2020 年第 1 期 第 15 卷

血液净化联合乙酰半胱氨酸治疗急性百草枯中毒的效果及对肺纤维化的影响

Effect of blood purification combined with acetylcysteine on acute paraquat poisoning and pulmonary fibrosis

作者：李加贝昌建祥李忠贤

英文作者：

单位：湖南省邵阳市中心医院急诊科410000

英文单位：

关键词：急性百草枯中毒；乙酰半胱氨酸；血液净化；肺纤维化

英文关键词：

• 摘要：

• 【摘要】目的    研究血液净化联合乙酰半胱氨酸治疗急性百草枯中毒的效果及对肺纤维化的影响。方法    选取邵阳市中心医院2016年6月至2018年5月收治的急性百草枯中毒患者82例，按随机数字表法分为对照组和观察组，各41例。对照组患者入院后给予洗胃、导泄、维持酸碱水电解质平衡、护胃、护肾脏等常规治疗联合血液灌流后血液滤过治疗；观察组在对照组治疗基础上给予乙酰半胱氨酸泡腾片治疗。比较2组患者机械通气比例、低氧血症和Ⅰ型呼吸衰竭发生率以及14 d内病死率，治疗1、4周后肺纤维化发生率，治疗前和治疗2周后动脉血气指标氧合指数、肺泡-动脉血氧分压差水平以及肝功能指标（丙氨酸转氨酶、天冬氨酸转氨酶）、肾功能指标(血肌酐)和心肌酶谱指标（肌酸激酶同工酶）水平。结果    观察组患者机械通气比例、低氧血症和Ⅰ型呼吸衰竭发生率以及14 d内病死率均明显低于对照组［73.2%（30/41）比95.1%（39/41）、36.6%（15/41）比73.2%（30/41）、31.7%（13/41）比75.6%（31/41）、26.8%（11/41）比58.5%（24/41）］(均P<0.05)。治疗4周后，观察组肺纤维化发生率低于对照组［39.0%(16/41)比56.1%（23/41）］(P<0.05)。治疗2周后，2组氧合指数均高于治疗前且观察组高于对照组［(403±16)mmHg（1 mmHg=0.133 kPa）比（395±14）mmHg］，肺泡-动脉血氧分压差均低于治疗前且观察组低于对照组［(23.5±4.5)mmHg比（27.1±3.2）mmHg］(均P<0.05)；观察组血清丙氨酸转氨酶、天冬氨酸转氨酶、血肌酐和肌酸激酶同工酶水平均低于治疗前，且显著低于对照组(均P<0.05)。结论    血液净化联合乙酰半胱氨酸治疗可提高急性百草枯中毒抢救效果，促进患者肝肾功能恢复，抑制肺纤维化进展，并能减轻心肌损伤，改善预后。

• 【Abstract】Objective    To analyze the effect of blood purification combined with acetylcysteine on acute paraquat poisoning and pulmonary fibrosis. Methods    From June 2016 to May 2018, 82 patients with acute paraquat poisoning admitted to Shaoyang Central Hospital were randomly divided into control group and observation group, with 41 cases in each group. The control group had routine gastric lavage, catharsis, acid-base water-electrolyte balance control, stomach-protecting, kidney-protecting treatments and blood purification. The observation group took acetylcysteine effervescent tablets on the basis of control group. Mechanical ventilation rate, incidences of hyoxemia and type Ⅰ respiratory failure, the 14-day mortality rate, incidence of pulmonary fibrosis after 1 and 4 weeks of treatment were observed. Oxygenation index, alveolar-arterial differential oxygen pressure, liver function indexes（alanine aminotransferase and aspartate aminotransferase）, renal function index（serum creatinine） and myocardial enzyme（creatine kinase isoenzyme） were detected before and 2 weeks after treatment. Results    Mechanical ventilation rate, incidences of hyoxemia and type Ⅰ respiratory failure and the 14-day mortality rate in the observation group were significantly lower than those in the control group［73.2%（30/41） vs 95.1%（39/41）, 36.6%（15/41) vs 73.2%（30/41）, 31.7%（13/41） vs 75.6%（31/41）, 26.8%（11/41） vs 58.5%（24/41）］(all P<0.05). After 4 weeks of treatment, incidence of pulmonary fibrosis in the observation group was significantly lower than that in the control group［39.0%(16/41) vs 56.1%（23/41）］(P<0.05). After 2 weeks of treatment, oxygenation index significantly increased and it was higher in the observation group than that in the control group［(403±16)mmHg vs （395±14）mmHg］; alveolar-arterial differential oxygen pressure significantly decreased and it was lower in the observation group than that in the control group［(23.5±4.5)mmHg vs (27.1±3.2)mmHg］; serum levels of alanine aminotransferase, aspartate aminotransferase, serum creatinine and creatine kinase isoenzyme in the observation group were significantly lower than those before treatment and those in the control group(all P<0.05). Conclusion    Blood purification combined with acetylcysteine can improve the rescue effect on acute paraquat poisoning, promote the recovery of liver and kidney function, inhibit the progress of pulmonary fibrosis, reduce myocardial injury and improve the prognosis.