急性百草枯中毒治疗的临床研究

目的 探讨甲泼尼龙联合环磷酰胺和重组人Ⅱ型肿瘤坏死因子受体一抗体融合蛋白(Etanercept,国产商品名益赛普)强化治疗法治疗急性百草枯中毒的临床疗效.方法 2005年11月至2007年11月经诊治的急性百草枯口服中毒患者136例,分为常规治疗组和强化治疗组.常规治疗组给予常规治疗,强化治疗组在常规治疗的基础上给予甲基强的松龙500 mg,静脉滴注,1次/d,连用3 d,然后改为200mg,静脉滴注,1次/d,根据病情14 d或21 d后逐渐减量至停药.环磷酰胺600 mg(首剂可酌增至800mg),静脉滴注,每周2次,连用2周,以后酌用.Etanercept25mg,皮下注射,每周2次,连用3周.分别于中毒后7、14、21 d和12周进行疗效评价.根据服毒量将患者分为3组:摄人20%原液或相当量<50 ml组、50-100 ml组、100 ml组,常规治疗组和强化治疗组均根据摄入毒物量分组比较.结果 中毒后7、14、21 d和12周强化治疗组不同服毒量患者其存活率均明显高于常规治疗组,差异有统计学意义(P<0.01).强化治疗组12周后治愈率分别为94.6%(<50 ml组)、75.0%(50-100 ml组)、12.5%(100ml组),而常规治疗组分别为16.7%、8.3%、0%,强化治疗组治愈率明显高于常规治疗组.12周后总体治愈率强化治疗组达到78-3%,明显高于常规治疗组(11.9%).差异均有统计学意义(P<0.01).百草枯中毒主要死亡原因为呼吸衰竭、多脏器功能障碍综合征(MODS)、急性肾衰竭、肝功能衰竭等,以上主要并发症强化治疗组明显低于常规治疗组.结论 采用甲泼尼龙联合环磷酰胺和Etanercept强化治疗急性百草枯中毒初步显示较好的疗效.

Clinical study on treatment of acute paraquat poisoning

Objective To investigate the clinical therapeutic effect of methylprednisolone combined with cyclophosphamide and Etanercept method on acute paraquat poisoning. Methods 136 patients with acute paraquat poisoning were divided into the normal therapy group and the intensive therapy group randomly.Methylprednisolone,cyelophosphamide and Etanercept were used in the intensive therapy group. Methylprednisolone 500 mg was given intravenously per day for continuous three clays followed by 200 mg intravenous per day. Then methylprednisolone was decreased gradually 14 d or 21 d later according to the patient's condition.Cyclophospharnide 600 mg was given intravenously twice weekly for 2 weeks and Etanercept 25 mg was given hypodermic injection twice weekly for 3 weeks. Curative effect evaluation was done at 7,14,21 d and 12 weeks after therapy. Results The survival rate of the intensive therapy group was obviously higher than that of the normal therapy group (P<0.01) on 7,4,21 d and 12 weeks. The cure rate of the intensive group were 94.6% (intake dose<50 ml 20% paraquat solution),75.0%(intake dose 50～100 ml 20% paraquat solution),12.5%(intake dose100 ml 20% paraquat solution) respectively, while the cure rate of the normal group were 16.7% (intake dose<50 ml 20% paraquat solution), 8.3% (intake dose 50～100 ml 20% paraquat solution),0% (intake dose100 ml 20% paraquat solution) respectively. The total cure rate of the intensive therapy group (78.3%) 12 weeks later was higher than that of the normal group (11.9%). Conclusion Methylprednisolone combined with cyclophosphamide and Etanercept intensive therapy has the curative effect on acute paraquat poisoning.