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目的:探讨血液灌流对急性百草枯中毒的疗效,如何对口服百草枯中毒患者进行科学救护,挽救患者生命,改善预后。方法:将2008年7月~2010年3月在我科确诊的70例急性口服百草枯中毒入选患者随机分成两组,治疗组33例,对照组37例。70例患者入院确诊后即给予洗胃、导泻、保护胃黏膜、免疫抑制等综合治疗措施,呼吸衰竭者行气管切开或气管插管,机械通气治疗。治疗组在常规治疗基础上加用血液灌流治疗,根据患者病情灌流次数为5~10次,每次灌流时间为2.0~2.5 h。观察两组患者肝、肾功能、心肌酶谱、病死率、死亡患者存活时间等指标的变化。结果:两组患者在年龄、性别、服药剂量及中毒后洗胃时间上没有显著性差异。采用不同的治疗方法,经过3周的治疗后,对照组的存活率16.22%,治疗组的存活率54.55%,两组比较具有统计学意义(P<0.05)。治疗组死亡病例存活时间长于对照组,两组间比较差异具有显著性。治疗组发生肝、肾、心等脏器功能损害病例比率分别为56%、55%、45%,明显少于对照组,两组比较有统计学差异(P<0.05)。结论:在常规治疗基础上应用血液灌流治疗,可以减轻百草枯中毒患者各个器官的损害,抑制肺纤维化,增加患者生存时间,降低患者的病死率。
Objective: To investigate the curative effect of hemoperfusion on acute paraquat poisoning, how to rescue patients with oral paraquat poisoning, save the patient’s life and improve the prognosis. Methods: A total of 70 acute paraquat poisoning patients diagnosed in our department from July 2008 to March 2010 were randomly divided into two groups: treatment group (33 cases) and control group (37 cases). 70 patients admitted to hospital after diagnosis given gastric lavage, cathartic, gastric mucosal protection, immunosuppression and other comprehensive treatment measures, respiratory failure were tracheotomy or endotracheal intubation, mechanical ventilation. The treatment group was treated with hemoperfusion on the basis of conventional treatment. According to the patient’s condition, the number of perfusion was 5 to 10 times and the perfusion time was 2.0 to 2.5 hours. The changes of hepatic and renal function, myocardial zymogram, case fatality rate and survival time of the patients in two groups were observed. Results: There was no significant difference in age, sex, dosage and time of gastric lavage after poisoning between the two groups. After 3 weeks of treatment, the survival rate of the control group was 16.22%, and the survival rate of the treatment group was 54.55%. There was significant difference between the two groups (P <0.05). Survival of death in the treatment group was longer than that in the control group, with significant difference between the two groups. The incidences of liver, kidney, heart and other organ dysfunction in the treatment group were 56%, 55% and 45%, respectively, which were significantly less than those in the control group. There was significant difference between the two groups (P <0.05). Conclusion: The application of hemoperfusion therapy on the basis of routine treatment can reduce the damage of various organs of paraquat poisoning, inhibit pulmonary fibrosis, increase the survival time of patients and reduce the mortality of patients.