百草枯中毒32例临床分析

目的探讨百草枯中毒的治疗经验和影响预后的因素。方法对32例百草枯中毒患者临床资料进行回顾性分析。结果经综合抢救后死亡20例,病死率为62.5%;存活12例,存活率37.5%。结论影响百草枯中毒患者预后的关键因素是中毒剂量、就诊时间及早灌流和透析。     

百草枯中毒32例的临床抢救体会

目的探讨百草枯中毒的治疗方法及临床疗效。方法采用早期清除毒物、血液灌流、血液透析和保护重要脏器等综合疗法抢救百草枯中毒患者32例。结果与结论好转5例,存活率为15.63%;死亡21例,死亡率为65.63%;6例因经济问题放弃治疗。百草枯中毒后主要导致肺、肝、肾等重要脏器损害,其中以肺组织损伤为主。目前尚无特效解毒剂,治疗困难,病死率高。综合疗法可挽救部分轻症患者的生命。     

18例百草枯中毒患者的救治和护理

目的通过百草枯中毒患者的救治和护理,探讨基础的治疗和护理对其预后的影响。方法对18例百草枯中毒患者通过促进毒物排泄、加强基础护理减轻病痛、注重心理护理等,从而减少毒物吸收,减轻中毒症状,减少并发症发生,提高临床救治效果。结果治愈2例,好转5例,自动出院6例,死亡5例。结论积极救治和精心护理能提高存活率。     

50例急性百草枯中毒患者的急救护理

目的探讨急性百草枯中毒的救治与护理经验。方法回顾性分析50例急性百草枯中毒患者救治的临床资料。结果本组50例患者中,存活34例,存活率68%,死亡11例,病死率22%。结论急性百草枯中毒可损害多系统组织器官,及时有效的治疗和护理措施,可提高患者的生存率。     

急性百草枯中毒35例救治体会

目的：探讨急性百草枯中毒患者提高存活率的有效治疗方法。方法：对35例急性百草枯中毒患者的临床资料进行回顾性分析。结果：23例患者在院内因多脏器功能衰竭死亡,4例家属放弃治疗,后随访死亡,8例经强化综合治疗治愈,总病死率达77.1%。结论：急性百草枯中毒病死率极高,血液净化和应用大剂量激素的冲击早期治疗,可以延长患者生存时间,显著阻滞肺纤维化的发生,能提高患者的长期生存率,降低病死率。     

百草枯中毒急救护理与预后分析

【摘要】目的总结百草枯中毒患者的抢救护理措施,提高百草枯中毒的抢救存活率。方法对21例百草枯中毒患者的临床表现、抢救护理措施的环节进行详细分析。结果8例治愈出院,3例出院后留有后遗症,救治成功率为52．4％,随访8例均恢复正常生活。死亡10例,病死率47．6％。结论百草枯中毒患者的病死率较高,抢救、护理措施及时、得当,能够降低百草枯中毒患者的病死率。     

血液灌流联合甲基泼尼松龙治疗百草枯中毒的疗效分析

目的探讨血液灌流联合甲基泼尼松龙治疗百草枯中毒的疗效。方法对我院2005年1月～2010年12月收治的36例百草枯中毒患者治疗资料进行回顾性分析。36例患者分为血液灌流(HP)组11例,血液灌流联合甲基泼尼松龙联合治疗组25例。所有患者来时均给予常规洗胃、药用炭吸收、补液、20%的甘露醇导泻、血液灌流治疗。结果联合治疗组的存活率明显高于血液灌流组,而且疗程短,并发症少。结论血液灌流联合甲基泼尼松龙治疗可明显提高百草枯中毒患者生存率,降低死亡率。     

50例百草枯中毒临床分析

目的:总结50例百草枯中毒的临床表现及救治。方法:对近5年中所收治的百草枯中毒作回顾性分析。结果:本组百草枯中毒存活率为56%。结论:百草枯中毒易引起多脏器损害,救治中应尽早采取得力的综合措施。     

分析34例百草枯中毒患者的综合治疗和护理体会

通过分析百草枯中毒患者的综合治疗和护理体会,提高患者存活率。回顾并分析我院34例百草枯患者的综合治疗措施与护理措施。通过洗胃、导泻等综合措施和心理护理、皮肤护理、口腔护理、消化道护理等护理措施,能大大提升患者的存活率。     

血必净和环磷酰胺治疗百草枯中毒疗效比较研究

目的：观察比较血必净和环磷酰胺在抢救急性百草枯中毒中的临床疗效。方法选取急性百草枯中毒患者68例,随机分为甲、乙两组,在催吐、导泻以及透析等治疗基础上,分别给予甲组以血必净和乙组环磷酰胺治疗。观察记录两组患者存活率及并发症情况。结果甲组患者肝、肾损伤发生率显著低于乙组（χ2=12.1,10.0, P〈0.05）,但肺损伤发生率明显高于乙组（χ2=12.5, P〈0.05）;两组存活率比较差异无统计学意义（χ2=0.06, P〉0.05）。结论血必净和环磷酰胺均可减轻百草枯中毒患者的脏器损害,提高存活率。     

Intravenous paraquat poisoning-induced multiple organ failure and fatality--a report of two cases

Paraquat poisoning is the most common cause of fatal herbicide intoxication, mostly through oral ingestion. This work reports two cases of death following intravenous paraquat injection. The clinical courses of the two cases were fulminated and fatal. Toxic symptoms and severe organ function impairment developed soon after paraquat injection. Timely treatment with activated charcoal hemoperfusion with pulse steroid and cyclophosphamide was attempted in both cases; however, both cases died within five days owing to multiple organ failure. In cases of intravenous paraquat intoxication, toxic signs develop more quicker than with oral ingestion. The prognosis of intravenous paraquat intoxication is extremely poor.     

