甲硫酸新斯的明对百草枯中毒的疗效观察  

Therapeutic effect of neostigmine methylsulfate on paraquat poisoning

作　　者：吴燕燕[1] 黄健[1] 罗杰[1] 陶杨[2] 鲁力[2] 赵金川[1] 陈蓉[1] 白伟志[1] 

机构地区：[1]重庆市急救医疗中心急诊科,重庆400014 [2]重庆市急救医疗中心ICU,重庆400014

出　　处：《第三军医大学学报》2017年第15期1578-1581,共4页Journal of Third Military Medical University

基　　金：重庆市卫生计生委医学科研项目:卫计委面上项目(20142082)~~

摘　　要：目的探讨甲硫酸新斯的明对百草枯中毒的治疗作用。方法回顾性分析2014年7月至2016年6月在我院治疗的百草枯中毒患者43例,根据患者是否加用新斯的明治疗分为常规治疗组(n=21)及新斯的明组(n=22)。对比两组患者入院时,入院后48 h的血清TNF-α、IL-6、IL-10水平及急性生理学及慢性健康状况(APACHEⅡ)评分、肺损伤评分(lung injury score,LIS);对比两组患者3个月内病死率。结果两组患者入院当天血清TNF-α、IL-6、IL-10水平相近,差异无统计学意义(P>0.05);治疗2 d后,新斯的明组血清TNF-α、IL-6水平明显低于常规治疗组(P<0.01)。两组患者入院当天APACHEⅡ评分、LIS评分相近,差异无统计学意义(P>0.05);分别治疗2 d后,新斯的明组APACHEⅡ评分、LIS评分低于常规治疗组(P<0.05)。两组患者在3 d内病死率差异无统计学意义(P>0.05),但新斯的明组7 d及30 d病死率低于常规治疗组(P<0.05)。结论百草枯患者早期加用新斯的明治疗,可减少TNF-α、IL-6炎性介质的合成,从而维持各个器官正常功能,减轻肺损伤,提高生存率。Objective To evaluate the efficacy of neostigmine methylsulfate in treatment of paraquat poisoning. Methods The clinical data were collected from 43 patients with paraquat poisoning treated at our center from July, 2014 to June, 2016. Twenty-one of the patients received conventional treatment and 22 received intramuscular injections of neostigmine （2 mg, twice daily for 7 consecutive days）, and in both groups, gastrointestinal decontamination, hemoperfusion, glucocorticoid, antioxidant therapy, cyclophosphamide and anticoagulant therapy were administered. The serum levels of tumor necrosis factor-α （TNF-α）, interleukin-6 （IL-6）, IL-10, APACHE Ⅱ score and lung injury score （LIS） were compared between the 2 groups both upon admission and at 2 d after commencement of the treatments. The mortality rates of the patients within 3 months were recorded and compared between the 2 groups. Results Before treatment, the serum levels of TNF-α, IL-6, IL-10, APACHE Ⅱ score and LIS were all comparable between the 2 groups. At 2 d after commencement of the treatments, the levels of TNF-α and IL-6, APACHE Ⅱ score and LIS were significantly lower in the neostigmine group than in the conventional treatment group （P〈0.05）. The 3-day mortality rates were similar between the 2 groups, but at 7 and 30 days, the mortality rates were significantly lower in neostigmine group than in the conventional treatment group （P〈0.05）. Conclusion Early intervention with neostigmine can reduce the production of such inflammatory cytokines as TNF-α and IL-6 to maintain the normal functions of the organs and alleviate lung injuries, thus promoting the survival of the patients with paraquat poisoning.

关 键 词：百草枯 急性中毒 新斯的明 

分 类 号：R459.7[医药卫生—急诊医学]