急性毒鼠强中毒血清炎性细胞因子动态变化及改良方案治疗的临床研究

目的 评价“改良方案”治疗急性毒鼠强中毒的临床疗效。方法 ①对48例确诊的急性毒鼠强中毒患者，分别在入院后即刻及中毒后1、3、5、7、9、11、13、15、17和19d抽取静脉血2ml，测定β-内啡肽（β-EP）、内皮素（ET）、一氧化氮（NO）与肿瘤坏死因子（TNF）；以30名健康献血者（乙对照组）为对照。②观察组采用“改良方案”治疗，并与36例既往采用“传统方案”治疗者（甲对照组）进行比较。结果 ①48例“改良方案”治疗者中45例治愈，3例死亡。②45例治愈者中，轻、中、重3组患者的β-EP、ET、NO和TNF均于入院后即刻显著升高，于中毒后1d达高峰，随后缓慢下降。轻、中、重3组β-EP恢复正常时间分别为中毒后9、13和17d；ET恢复正常时间分别为中毒后7、13和15d；NO恢复正常时间分别为中毒后7、11和11d；TNF恢复正常时间分别为中毒后9、11和17d。③3例死亡者β-EP、ET、NO和TNF在入院后即刻均显著升高，在治疗过程中继续升高。④观察组重度中毒者治愈率（84．2％）比甲对照组（41．7％）有显著提高（P〈0．01），观察组中轻、中、重各组的安定和苯巴比妥用量、止惊时间均比甲对照组中各对应组显著减少（P均〈0．01）。结论 ①血清β-EP、ET、NO和TNF水平与急性毒鼠强中毒程度及病情转归相关。②血清β-EP、ET、NO和TNF水平在治疗过程中稳定下降提示预后良好，持续升高提示预后不良。③采取相应措施降低β-EP、ET、NO和TNF水平可改善毒鼠强的预后。④“改良方案”可作为急性毒鼠强中毒治疗的一种较为理想方案。

Changes in serum contents of inflammatory mediators after tetramethylene-disulfo-tetramine poisoning and clinical study of a new treatment regime for the poisoning

OBJECTIVE: To study the changes in serum contents of beta-endorphin (beta-EP), endothelins (ET), nitric oxide (NO) and tumor necrosis factor (TNF) after acute tetramethylene-disulfo-tetramine (TDT) poisoning and therapeutic effect of a new treatment regime. METHODS: (1) Forty-eight patients with tetramethylene-disulfo-tetramine poisoning (experiment group) were enrolled in this study. The serum levels of beta-EP, ET, NO and TNF were measured upon hospitalization and 1, 3, 5, 7, 9, 11, 13, 15, 17 and 19 days after poisoning, respectively, and compared with those of 30 healthy individuals (control group B). (2) They were treated with the improved regime and compared with patients treated with the conventional regime designated as control group A. RESULTS: (1) In 48 patients treated with improved regime, 45 were cured and 3 died. (2) The serum levels of beta-EP, ET, NO and TNF from 45 patients who were cured were significantly higher at hospitalization compared with those of healthy individuals, with the peak values appeared on day 1 after poisoning in the mild, moderate and severe groups. Beta-EP levels returned to normal range on days 9, 13 and 17 after poisoning respectively in the mild, moderate and severe groups. ET levels returned to normal range on days 7, 13 and 15 after poisoning respectively in the mild, moderate and severe groups. NO levels returned to normal range on days 7, 11 and 11 after poisoning respectively in the mild, moderate and severe groups. TNF levels returned to normal range on days 9, 11 and 17 after poisoning respectively in the mild, moderate and severe groups. (3) The serum levels of beta-EP, ET, NO and TNF in 3 non-survivors were very high at hospitalization and continued to increase in the course of treatment. (4) The cumulative doses of diazepam and Phenobarbital, and the eclampsia time were significantly less in the experiment group than those of control group A. CONCLUSION: (1) The serum levels of beta-EP, ET, NO and TNF are correlated with the severity of tetramethylene-disulfo-tetramine poisoning and general conditions of the patients. (2) When the serum levels of beta-EP, ET, NO and TNF decrease gradually in the course of treatment, prognosis is better. On the contrary, the prognosis is poor when their levels increase gradually. (3) Measures to decrease levels of beta-EP, ET, NO and TNF result in a better prognosis of patients with tetramethylene-disulfo-tetramine poisoning. (4) The improved regime can be considered a better therapeutic strategy in tetramethylene-disulfo-tetramine poisoning.