血液净化联合免疫抑制治疗百草枯中毒疗效观察与评价

目的分析百草枯中毒临床特点、进一步探讨其临床有效治疗方法。方法对宣城市人民医院重症医学科自2010年9月～2013年6月收治的28例口服百草枯中毒采取血液净化（血液灌流＋持续血液滤过）＋甲泼尼松龙方案救治结果进行分析。结果28例患者口服百草枯中毒患者治疗后死亡20例，存活8例，病死率达71．4％；其中存活病例服药量原液均在20mL以内。死亡组入院48h内白细胞计数总胆红素、AST、CR、C反应蛋白均显著升高，与存活组比较差异有统计学意义（P均〈0．05）；中性细胞百分比率、BUN、ALT、DBIL死亡组与存活着比较差异无统计学意义（P均〉0．05）。百草枯可致多器官损伤、衰竭，不可逆性肺损伤导致呼吸衰竭是百草枯致死主要原因。结论这一治疗方案疗对百草枯中毒治疗效果较差，对服用较大剂量（约原液20mL以上）病例，仅可延缓病情进展，并不能改变患者死亡的预后。

Observation and evaluation of curative effect of blood purification combined with immunosuppressive therapy in the treatment of paraquat poisoning

Objective To analyze the clinical characteristics of paraquat poisoning, and further explore it＇ s clinical effective treatment methods. Methods The treatment results of blood purification（hemoperfnsion combined with continuous hemofiltration） combined with methylprednisolone for 28 cases with oral paraquat poisoning in the intensive care unit of the people＇s hospital of Xuancheng from September 2010 to June 2013 were analyzed. Results 20 cases of 28 cases with oral paraquat poisoning died after the treatment,8 cases survived, the mortality rate was 71.4%.The dose of solution in survival cases were all within 20mL.The count of WBC, DBIL, AST, CR, CRP were significantly increased in death group within 48 hours,and compared with the survival group,the diffe-rence was significant （P 〈 0.05）;The differences were not significant in the neutronphil percentage,BUN, ALT,DBIL between the death and survival group（P ~ 0.05）. Paraquat could cause multiple organ injury or failure,but respiratory failure caused by irreversible pulmonary injury played an important role in paraquat leading to death. Conclusion The curative effect of treatment method on paraquat poisoning is poorer,it can only delay the progress of the disease for the cases taken above a certain dose solution（about 20mL solntion）,but can not change the prognosis of patient＇s death.