龙勇 曾俊峰 江乾 饶淑萍

[摘要] 目的：探讨急性百草枯中毒致肺损伤的机制及其治疗方式。方法：选取我院50例百草枯中毒致肺损伤患者，给予胸片、CT等检查，给予清除毒物、血液净化、药物治疗等综合治疗。通过资料分析，总结发病机制及治疗方法。结果：肺间质病变、毛玻璃样变见于绝大多数患者，发生率均远远高于其他病变（P<0.05）。纵隔病变、心包病变等少见。治疗后，存活患者动脉血氧分压（PaO2）、氧合指数（PaO2/FiO2）均显著提高（P<0.05）；PaO2达90%以上，PaO2/FiO2达400以上，二氧化碳分压（PaCO2）显著减低（P<0.05）。50例患者中存活29例，死亡率为42%。结论：百草枯中毒致肺损伤机制较为复杂，综合疗法治疗百草枯中毒肺损伤效果确切，降低了死亡率。

[关键词] 百草枯；肺损伤；发病机制；治疗

[中图分类号] R979.8;R563 [文献标识码]B[文章编号]1673-7210（2011）11（c）-171-02

Pathogenesis and therapies of lung injury caused by acute Paraquat poisoning

LONG Yong, ZENG Junfeng, JIANG Qian, RAO Shuping

Department of Emergency, the People's Hospital of Yichun City, Jiangxi Province, Yichun 336000, China

[Abstract] Objective: To investigate the pathogenesis and therapies of lung injury caused by acute Paraquat poisoning. Methods: 50 patients with acute Paraquat poisoning of our hospital were examined with chest radiograph and CT, and treated comprehensively including poison elimination, blood purification and pharmacotherapy. Then the pathogenesis and therapies were concluded through analyzing the data acquired. Results: The interstitial lung disease and ground-glass attenuation were discovered from most of the patients and the incidence was far higher than the other pathologic changes (P<0.05), while the mediastinal pathologic change and pericardial pathologic change occurred rarely. After the treatment, the arterial oxygen tension (PaO2), oxygenation index (PaO2/FiO2) of the survival patients were increased dramatically (P<0.05); PaO2 took over 90% and PaO2/FiO2 over 400, PaCO2 was decreased dramatically (P<0.05). The death rate out of 50 patients was 42%. Conclusion: The pathogenesis of lung injury caused by acute Paraquat poisoning is quite complicated. Adopting comprehensive therapy on this injury has a good curative effect with improving the patients respiratory function and decreasing the mortality.

[Key words] Paraquat; Lung injury; Pathogenesis; Treatment

急性百草枯 （Paraquat，PQ）为高效有机杂环类接触性脱叶剂和除草剂，但对人畜有极强的毒性，可造成以肺为主的多种脏器严重损伤，致死率极高[1]。目前对百草枯中毒所致肺损伤的机制尚在探索阶段，治疗上也无特效解毒药物。本研究从临床症状、影像学表现等出发，通过临床治疗经验，结合文献探讨百草枯中毒所致肺损伤的机制及治疗手段。

1 资料与方法

1.1 一般资料

选取2000~2010年在我院治疗的百草枯中毒患者50例，均为口服中毒，服毒史可靠。其中，男15例，女35例；平均年龄（36.8±4.2）岁。其中，口服量<10 ml 20例，10~30 ml 15例，>30 ml 15例。服毒至就诊我院的时间<6 h 30例，6~24 h 10例，>24 h 10例。患者均有不同程度的消化道症状：包括口腔和舌糜烂溃疡、胸骨后烧灼痛、恶心、呕吐、腹痛、腹泻；心肺症状：呼吸急促、胸闷、肺底湿性啰音；5例患者出现泌尿系统症状：少尿或无尿、尿黄等。5例患者有神经系统症状：意识障碍、神经反射呈阳性等。

1.2 方法

1.2.1 清除毒物所有患者入院后经简单采集病史确立诊断，侧卧位马上给予2％碳酸氢钠溶液洗胃，用肥皂水彻底清洗污染的皮肤、眼睛。……