急性百草枯中毒的急救体会

目的:通过回顾分析在急救医学科救治的急性百草枯中毒患者,以总结急性百草枯中毒救治中第一时间的处理要点,以及院内救治的用药方法和治疗手段,并对防治肺纤维化及其他严重致死性并发症的方法进行探讨。方法:该科近期收治的急性百草枯中毒患者14例,其中男4例,女10例,年龄12~65岁,平均年龄为32.6岁。对其早期处理方法、急诊用药方式、方法以及其他治疗手段进行了分析,对其死亡率、救治成功率、严重并发症的发生率、病死率进行总结分析。结果:所有患者均为口服市售20%百草枯溶液而中毒,服毒物剂量约10~100 ml。经抢救治疗,14例患者中死亡12例(85.7%),治愈2例(14.3%);死亡时间为中毒后3~18 d,平均为10.8 d。所有患者均出现不同程度的器官功能损害等并发症,除局部黏膜损伤外,肺纤维化和急性肝、肾功能损害为最常见、严重的并发症,死于上述并发症者分别为12/12、8/10和8/10。结论:百草枯中毒救治成功与否,关键在于服毒后第一时间及时失活和吸附处理。一旦出现肺纤维化,病情基本无法逆转。各种药物对晚期患者的并发症防治和治愈率的提高可能有一定作用。

Emergency treatment of acute paraquat intoxication

Objective: To sum up the key points of the first-aid measures,nosocomial medication and other options in the management of acute paraquat intoxication by a retrospective analysis of the cases treated in our department,and to investigate the ways to prevent lung fibrosis and other severe and fatal complications.Methods: We retrospectively analyzed the clinical data of 14 cases of acute paraquat intoxication in comparison with other reports,including early emergency management,nosocomial medication and other treatment,as well as the mortality,cure rate and the incidence and death rate of severe complications.Results: Of the total number,2 cases survived and 12 died 3-18(mean 10.8) days after the intoxication,with a cure rate of 14.3% and a mortality rate of 85.7%.Various degrees of organ dysfunction and other complications occurred in all cases.Except local mucous membrane injuries,lung fibrosis,acute renal and hepatic function impairment were the most commonly seen and severe complications,with mortality rates of 100%,80% and 80%,respectively.Conclusion: No specific antidote has been found for paraquat intoxication up to now.Early de-activation and adsorption are the only confirmed effective methods to improve the survival rate.Once lung fibrosis occurs,all will be irreversible.Various kinds of medication and other managements may benefit the prevention and treatment of complications for late stage cases.