Protective effect of 3-methyl-1-phenyl-2-pyrazolin-5-one,a free radical scavenger,on acute toxicity of paraquat in mice

Paraquat poisoning results in damages of multiple organs including liver, kidney and lung, and antioxidants have been proven to have protective effects. As a novel free radical scavenger, 3-methyl-1-phenyl-2-pyrazolin-5-one (MCI-186), was introduced to clinical use recently, its protective effect was studied on acute toxicity of paraquat in male ddY mice. When paraquat (175 mg/kg) were given orally, the survival rate was only 8% on the 6th day of paraquat ingestion in Control Group mice. Protective effect of MCI-186 was most evident and the survival rate was 42% on the 6th day and 38% on the 14th day of paraquat ingestion, respectively, when mice were treated immediately. A delay of 30 min in treatment resulted in an abrupt reduction of the survival rate. These results suggested that MCI-186 used in acute phase of paraquat intoxication might serve as a clinically available antidote for attenuating paraquat toxicity.     

百草枯肺损伤MSCT征象与中毒机制的对照研究

目的 探讨百草枯中毒肺MSCT(多层计算机X线断层扫描)征象及其中毒机制.方法 对百草枯中毒患者的不同时期分别行胸部MSCT检查,并对30例胸部MSCT影像征象及其中毒机制进行回顾性分析.结果 30例病例均出现了肺纹理增多、磨玻璃征,部分出现肺实变、胸水和气肿,存活到晚期者均见到肺纤维化.结论 百草枯中毒在肺部有明确的影像学征象,其中毒机制与影像学表现密切相关,MSCT征象与中毒机制的对照研究对临床治疗有不可或缺的指导意义.     

47例自服百草枯中毒患儿病例分析

目的:通过分析47 例儿童自服百草枯中毒病例的特征、治疗情况及预后,为防治儿童百草枯中毒措施的制定提供参考。 方法:回顾性分析某三甲儿童医院自2012年1月至2017年1月自服百草枯中毒患儿的临床资料,分析其人口学特征、临床特征、影响预后的因素以及随访生存情况。结果:自服患儿男29例,女18例,年龄(12.3±1.7)岁。所有患儿均来自农业种植地区,留守儿童占比42.6%(20/47)。百草枯均为浓度20%的水剂,服药量10(5,20)mL。34例患儿出现肺、肾、肝、心等两个以上器官损害。服药7 d后26例患者出现呼吸困难。病死率48.9%(23/47),死亡时间分布在中毒后30 d内,早期病死率高。将病例资料分为存活组、死亡组,与死亡组相比,存活组患儿服药量少、就医时间短(P<0.01)。结论:儿童自服百草枯以青少年为主,具有服药量大、致死率高的特点。急性百草枯中毒缺乏特效解毒药物,应采取综合治疗措施,中毒后早期的医疗干预尤为重要。     

Toxicokinetics of paraquat in humans

1. The toxicokinetics of paraquat were studied in 18 cases of acute human poisoning using a specific radioimmunoassay. Plasma paraquat concentration exhibited a mean distribution half-life (t1/2 alpha) of 5 h and a mean elimination half-life (t1/2 beta) of 84 h. Cardiovascular collapse supervened early during the course of the intoxication and was associated with the distribution phase. Death related to pulmonary fibrosis occurred late and was associated with the elimination phase. 2. Pharmacokinetic analysis of urine paraquat excretion confirmed the biphasic decline of paraquat. Moreover, renal paraquat and creatinine clearances were not correlated but renal paraquat clearance was never higher than the renal creatinine clearance. 3. Tissue paraquat distribution was ubiquitous with an apparent volume of distribution ranging from 1.2 to 1.6 l/kg. Muscle could represent an important reservoir explaining the long persistence of paraquat in plasma and urine for several weeks or months after poisoning.     

High-dose cyclophosphamide and dexamethasone in paraquat poisoning: a prospective study.

Between March 1986 and March 1988, 47 consecutive patients, whose paraquat intoxication was confirmed by urine testing, were enrolled in a prospective study on the treatment of paraquat poisoning. Fourteen received a standard treatment regimen consisting of fluid replacement and oral absorbents, and 33 received high-dose cyclophosphamide and dexamethasone, in addition to standard therapy. The case fatality rate in both treatment groups (63 and 61%) was similar. In addition, all 26 patients whose paraquat serum concentrations were measured and who had a probability of survival of less than 65% according the survival curve of Hart et al. died, regardless of therapy. These included four in the cyclophosphamide/dexamethasone group and two in the standard treatment group who had prior survival probabilities between 50 and 65%. This indicated that the cut-off curve relating mortality and paraquat serum concentrations was similar in both treatment groups. High-dose cyclophosphamide/dexamethasone treatment is unlikely to improve the prognosis of paraquat poisoning.     

