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目的探讨血必净和乌司他丁对百草枯中毒肺纤维化的早期干预效果和血浆凝血酶原时间(PT)值早期预测肺纤维化的价值。方法急性百草枯中毒患者51例,均行常规血液灌流3d。随机分为三组:A组20例,加用血必净50ml,加入0.9%氯化钠100ml静脉滴注,每12小时1次,连用14d;B组19例,加用乌司他丁30万U,加入0.9%氯化钠30ml中泵注,每8小时1次,连用14d;C组12例,仅给予常规治疗作为对照。在第1、7和14天分别检测患者血浆PT;同时于第7和14天分别行高分辨率CT(HRCT)检查评估肺纤维化发生情况。结果第14天,A组和B组的HRCT评分均低于C组[(9.7±0.4)分和(8.8±1.5)分vs.(17.7±2.3)分](P<0.05)。与C组比较,A、B两组第14天病死率较低(25.0%、31.6%vs.50.0%)(P<0.05)。第14天,肺纤维化组(30例)的PT长于非肺纤维化组(4例)[(18.5±4.7)s vs.(12.1±3.2)s](P<0.05)。结论血浆PT与急性百草枯中毒致肺纤维化的发生及严重程度相关。在血液灌流的基础上,应用血必净及乌司他丁可以一定程度上减轻肺纤维化程度,减少多器官功能衰竭等并发症的发生,延长生存时间。
Objective To investigate the early intervention effects of Xuebijing and ulinastatin on paraquat poisoning pulmonary fibrosis and the value of plasma prothrombin time (PT) value in the early prediction of pulmonary fibrosis. Methods Acute paraquat poisoning in 51 patients, were performed conventional blood perfusion 3d. Randomly divided into three groups: A group of 20 cases, plus Xuebijing 50ml, adding 0.9% sodium chloride 100ml intravenous infusion, once every 12 hours, once every 14d; B group 19 cases, plus ulinastatin 30 10,000 U, adding 0.9% sodium chloride 30ml pump injection, once every 8 hours, once every 14d; C group of 12 cases, only given conventional treatment as a control. Patient plasma PT was measured on days 1, 7 and 14, and concurrent high resolution CT (HRCT) examinations were performed on days 7 and 14 to assess the incidence of pulmonary fibrosis. Results On the 14th day, the HRCT scores of group A and group B were lower than those of group C [(9.7 ± 0.4) vs (8.8 ± 1.5) vs (17.7 ± 2.3)] (P <0.05). Compared with group C, the mortality rates of group A and B on day 14 were lower (25.0%, 31.6% vs. 50.0%) (P <0.05). On day 14, PT of lung fibrosis group (30 cases) was longer than that of non-pulmonary fibrosis group (4 cases) [(18.5 ± 4.7) s vs. (12.1 ± 3.2) s] (P <0.05). Conclusions Plasma PT is associated with the occurrence and severity of pulmonary fibrosis caused by acute paraquat poisoning. On the basis of hemoperfusion, the application of Xuebijing and ulinastatin can reduce the degree of pulmonary fibrosis to a certain extent, reduce the occurrence of multiple organ failure and other complications, and prolong the survival time.