大黄治疗急性百草枯中毒的研究

目的探讨使用大黄治疗急性百草枯中毒的疗效。方法将114例急性百草枯中毒患者随机分为治疗组和对照组各57例，治疗组彻底洗胃、口服白陶土后，口服或鼻饲用大黄粉20g入80℃温水200mL浸泡20min液体，每2h1次，至大便检测不到百草枯成分停止，以后每日用大黄粉15g加温水浸泡后口服，保持大便2次／d，连用14d。对照组在彻底洗胃、口服白陶土后，给予甘露醇常规导泻，在大便检测不到百草枯成分停止用药。2组均给予常规血液灌流、激素治疗、抗自由基、免疫抑制剂及对症治疗。观察2组患者治疗6，12及24h大便百草枯成分转阴率及出现大便隐血率，及治疗24，72，168h肌钙蛋白I、血肌酐、谷丙转氨酶、谷草转氨酶、直接胆红素平均水平，观察治疗14d、90d时肺间质纤维及低氧血症发生率，统计治疗后90d病死率。结果治疗组第6，12，24h大便百草枯成分转阴率明显高于对照组（P均〈0．05），治疗组患者第6，12，24h大便隐血率，第24，72，168h肌钙蛋白I、血肌酐、谷丙转氨酶、谷草转氨酶、直接胆红素平均水平，第14，90天肺间质纤维化及低氧血症发生平均明显低于对照组（P均〈0．05）；2组病死率比较无显著性差异（P〉0．05）。结论使用中药大黄治疗急性百草枯中毒能更快排出消化道毒物，减少吸收，具有保护胃肠道黏膜的作用，能减少降低肺间质纤维化发生率，减轻肺、心脏、肝脏、肾脏功能损伤程度，有效降低肺间质纤维化的发生。

Study on rhubarb in the treatment of acute paraquat poisoning

Objective It is to approach the curative effect of rhubarb in the treatment of patients with acute paraquat poi- soning. Methods 114 cases of patients with acute paraquat poisoning were randomly divided into treatment group and control group and 57 cases in each. After treated with complete gastric lavage and oral kaolin, patients in treatment group were treated with rhubarb powder 20 g soak in 200 mL warm water at 80 ℃ for 20 minutes, according to the dose every 2 hours drink 1 times in the stool did not detected paraquat component to stop, then with rheum 15 g a day by oral administration with warm water, maintain defecate twice a day for 14 days. Patients in control group were given mannitol conventional to rush down; still there was hot paraquat component in stool to stop medication. All patients in two groups were given conventional blood perfu- sion, hormone therapy, anti free radical, given immunosuppressant and symptomatic treatment, stool paraquat component neg- ative rate and fecal occult blood rate in patients with 6 hours, 12 h and 24 hours treatment were detected, the levels of troponin 1, creatinine, alanine aminotransferase, aspartate transaminase, bilirubin direct after 24, 72 and 168 hours treatment were ob- served, the incidence of pulmonary interstitial fibrosis and hypoxemia after 14 and 90 days were measured, and the mortality of 90 days was observed in both groups. Results the stool paraquat component negative rate after treatment for 6, 12 and 24 hours in treatment group were significantly higher than that in control group （ all P 〈 0.05） , the fecal occult blood rate at 6, 12 and 24 hours, the levels of troponin 1, creatinine, alanine aminotransferase, aspartate transaminase, bilirubin direct at 24, 72 and 168 hours, and the incidence of pulmonary interstitial fibrosis and hypoxemia after 14 and 90 days in treatment group were markedly lower than that in control group （ all P 〈 0. 05 ） ; there was no significant difference in mortality rate between two groups （P 〉 0. 05 ）. Conclusion In the treatment of acute paraquat poisoning, rhubarb can quickly exhaust digestive poison, reduce absorption, with the protection of the gastrointestinal mucosa, and can reduce the incidence of pulmonary interstitial fi- brosis, reduce the function damage degree of lung, heart, liver, and kidney, effectively reduce the pulmonary interstitial fibrosis.