陈志红　郭燕　王新刚

[摘要] 目的 探討思密达、甘露醇、活性炭联合用药对百草枯中毒患者疗效及焦虑抑郁的影响。 方法 选择2014年6月～2016年6月解放军第一六九医院（湖南师范大学附属湘南医院）收治的百草枯中毒患者86例，按照随机数字表法将其分为对照组和观察组，每组各43例。对照组采用常规治疗，观察组在对照组的基础上给予思密达、甘露醇、活性炭治疗。两组疗程均为7 d。比较两组疗效和肺纤维化、呼吸衰竭、多器官功能障碍综合征（MODS）的发生时间，记录两组治疗前后肝功能指标[谷草转氨酶（AST）和谷丙转氨酶（ALT）]和焦虑、抑郁评分。 结果 观察组总有效率（62.79%）显著高于对照组（32.56%），差异有统计学意义（P < 0.05）；观察组肺纤维化、呼吸衰竭和MODS的发生时间均晚于对照组，差异均有统计学意义（均P < 0.05）；治疗后两组AST、ALT水平均较治疗前显著降低，且观察组显著低于对照组（均P < 0.05）。治疗后两组焦虑、抑郁评分均较治疗前显著降低，且观察组显著低于对照组，差异均有统计学意义（均P < 0.05）。 结论 思密达、甘露醇、活性炭联合用药对百草枯中毒患者疗效较好，可改善患者焦虑和抑郁症状，具有重要的研究意义。

[关键词] 思密达；甘露醇；活性炭；百草枯中毒；疗效；焦虑；抑郁

[中图分类号] R595.4 [文献标识码] A [文章编号] 1673-7210（2017）09（c）-0136-04

[Abstract] Objective To investigate the influence of combined medication of Dioctahedral Smectite， Mannitol and Activated Carbon for the effect and anxiety-depression of patients with paraquat poisoning. Methods Eighty-six cases of patients with paraquat poisoning admitted to No.169 Hospital of PLA （Xiangnan Hospital Affiliated to Hu′nan Normal University） from June 2014 to June 2016 were selected and divided into two groups by random number table， with 43 cases in each group. The control group was given routine treatment， the observation group was given combined medication of Dioctahedral Smectite， Mannitol and Activated Carbon on the basis of control group. The course of both groups was 7 days. The therapeutic effects， the occurrence time of pulmonary fibrosis， respiratory failure and multiple organ dysfunction syndrome （MODS） of the two groups were compared， and the indexes of liver function [aspartate aminotransferase （AST）， alanine transaminase （ALT）] and scores of anxiety and depression of the two groups before and after treatment were compared. Results The total effective rate of observation group （62.79%） was higher than that of control group （32.56%）， with statistically significant difference （P < 0.05）. The occurrence time of pulmonary fibrosis， respiratory failure and MODS in observation group was later than those of control group， with statistically significant differences （all P < 0.05）. After treatment， the levels of AST， ALT in the two groups were all lower than those before treatment， which of observation group were lower than those of control group （all P < 0.05）. After treatment， the scores of anxiety and depression in both groups were all lower than those before treatment， which of observation group were lower than those of control group， the differences were all statistically significant （all P < 0.05）. Conclusion Combined medication of Dioctahedral Smectite， Mannitol and Activated Carbon for patients with paraquat poisoning has good curative effect， which can improve the symptoms of anxiety and depression. It has important research significance.endprint

[Key words] Dioctahedral Smectite； Mannitol； Activated Carbon； Paraquat poisoning； Curative effect； Anxiety； Depression

百草枯又叫克无踪、对草快，是被广泛应用的一种有机杂环类接触性除草剂和脱叶剂，具有很强的毒性，可经消化道、呼吸道及皮肤吸收进入人体后引起中毒，人体口服致死量为30～40 mg/kg，且调查显示中毒后死亡率达60%以上，严重影响人们的身心健康和生命安全[1-4]。目前，对重度百草枯患者的治疗主要采用对症支持治疗和药物治疗。本研究旨在探讨思密达、甘露醇、活性炭联合用药对百草枯患者疗效及焦虑抑郁的影响，以期为临床治疗提供指导。现报道如下：

1 资料与方法

1.1 一般资料

选择2014年6月～2016年6月于解放军第一六九医院（湖南师范大学附属湘南医院）收治的百草枯中毒患者86例，按照随机数字表法分为观察组和对照组，每组各43例。……