"水化疗法"治疗重度急性百草枯中毒  

Treatment of"hydration therapy"for acute paraquat poisoning

作　　者：程友林 冯恩民 刘光增 谭植华 王海玲 李建林 魏栋 李琳[1] 王海石[2] Cheng Youlin;Feng Enmin;Liu Guangzeng;Tan Zhihua;Wang Hailing;Li Jianlin;Wei Dong;Li Lin;Wang Haishi(Department of Critical Care Medicine,Shouguang People's Hospital Affiliated to Weifang Medical College,Weifang 262700,Shandong,China;Department of Poisoning and Occupational Disease,Shandong Provincial Hospital,Jinan 250000,Shandong,China)

机构地区：[1]潍坊医学院附属寿光市人民医院重症医学科,山东潍坊262700 [2]山东省立医院中毒与职业病科,济南250000

出　　处：《中华危重病急救医学》2020年第7期846-849,共4页Chinese Critical Care Medicine

基　　金：山东省潍坊市卫生计生委科研项目(2017wsjs100)。

摘　　要：目的探讨自拟"水化疗法"治疗重度急性百草枯中毒(APP)的临床疗效。方法采用历史对照研究方法,选择2014年2月至2019年6月潍坊医学院附属寿光市人民医院收治的58例重度APP患者作为研究对象。将2016年5月10日以前收治的26例患者纳入标准治疗组,患者由急诊科收入重症监护病房(ICU)后立即给予反复洗胃、导泻、活性炭或蒙脱石散肠道吸附、药物治疗及血液净化等标准治疗。从2016年5月10日开始收治的32例患者纳入强化治疗组,在标准治疗的基础上进行"水化疗法",即以0.9%NaCl和(或)5%葡萄糖注射液全天不间断匀速持续静脉补液,保证患者入ICU后48~72 h每日补液总量达到200 mL/kg,同时应用呋塞米强化利尿,保证出入量及水、电解质平衡,治疗过程中出现心力衰竭或急性肺间质水肿者立即终止"水化疗法"。治疗后6个月对所有患者进行随访,可正常活动、无不适主诉及无心、肺、肝、肾等器官功能损害者视为治愈,评价"水化疗法"的治疗效果。结果两组患者性别、年龄、服毒量、服毒至入ICU时间比较差异均无统计学意义。强化治疗组32例患者在持续补液治疗过程中均未出现心力衰竭。随访6个月时,强化治疗组总体治愈率明显高于标准治疗组〔59.4%(19/32)比19.2%(5/26),P<0.05〕。在随访6个月治愈患者中,两组年龄和服毒至入ICU时间差异无统计学意义;但强化治疗组服毒量明显大于标准治疗组(mL:54.06±26.03比23.00±4.47,P<0.05)。两组随访6个月治愈患者的胸部CT均显示,肺纤维化病灶随时间延长逐渐缩小,并非完全呈渐进性和不可逆性。结论以强化利尿为主的"水化疗法"可明显提高重度APP患者的抢救成功率。Objective To explore the clinical value of "hydration therapy" in the treatment of severe acute paraquat poisoning (APP).Methods A prospective historical control observation was conducted. Fifty-eight patients with severe APP admitted to Shouguang People's Hospital Affiliated to Weifang Medical College from February 2014 to June 2019 were enrolled. Twenty-six patients admitted before May 10th, 2016 were enrolled in the standard treatment group. After being admitted to intensive care unit (ICU) from the department of emergency, patients in the standard treatment group were immediately given standard treatment such as repeated gastric lavage, catharsis, adsorption of poison by activated carbon or montmorillonite powder, drug treatment and blood purification. From May 10th, 2016, 32 patients were enrolled in the intensive treatment group. On the basis of standard treatment, "hydration therapy" was carried out, that was, 0.9% NaCl and/or 5% glucose injection were used for continuous intravenous infusion throughout the day, so as to ensure that the total amount of fluid infusion per day reached 200 mL/kg within 48-72 hours after ICU admission. At the same time, furosemide was used to strengthen diuresis to ensure the balance of water and electrolyte. If heart failure or acute pulmonary interstitial edema occurred during the treatment, "hydration therapy" should be stopped immediately. Six months after treatment, all patients were followed up. The patients with normal activity, no complaints of discomfort and no damage of heart, lung, liver, kidney and other organs were regarded as cured. The therapeutic effect of "hydration therapy" was evaluated.Results There was no significant difference in gender, age, dosage or time from taking poison to ICU between the two groups. In the intensive treatment group, 32 patients did not appear heart failure during continuous rehydration treatment. Follow-up after 6 months showed that the overall cure rate in the intensive treatment group was significantly higher than that in the sta

关 键 词：百草枯 中毒 强化利尿 水化疗法 

分 类 号：R595.4[医药卫生—内科学]