Objective To observe the effects of mild hypothermia on the myocardial mitochondrial injury induced by oxidative stress after restoration of spontaneous circulation (ROSC) in rat of cardiac arrest model.Methods Eighteen male Wistar rats were randomly (raudom number) divided into normal temperature group and mild hypothermia group after ROSC.Ultrasound was used to measure the left ventricular ejection fraction (EF),shortening fraction (FS) and stroke volume (SV).The levels of glutathione (GSH),malondialdehyde (MDA) and adenosine triphosphate (ATP) in myocardium were detected.The ultramicroscopic structure of myocardial mitochondria was observed under transmission electron microscope at 4 h after ROSC.Results There were no significant differences in basic life support (BLS) time,dosage of epinephrine and number of defibrillation attempt between two groups (P ＞ 0.05).The concentrations of GSH and ATP in myocardium of rats in hypothermia group were significantly higher than those in normal temperature group,while the level of MDA was significantly lower in hypothermia group than that in normal temperature group.Echocardiographic findings showed that hypothermia could significantly improve the EF,FS and SV after ROSC.The hypothermia decreased the myocardial mitochondria injury rather than normothermia [mitochondrial injury score:(0.21-±0.04) vs.(0.42 ±0.08),P ＜ 0.05].Conclusions In this model,mild hypothermia can decrease myocardial oxidative stress injury,improving the cardiac function after ROSC.

Objective To explore the effects of estrogen on oxidative stress of the lung tissue induced by acute paraquat (PQ) poisoning. Methods Thirty-two male adult New Zealand rabbits were randomly divided into model group and estrogen intervention group, 16 rabbits in each group. The model of lung injury induced by PQ poisoning was reproduced by feeding 16 mg/kg of 20% PQ through gastric tube. The rabbits in estrogen intervention group received intravenous infusion of 5 mg/kg estrogen after PQ challenge for 7 days, and the rabbits in model group received an equal volume of normal saline. Three rabbits in each group were sacrificed at 1, 2 and 3 days respectively after exposure. The lung tissue was harvested, the levels of reactive oxygen species (ROS) was determined by 2',7'-dichlorofluorescin diacetate (DCFH-DA), malondialdehyde (MDA) was determined by thiobarbituric acid (TBA), the mRNA expression of manganese-containing superoxide dismutase (MnSOD) was determined by reverse transcription-polymerase chain reaction (RT-PCR), and adenosine triphosphatase (ATP) content in mitochondrion was determined by enzyme linked immunosorbent assay (ELISA). The pathological changes in lung were observed under light microscopy using hematoxylin and eosin (HE) staining, and the lung injury was evaluated with lung injury score. Results The contents of ROS and MDA in lung within 3 days after PQ poisoning were gradually increased, and MnSOD mRNA expression and ATP content were gradually decreased. Estrogen intervention could significantly reduce the production of ROS and MDA after PQ poisoning [3-day ROS (fluorescence intensity): 161.05±30.04 vs. 188.30±31.80, 3-day MDA (mmol/L): 98.71±0.92 vs. 122.12±1.24], up-regulate MnSOD mRNA expression (integral A value: 3.05±0.90 vs. 1.22±0.24), and increase ATP content in mitochondrion (ng/L: 3.75±0.92 vs. 2.28±0.29) with statistically significant differences (all P < 0.01). In lung tissue after PQ poisoning, congestion, edema, focal pulmonary consolidation, pulmonary interstitial and alveolar space were infiltrated by a large number of neutrophil, alveolar interval were thickened obviously and the above phenomenon were most serious at 3 days after poisoning as shown under optical microscope. Estrogen intervention could significantly improve lung injury as compared with that of model group, and the lung injury score at 3 days was significantly lower than that of model group (11.8±0.7 vs. 13.5±1.0, P < 0.01). Conclusions The oxidative stress indicators in the lung tissue after PQ poisoning were obviously abnormal, the pathological damage was serious with time dependence. The administration of estrogen can reduce acute lung injury after PQ poisoning by reducing the oxidative stress.

目的:观察前列地尔注射液对急性百草枯患者血清心肌酶值的影响,探讨其对心肌的保护作用.方法:将2012年2月至2013年2月我科收治的急性百草枯中毒患者30例随机分为治疗组(n=15)和对照组(n=15),对照组予洗胃、血液灌流联合血液透析、甲基强的松龙静脉注射、护肝、营养心肌等综合治疗,治疗组在对照组基础上加用前列地尔,分别于患者入院后即刻和第5天采静脉血,检测血清心肌酶,包括:天冬氨酸转氨酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH),比较两组血清心肌酶、多脏器功能障碍综合征(MODS)的发生率和病死率.结果:治疗后治疗组的AST、CK、α-HBDH均显著低于对照组(P＜0.05),但两组治疗组的CK-MB、LDH无明显差异(P＞0.05);两组的MODS发生率、病死率均无明显差异(P＞ 0.05).结论:早期使用前列地尔可改善急性百草枯中毒患者心肌酶,对急性百草枯中毒的心肌损伤有一定保护作用.

