大剂量盐酸氨溴索治疗急性百草枯中毒肺损伤的临床观察

目的观察大剂量盐酸氨溴索治疗急性百草枯中毒（PQ）肺损伤的疗效。方法将41例急性百草枯中毒肺损伤患者分为治疗组（21例）和对照组（20例），对照组给予大剂量甲泼尼龙、抗氧化以及血液净化等治疗，使用呼吸机通气；治疗组在对照组治疗基础上加用盐酸氨溴索注射液20mg·kg^-1·d^-1静脉滴注q12h，3-5d．观察两组动脉血气、呼吸参数，X线胸片变化（第1、3、5天），发生多脏器功能障碍综合征（MODS）（≥3个脏器）及多器官衰竭（MOF）病例，病死率与死亡病例存活时间。结果治疗后两组氧分压、氧合指数以及自主呼吸频率与潮气量、呼气末正压、X线胸片改变等均有改善（P〈0．01），治疗组的改善与对照组比较改善更为显著（P〈0．05）。两组间MODS（≥3）与MOF、病死率与死亡病例存活时间差异无统计学意义（均P〉0．05）。结论大剂量盐酸氨溴索注射液虽未能逆转患者的整个病程，但可以显著改善动脉血气、呼吸参数，对急性PO中毒肺损伤有积极的治疗作用。

Treatment of pulmonary damage in acute paraquat poisoning with high dose ambroxol hydrochloride: clinical observation of 21 cases

Object ive To observe the effects of treatment of pulmonary damage in acute paraquat poisoning with high dose ambroxol hydrochloride. Methods Forty-one sex, age, amount of paraquat taken, admission time after poisoning, and general conditions-matched patients with acute paraquat poisoning were randomly divided into 2 groups： routine treatment group （n=20）, undergoing high dose methyl prednisolone , antioxidant therapy, and blood purification; and high dose ambroxol hydrochloride group, undergoing intravenous infusion of ambroxol hydrochloride 20 mg·kg^-1·d^-1 q 12 h for 3-5 days in addition to the routine treatment. The artery blood gas, respiratory parameters, X-ray film changes （on days 1, 3, and 5）, number of cases with multiple organ dysfunction syndrome （MODS） and multiple organ failure （MOF）, mortality, and survival time of the death cases were observed. Results After treatment the oxygen partial pressure, oxygenation index, respiratory rate, tidal volume, positive end-expiratory pressure , and X-ray film changes were all improved in these 2 groups （all P〈0.01）, especially in the treatment group compared with the group （all P〈0.05）. The number of MODS case, mortality, and survival time of the death cases of the ambroxol group was 11, 38%, and （5.4±1.5） d, all not significantly different from those of the control group 12, 40%, and （5.1±1.7） d, all P〉0.05]. Conclusion Though unable to reverse the whole disease course of acute paraquat poisoning , high dose ambroxol improves the artery blood gas and respiratory parameters, thus presenting positive therapeutic effects.