应用连二亚硫酸钠判断百草枯中毒的程度和预后  

Prediction of the outcome of patients subjected to paraquat poisoning by using the determination of paraquat levels in urine and serum with sodium dithionite

作　　者：李恒[1] 谢文卿[1] 张萍[1] 李一文[1] 陈燕燕[1] 陈江华[1] 

机构地区：[1]浙江大学医学院附属第一医院肾脏病中心,杭州310003

出　　处：《中华急诊医学杂志》2010年第4期361-364,共4页Chinese Journal of Emergency Medicine

摘　　要：目的应用连二亚硫酸钠显色法判断百草枯中毒的程度和预后。方法将不同浓度的百草枯标准品与过量连二亚硫酸钠在碱性条件下反应，建立百草枯检测标准比色卡和标准曲线。应用连二亚硫酸钠显色法前瞻性检测浙江大学医学院附属第一医院2008年1月至2009年5月间收治的22例百草枯中毒患者血、尿液百草枯浓度，回顾性分析了患者就诊即刻血、尿百草枯浓度与患者预后的相关性。结果22例百草枯中毒患者经血液灌流、血浆置换和血液滤过治疗后随访3月以上，存活6例（27．3％）。6例存活者就诊即刻百草枯半定量检测显示为极浅（3例）或浅（3例），16例死亡患者就诊即刻百草枯半定量检测显示为浅（1例）、中（2例）、深（2例）、极深（11例）。6例存活患者与16例死亡患者就诊即刻尿百草枯质量浓度分别为（1．95±1．76）mg／L和（53．4±45．9）mg／L，P〈0．01。6例存活患者和13例死亡患者就诊即刻血清百草枯质量浓度分别为（1．70±1．39）mg／L和（29．5±22．1）mg／L，P〈0．01。22例百草枯中毒患者存活状况与就诊即刻尿百草枯半定量、定量检测结果及血清百草枯质量浓度均显著相关（-分别为-0．804、-0．772，和-0．593，P〈0．01）。结论应用连二亚硫酸钠可迅速检测患者血、尿百草枯质量浓度，有助于了解患者中毒程度和判断预后。Objective To measure the paraquate （Pq） levels in urine and serum of patients with sodium dithionite in order to predict the outcome of patients after paraquart intoxication. Method Standard colorimetry and standard curve for paraquat measurement was established using sodium dithionite to react with paraquat in different concentrations and in alkaline medium. Twenty-two patients with paraquat poisoning were admitted from January 2008 to May 2009. Serum and urine samples of these patients were collected. The paraquat concentrations in the serum and urine samples were semi-quantitatively and quantitatively determined with the methods as mentioned. The relationships between the outcome of patients and the levels of Pq in the urine and serum samples were analyzed. Results Six （27.3 % ） of the 22 patients survived after hemoperfusion, plasma exchange, and hemofiltration therapies, and were followed up for over 3 months. According to our colorimetry for the detection of paraquat, urine samples from 6 survivals showed very light color in 3 patients and light color in as many. The urine samples from the 16 died ones showed light color in one patient, moderate color in 2, dark color in 2 and very dark color in 11 patients. The mean concentrations of paraquat in urine samples of 6 survivals and 16 died patients were （ 1.95 ± 1.76） mg/L and （53.4±45.9） mg/L, respectively （ P 〈 0.01 ）. The mean concentrations of paraquat in serum sample of 6 survivals and 13 died ones were （ 1.70 ± 1.39） mg/L and （29.5 ± 22.1 ） mg/L, respective （P 〈 0.01 ）. The outcomes of these patients were closely related to semi-quantitative values of urine samples （is： - 0. 804, P 〈 0.01 ）, quantitative values of urine samples （is： - 0.772, P 〈 0.01 ）, and quantitative values of serum samples （rs： - 0. 593, P 〈 0.01 ）. Conclusions Alkaline sodium dithionite can be used for the rapid determination of paraquat in urine and serum. Theses measurements can serve as predictors of outcome of patie

关 键 词：百草枯 中毒 连二亚硫酸钠 氢氧化钠 比色 尿液 血清 预后 

分 类 号：R595.4[医药卫生—内科学]