目的 探讨百草枯中毒患者肺损害时的护理措施.方法 对我院于2009~2012年间收治的34例百草枯中毒患者的救护资料进行分析,并详细介绍护理措施及经验.结果 让患者取半坐卧位,可以改善呼吸困难,缩小肺纤维化的范围;创造良好的室内环境,加强口腔护理,可有效地预防肺部感染.高度谨慎应用氧疗,正确掌握用氧指征及用氧方法,避免增强百草枯的毒性,加强肺纤维的护理,提高患者的生存质量.严密观察病情变化,严格掌握输液量及速度,避免发生和加重肺水肿,是百草枯中毒患者肺护理的关键.结论 对急性百草枯中毒患者采取积极、合理的护理措施,对预防或减轻肺损害,降低病死率有重要意义.

目的:观察乌司他丁对急性百草枯(PQ)中毒致肺损伤临床疗效.方法:将41 例急性PQ 中毒患者随机分为治疗组21 例和对照组20 例,所有患者均予洗胃、血液灌流+血液透析(HP+HD)及甲基强的松龙静脉注射等综合治疗,治疗组在对照组基础上加用乌司他丁20 万单位+0.9%生理盐水100 ml 静脉滴注,每日2 次,连续3-5 d.比较两组动脉血气、X 线胸片(第1、3、5 天)变化、多脏器功能障碍综合征(MODS)(≥3 个脏器)发生率、病死率、死亡病例的存活时间.结果:治疗后两组的动脉血气及X 线胸片等较治疗前均有显著改善(P＜0.01),且治疗组明显优于对照组(P＜0.05);两组MODS 发生率、病死率与死亡病例存活时间无明显差异(P＞0.05).结论:乌司他丁可改善PQ 中毒后肺损伤患者动脉血气及X 线胸片,对急性PQ 中毒肺损伤有积极治疗作用.

Objective To determine the effects of pyrrolidine dithiocarbamate(PDTC),a nuclear factor-κB (NF-κB) inhibitor,on paraquat-induced early-stage acute lung injury.Methods Following establishment of paraquat-induced lung injury mice model,64 adult male SD rats were randomly divided into PQ+PBS gioup (32 SD rats were treated with phosphate buffer solution) and PQ+PDTC group (32 SD rats were treatecl with 100 mg/kg PDTC).The survival rate of two groups was assessed at hours 24,48 and 72 respectively.Haematoxylin-eosin staining was employed to assess the acute lung injury for scoring,and immunochemical assay was used to detect inflammatory cell infiltration in the lungs.The level of TNF-α and IL-6 was measured by enzyme-linked immunosorbent assay and activation of NF-κB in the lungs was assessed by using Western blotting.Results PDTC improved the survival rate at 72 hours as compared with group PQ+PBS[24/32(75％) in group PQ+PDTC vs 13/32(40.6%) in group PQ+PBS,P=0.015] and acute lung injury score at 24 hours (7.5±1.0 vs 9.8±1.5),48 hours (9.7±0.8 vs 12.0±0.9) and 72 hours (11.5±1.0 vs 14.5±1.0) (all P＜0.05).PDTC resulted in reduced cell count with myeloperoxidase expression,the levels of TNF-α and IL-6 in the lungs and the protein levels of NF-κB in the nucleus and cytoplasm (all P＜0.05).Conclusion PDTC reduces early-stage mortality of acute lung injury by suppressing infiltration of myeloperoxidase-positive inflammatory cells and inhibiting NF-κB activation leading to decreased TNF-α and IL-6 expression in the lungs.

