王莎莎 张冰 冯文玉
【摘要】 目的:分析急性百草枯中毒(APP)患者采取参附注射液联合持续血液灌流治疗效果及其对肺损伤的影响。方法:选取2018年1月-2019年1月笔者所在医院接收的78例急性百草枯中毒患者,根据先后入院时间分为两组,对照组(n=39)开展常规药物治疗与持续血液灌流,研究组(n=39)则接受持续血液灌流联合参附注射液,统计各组治疗前后临床指标及肺纤维化发生率。结果:治疗前两组血一氧化氮、Ⅲ型前胶原肽、诱导型一氧化氮合酶比较差异无统计学意义(P>0.05),治疗后研究组均低于对照组,差异均有统计学意义(P<0.05);研究组肺纤维化发生率及治疗总有效率分别为20.51%、94.87%,均优于对照组的51.28%、76.92%,差异均有统计学意义(P<0.05)。结论:急性百草枯中毒治疗过程中,通过参附注射液联合持续血液灌流不仅可以改善患者肺损伤,同时有助于肺纤维化发生率降低,确保良好的治疗效果,值得采纳并推广。
【关键詞】 百草枯 中毒 肺损伤 持续血液灌流 参附注射液 影响
[Abstract] Objective: To analyze the effect of Shenfu Injection combined with continuous hemoperfusion on patients with acute paraquat poisoning (APP) and its effect on lung injury. Method: From January 2018 to January 2019, 78 patients with acute paraquat poisoning in our hospital were selected, according to the time of admission, they were divided into two groups. The control group (n=39) was treated with the routine drug treatment and continuous blood perfusion, the research group (n=39) was treated with continued blood perfusion combined with Shenfu Injection. The incidence of clinical and pulmonary fibrosis before and after treatment were counted. Result: There were no statistically significant differences in nitric oxide, type Ⅲ procollagen peptide and inducible nitric oxide synthase of two groups before treatment (P>0.05). After treatment, the indexes in the study group were lower than those in the control group, the differences were statistically significant (P<0.05). The incidence of pulmonary fibrosis in the study group and the total effective rate of treatment were 20.51% and 94.87% respectively, better than 51.28% and 76.92% of the control group, the differences were statistically significant (P<0.05). Conclusion: In the course of treatment of acute paraquat poisoning, Shenfu Injection combined with continuous hemoperfusion can not only improve the lung injury, but also help to reduce the incidence of pulmonary fibrosis and ensure good therapeutic effect, which is worth adopting and popularizing.
急性百草枯中毒是我国常见、多发农药中毒急危重症之一,近些年来,临床上百草枯中毒口服患者越来越多,而且有上升趋势[1]。现阶段,急性百草枯中毒并没有特效治疗药物,患者如果未得到及时治疗,具有较高病死率[2]。目前,临床上主要采取早期血液灌流方式进行治疗,而且该方法被广泛应用于临床上。据有关资料显示,中药参附注射液在氧自由基方面具有拮抗效果,有助于肺循环改善,而且能够避免对肺功能造成严重损伤[3]。基于此,本次试验针对笔者所在医院2018年1月-2019年1月接收的急性百草枯中毒患者实施持续血液灌流联合参附注射液治疗效果及其对肺功能的影响进行简单分析,以下为详细报告。
1 资料与方法
1.1 一般资料
本次试验78例急性百草枯中毒患者均为笔者所在医院2018年1月-2019年1月接收。纳入标准:(1)与《职业性急性百草枯中毒的诊断(GBZ246-2013)》中急性百草枯中毒诊断标准相符[4];(2)百草枯(PQ)质量浓度在10~30 mg/L;(3)具备完整临床资料;(4)具备正常沟通及理解能力。排除标准:(1)合并精神异常、心理障碍;(2)存在心脏、肝脏及肾脏器官功能不全;(3)存在脑血管疾病、感染性疾病、肺疾病、脓毒症及其他代谢性疾病;(4)存在药物过敏史;(5)由于个人因素拒绝或者中途选择退出;(6)存在凝血功能障碍。以先后入院时间为依据平均分为两组,对照组39例,男20例,女19例;年龄24~51岁,平均(39.56±3.54)岁;平均动脉压(85.62±2.42)mm Hg;血中PQ(3.39±0.37)mg/L;研究组39例,男22例,女17例;年龄25~48岁,平均(39.47±3.48)岁;平均动脉压(86.12±2.37)mm Hg;血中PQ(3.42±3.51)mg/L。两组一般资料比较差异无统计学意义(P>0.05)。患者本人或者家属签署研究同意书,研究经医院伦理委员会批准。