百草枯“孪生兄弟”敌草快急性中毒的新认识——6例病例总结并文献复习  

A new understanding of acute poisoning by ingestion of diquat： paraquat′s twin brother——a summary of 6 cases and a review of the literature

作　　者：赵旭明[1] 朱建军[1] 朱建良[1] 肖盐[1] 刘励军[1] Zhao Xu-ming;Zhu Jian-jun;Zhu Jian-liang;Xiao Yan;Liu Li-jun(Department of Emergency Medicine, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China)

机构地区：[1]苏州大学附属第二医院急诊科,江苏苏州215000

出　　处：《中国急救医学》2018年第6期493-496,共4页Chinese Journal of Critical Care Medicine

基　　金：苏州市科技局医疗卫生项目（SYS201506）

摘　　要：目的 探讨敌草快急性口服中毒的临床特征、治疗现状及预后。方法 回顾苏州大学附属第二医院急诊科收治的6例敌草快口服中毒患者，结合国内外数据库检索既往病例文献，进行汇总分析。结果 根据纳入标准、排除标准，共纳入27例患者，14例为国外报道病例。其中男性15例，女性12例，平均年龄32.5岁。口服剂量平均17.4 g。主要中毒表现：①毒物对口咽、消化道黏膜直接损害，以黏膜溃疡为主；②系统毒性，肾、肺、心血管、脑为主要靶器官，以急性损伤过程为主，少数表现为迟发性。洗胃、吸附导泻、对症治疗为临床普遍所采用；血液净化率达70%；大剂量糖皮质激素或免疫抑制剂仅在一篇病例报道中使用。本研究中总病死率高达52%。结论 敌草快临床表现与百草枯类似，中重度中毒患者易出现多脏器功能损害。糖皮质激素使用没有依据；血液净化虽证据不足，仍是一种积极的选择。Objective To discuss the clinical features, treatment and prognosis of acute oral poisoning by diquat. Methods Review 6 cases of acute oral poisoning by diquat in our hospital and retrieve the previous case reports in domestic and foreign databases, then perform a summary analysis. Results According to the inclusion and exclusion criteria, a total of 27 patients were included. 14 patients were reported abroad. There are 15 male and 12 female. The average age was 32.5 years. The average oral dose was 17.4 g. The major toxic symptoms included： First, diquat directly damaged the musous membrane of the oropharynx and the digestive tract, mainly with mucous ulcer. Second, diquat was capable of multiple organ damage： kidney, lung, cardiovascular and brain. Most of them were acute injuries and a few were delayed. At present, gastric lavage, adsorption, catharsis and symptomatic treatments are routine measures. In this investigation, the blood purification rate was 70%, but glucocorticoid and immunosuppressive agents were used only in one report. The total mortality rate in this study is as high as 52%. Conclusion The clinical features of diquat are similar to those of paraquat; the patients with moderate and severe poisoning are prone to multiple organ dysfunction. There is no basis for the use of glucocorticoids. Although the evidence is insufficient, blood purification is a positive choice of treatment.

关 键 词：中毒 敌草快 百草枯 血液净化 

分 类 号：R734.2[医药卫生—肿瘤]