Objective To investigate the clinical value of lung-protective ventilation strategy(LPVS) in acute paraquat poisoning(APP)-induced lung injury.Methods Thirty-one patients with APP-induced lung injury were randomized into the LPVS group(16 cases) and conventional mechanical ventilation group(control group,15 cases).They were all in accordance with the indications of mechanical ventilator.In the ventilation period within 3 ～ 5 days,the following indices of the two groups were observed:the ventilator parameters including volume tidal(VT),positive end-expiratory pressure(PEEP),peak inspiratory pressure(PIP),mean airway pressure(MAP);the arterial blood gas indicators including arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon-dioxide(PaCO2),oxygenation index(PaO2 /FiO2);ventilator-associated lung injury(VALI),chest X-ray and fatality.Results As compared to the control group,in the LPVS group the levels of MAP and PIP were lower(P < 0.01,P < 0.05,respectively),whereas the levels of PEEP,PaCO2 and PaO2 /FiO2 were remarkably higher(P < 0.05,P < 0.01,P < 0.01,respectively);the incidence of VALI was lower(P < 0.05),and there were more patients whose process of lung injury was delayed revealed on the chest X-ray(P < 0.05).Nevertheless,the level of PaO2 and the fatality showed no significant differences between the two groups(all P > 0.05).Conclusion The application of LPVS can improve the respiratory function of patients with APP-induced lung injury,reduce the incidence of VALI,thus has positive therapeutic effects on APP-induced lung injury.

BACKGROUNDPlatelet endothelial cell adhesion molecule-1 (PECAM-1), also known as CD31, is mainly distributed in vascular endothelial cells. Studies have shown that PECAM-1 is a very significant indicator of angiogenesis, and has been used as an indicator for vascular endothelial cells. The present study aimed to explore the relationship between the expression of PECAM-1 and the degree of acute lung injury (ALI) and fibrosis in paraquat (PQ) induced lung injury in rabbits.METHODSThirty-six adult New Zealand rabbits were randomly divided into three groups (12 rabbits in each group) according to PQ dosage: 8 mg/kg (group A), 16 mg/kg (group B), and 32 mg/kg (group C). After PQ infusion, the rabbits were monitored for 7 days and then euthanized. The lungs were removed for histological evaluation. Masson staining was used to determine the degree of lung fibrosis (LF), and semi-quantitative immune-histochemistry analysis to determine the expression of PECAM-1. Pearson's product-moment correlation analysis was performed to evaluate the relationship between the expression of PECAM-1 and the extent of lung injuries expressed by ALI score and degree of LF.RESULTSRabbits in the three groups showed apparent poisoning. The rabbits survived longer in group A than in groups B and C (6.47±0.99 days vs. 6.09±1.04 days vs. 4.77±2.04 days) (P<0.05). ALI score was lower in group A than in groups B and C (8.33±1.03 vs. 9.83±1.17 vs. 11.50±1.38) (P<0.05), and there was statistically significant difference between group B and group C (P=0.03). LF was slighter in group A than in groups B and C (31.09%±2.05 % vs. 34.37%±1.62 % vs. 36.54%±0.44%) (P<0.05), and there was statistically significant difference between group B and group C (P=0.026). The PEACAM-1 expression was higher in group A than in groups B and C (20.31%±0.70% vs. 19.34%±0.68% vs. 18.37%±0.46%) (P<0.05), and there was statistically significant difference between group B and group C (P=0.017). Pearson's correlation analysis showed that the expression of PECAM-1 was negatively correlated to both ALI score (Coe=-0.732, P=0.001) and degree of LF (Coe=-0.779, P<0.001).CONCLUSIONSThe PECAM-1 expression significantly decreases in New Zealand rabbits after PQ poisoning, and the decrease is dose-dependent. The PECAM-1 expression is negatively correlated with ALI score and LF, showing a significant role in the development of lung injuries induced by PQ.