Paraquat poisoning in man

In three cases of intoxication by Gramoxone^®, the concentration of paraquat dichloride in blood, dialysate, feces, and urine was determined spectrophotometrically after a clean-up of the biological material by means of ion exchange chromatography (with Dowex 50W-X12 or Zeo-Karb 225).Although good results were obtained after clean-up with Dowex 50W-X12, Zeo-Karb was preferred as ion exchange resin, especially when large sample volumes were needed for the determination.The reported findings indicate that: only 5 to 10% of an ingested dose of paraquat dichloride is absorbed in man, Fullers' earth is very useful, and that primary, e.g. immediate, hemodialysis is necessary.     

急性百草枯中毒预后影响因素的临床分析

目的分析影响百草枯中毒病人预后的因素,研究改善患者预后的临床诊治方案。方法随机选取该院2010年11月1日至2012年1月31日期间急性百草枯中毒病例共49例,进行前瞻性观察研究,根据百草枯中毒严重程度指数(severity indexof paraquat poisoning,SIPP)高低分为低百草枯中毒严重程度指数组(A组)(≤20 h×mg.L-1)35例、高百草枯中毒严重程度指数组(B组)(20 h×mg.L-1)14例;按有无血液灌流分为血液灌流组26例、未行血液灌流组23例;根据患者病情转归分为存活组20例、死亡组29例。使用高压液相色谱法测定患者血清百草枯药物浓度,定期监测患者肝、肾功能、血气分析,并行肺部高分辨CT检查了解肺纤维化情况。分析百草枯血清药物浓度、脏器受损情况、肺纤维化、氧合指数等与患者预后的关系。结果 A、B两组比较,B组肺部纤维化范围大、脏器功能受损数目多,差异有统计学意义(分别P=0.022和P=0.01);B组氧合指数较低,差异有统计学意义(P=0.001)。存活组与死亡组比较,死亡组肺部纤维化范围较大、死亡组脏器功能受损数目多,差异有统计学意义(P0.05);死亡组氧合指数较低,差异有统计学意义(P0.05)。A、B两组比较,死亡率无统计学意义(P=0.081)。存活组与死亡组相比,服毒量、血清药物浓度、百草枯中毒严重程度指数差异均有统计学意义(P0.05)。血液灌流组与未行血液灌流组比较,存活率无统计学意义(χ2=0.882,P=0.348)。结论影响急性百草枯中毒患者预后的因素分别为服毒剂量、肺纤维化范围、氧合指数、脏器功能损害个数。提倡早期综合治疗,保护脏器功能,以提高中毒患者存活率。     

百草枯中毒60例抢救分析及预防对策

目的探讨百草枯中毒的抢救体会及预防对策。方法回顾性分析我院近年来收治的60例百草枯中毒患者的临床资料。结果 60例百草枯中毒患者,均有不同的消化道黏膜烧伤,经过综合抢救,存活7例,死亡53例,死亡率为88.33%。死亡者均出现呼吸窘迫综合征,其中,伴随中毒性心肌炎18例、急性肾功能衰竭15例、中毒性肝炎11例、消化道穿孔6例、皮下气肿3例。死亡时间为中毒后2～16d,平均9.4d。结论只有积极做好预防工作,在农村对百草枯毒性进行大量宣传,加强农民对此农药的使用管理,才能降低误服率;一旦发现中毒事件,应尽早实施全方位综合治疗,以尽可能降低病死率。     

Paraquat poisoning: a review.

The pathophysiology, symptoms and treatment of paraquat intoxication, primarily from oral ingestion, and the pharmacology and pharmacokinetics of paraquat are reviewed. Toxicity has occurred after topical application, oral ingestion or inhalation of paraquat. Systemic toxicity has not been reported from smoking of paraquat-contaminated marijuana but heavy abusers of contaminated marijuana may experience coughing, hemoptysis and mouth irritation. Following ingestion of 30 mg/kg or 50 ml of a 21% (w/w) solution of paraquat (as the base), hepatic, cardiac or renal failure or death may occur. Smaller doses (greater than or equal to 4 mg/kg of paraquat base) may cause respiratory distress, renal dysfunction or, occasionally, jaundice or adrenal cortical necrosis. When paraquat ingestion is suspected, the drug should be removed immediately from the gastrointestinal tract by gastric lavage or by whole-gut irrigation. Adsorbents such as Fuller's earth, bentonite or activated charcoal may be used during gastric lavage. Combined use of forced diuresis (with furosemide, mannitol and i.v. dextrose in water or normal saline), hemodialysis or hemoperfusion is recommended until the compound cannot be detected in body fluids or the dialysate. Immediate and effective treatment is necessary to prevent systemic toxicity or death from paraquat intoxication.