N-乙酰半胱氨酸治疗急性百草枯中毒患者的临床研究  

Clinical study of N-acetylcysteine in the treatment of acute paraquat poisoning

作　　者：陈慧敏[1] 姚梦雅 孙宝迪 杨佩[1] 狄佳 张炜[1] 黄昌宝 杨志州 聂时南[1] CHEN Huimin;YAO Mengya;SUN Baodi;YANG Pei;DI Jia;ZHANG Wei;HUANG Changbao;YANG Zhizhou;NIE Shinan(Department of Emergency Medicine,Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China)

机构地区：[1]中国人民解放军南京总医院急救医学科,南京210002

出　　处：《临床急诊杂志》2018年第3期168-171,共4页Journal of Clinical Emergency

基　　金：江苏省社会发展面上项目(No:BE2017720)

摘　　要：目的:探讨N-乙酰半胱氨酸(NAC)注射液治疗急性百草枯中毒患者的临床疗效。方法:以2016-01-2017-12期间就诊于我科的急性百草枯中毒患者为研究对象,将入选患者随机分为对照组和NAC治疗组,比较两组患者入科时血浆百草枯浓度、APACHEⅡ评分及中毒至入院时间,比较两组患者住院期间呼吸情况、肝肾功能、氧化应激水平及预后方面的差异。结果:两组患者年龄、性别、血浆百草枯浓度及APACHEⅡ评分无差异;治疗组患者氧分压和氧合指数高于对照组,NAC未能降低治疗组患者呼吸频率和有创呼吸机使用时间;治疗组患者转氨酶、胆红素及肌酐均低于对照组,NAC在一定程度上增加了治疗组患者尿量和肾小球滤过率,两组患者需行CRRT的比例差异无统计学意义,两组患者血清中MDA含量逐渐增加,SOD和GSH-Px活性逐渐降低,和对照组相比,治疗组患者MDA含量低,SOD和GSH-Px活性高,两组患者预后差异无统计学意义。结论:NAC能在一定程度上改善急性百草枯中毒患者的氧合和肝肾功能,减轻氧化应激,但未能改善患者预后。Objective：To investigate the clinical efficacy of N-acetylcysteine injection in patients with acute paraquat poisoning.Method：Clinical data of patients with acute paraquat poisoning admitted to our emergency department from January 2016 to December 2017 was investigated in the study.The selected patients were randomly divided into control group and NAC treatment group.The plasma paraquat concentration,APACHEⅡ score and time from poisoning to admission were compared between the two groups.The differences in respiration,liver and kidney function,oxidative stress and prognosis between the two groups were compared.Result：There were no differences in age,sex,plasma paraquat concentration and APACHEⅡscore between the two groups.Oxygen partial pressure and oxygenation index were higher in the treatment group than those in the control group.NAC failed to reduce the respiratory rate and time of invasive ventilator in the treatment group.Patients in the treatment group had lower transaminase,bilirubin and creatinine than those in the control group.NAC increased the urine output and glomerular filtration rate in the treatment group to a certain extent.There was no difference in the need of CRRT between the two groups.Serum MDA content gradually increased,SOD and GSH-Px activity decreased in the two groups.Compared with the control group,the treatment group patients had low MDA content,and high SOD and GSH-Px activity.The two groups had no difference in prognosis.Conclusion：NAC can improve oxygenation and liver and kidney function,reduce oxidative stress in patients with acute paraquat poisoning to a certain extent,but failed to improve the prognosis.

关 键 词：N-乙酰半胱氨酸 急性百草枯中毒 氧合 肝功能 肾功能 氧化应激 预后 

分 类 号：R595.4[医药卫生—内科学]