free radicals and immunosuppressant 8 patients were selected as observation group .The curative effects between the two groups were compared .Results The clinical features of the patients with acute lung injury caused by pa‐raquat poisoning were gastrointestinal complaints ,pneumothorax ,subcutaneous emphysema and melena .From the first day after hospitalization to the 3th day ,alanine aminotransferase （ALT） ,total bilirubin （TBIL） ,blood urea nitrogen （BUN） ,serum creati‐nine （Scr） ,creatine kinase‐MB （CK‐MB） and white blood cell （WBC） were increased .While arterial partial pressure of oxygen （PaO2 ） were obviously decreased .All the indexes had been decreased on the day of discharged from hospital except PaO 2 .The mor‐tality rate of observation group （22 .2% ） was significantly lower than that of the control group （75 .0% ） （P〈0 .05） .Lung imaging examination showed that most of the patients had interstitial lung disease and lung ground‐glass opacity ,both of the incidence were significantly higher than that of other pathological types （P〈0 .05） ,the percentage of these two lesion types were higher than other types .And the percentage of exudative lesion was higher than that of mediastinal lesion and cardiac disease .Conclusion Inflamma‐tion ,oxidative damage and abnormal gene expression are the theory of acute lung injury caused by paraquat poisoning .Vomiting ,en‐ema and gastric lavage combined with blood purification ,removal of oxygen free radicals and immunosuppressant treated on the pa‐tients will help to improve the prognosis of the patients .
出处
《检验医学与临床》
CAS
2016年第14期1958-1960,共3页
Laboratory Medicine and Clinic
关键词
百草枯中毒
急性肺损伤
原理
预防
paraquat poisoning
acute lung injury
theory
prevention