Objective To explore the effects of pyrrolidine dithiocarbamate (PDTC) on the acute lung injury and the activation of Nrf2 pathway after Paraquat (PQ) induced lung injury.Methods Fortyeight adult male SD rats with lung injury induced by PQ were randomly (random number) divided into control group and PDTC group.Three animals were sacrificed at every 1-week interval,7d,14d and 21 days after PQ intoxication,and the lungs of rats were removed for acute lung injury score after HE staining,and for lung fibrosis assessment after Masson staining,and the levels of reduced glutathione (GSH) and malondialdehyde (MDA) in the lung tissue homogenate were assayed and the phosphorylation of Nrf2 (nuclear-E2-related factor 2) was detected by Weston blot.The mean values of detected variables between two groups were compared by t test,and survival curve was tested by Wilcoxon (Gehan) test.Results The intoxication symptoms of rats were obvious,and 4 rats in control group and 9 rats in PDTC group survived until 21days.The survival time of animals in PDTC group was longer than that in control group (Wilcoxon (Gehan) =10.17023,P =0.001).The levels of MDA in control group were higher than those in PDTC group,while the levels of GSH in control group were lower than those in PDTC group.The levels of phosphorylation of Nrf2 in PDTC group were higher than those in control group at 1-week intervals,1-week:(0.32±0.04) vs.(0.23±0.05),P=0.003; 2-week:(0.62±0.06) vs.(0.33±0.03),P＜0.001; 3-week:(0.61 ±0.04) vs.(0.33±0.05),P＜0.001.The acute lung injury (ALI) scores in PDTC group were lower than those in control group,1-week:(5 ± 0.95) vs.(8 ± 1.23),P =0.002 ; 2-week:(9±1.18) vs.(11±1.02),P=0.019; 3-week:(11±1.33) vs.(12±1.42),P=0.002.The percentages of lung fibrosis at 1-week intervals after PQ intoxication were (40.87 ± 7.25) ％,(43.38 ±5.71)％ and (45.91 ± 3.97)％ in control group,and they were higher than those in PDTC group (32.92±2.34)％,(33.45 ±3.04)％ and (35.27 ±3.81)％ in PDTC group,P=0.017,0.001 and 0.001 respectively.Conclusions Attenuation of acute lung injury and lung fibrosis,and prolongation of survival time of SD rats by PDTC were associated with activation of Nrf2 pathway.

Objective To explore the relationships between the expression of PECAM-1 and the degree of ALI in Paraquat induced lung injury model of rabbits. Method Thirty six adult New Zealand rabbits were randomly divided into three groups: 8 mg/kg (Group A), 16 mg/kg (Group B) and 32 mg/kg ( Group C) according to the dose of Paraquat which were infusion into stomach. After poisoned, the animals were monitored for seven days, and then sacrificed. The upper lobe of lung were removed for HE,Masson staining and immunohistochemisty. The ALl score, fibrosis of lung and expression of PECAM-1 were semiquantitative analyzed. Results Each group has 12 animals suffered from poisoning. The survival time of animals in Group C was (6. 47 ± 0. 99 ) days, shorter than (6. 09 + 1.04) days ( P = 0. 031 ) in Group B and (4. 77 + 2. 04) days ( P = 0. 0 07) in Group A. The ALI score were ( 8. 33 ± 1.03) points in Group A, superior to (9. 83 ± 1.17) points ( P = 0. 047 ) in Group B and ( 11.50 + 1.38) points ( P ＜ 0. 01 ) in group C, Group B vs Group C, P=-0.03o The fibrosis degree of lung was (31.09 +2.05)% in Group A,not severe as (34. 37 ±1.62)% (P=0. 002) in Group B and (36. 54 ±0. 44)% (P ＜0. 01 ) in Group C, Group B vs Group C, P = 0. 026. The Pearson correlation analysis showed the expression of PECAM-1 was negative correlated to ALI score (Coe = -0. 732, P =0. 001 ) and fibrosis degree of lung (Coe = -0. 779, P ＜ 0. 001 ) . Conclusions The expressions of PECAM-1 were significantly decreased in New Zealand after Paraquat poisoned, which were dose dependent, correlated to ALI scored and fibrosis degree of lung, so it may play an important role in the development of lung injured induced by Paraquat.

Objective To analyze the efficacy of alprostadil for treatment of pulmonary damage in acute paraquat poisoning.Methods 30 patients with paraquat poisoning were randomly divided into treatment group(n=15) and control group(n=15),all patients underwent sequential blood purification(plasma exchange + hemoperfusion + hemodialysis) combined with comprehensive treatment.The control group was intravenously infused methylprednisolone;the treatment group was treated based on the use of alprostadil.Results In the control group 40% patients were effective,in the treatment group 75% patients were effective,the effective ratio between the two groups was significant(P 0.05).After treatment,PaO2,PaCO2,PaO2/FiO2 improved significantly than the control group(P 0.05).After treatment,X-ray prompted improvement in 9 patients with acute pulmonary damage,which were significantly more than the control group(n=5,P 0.05);there was no difference in mortality.Conclusion Alprostadil injection can significantly improve arterial blood gas,respiratory parameters,which has a positive therapeutic effect on pulmonary damage in acute paraquat poisoning.

OBJECTIVE:To analysis clinical characteristics of the multiple organ dysfunction syndrome (MODS) caused by acute paraquat poisoning (APP). METHOD:Clinical data of 68 APP cases from Jan 2006 to Jun 2009, including age, gender, poisoning time and dosage, and MODS time, were compared in two groups, i.e. the death (37 cases) and survived (31cases) groups. It was less than 24 hours from poisoning to rescue in all cases. RESULTS:Among the 68 cases, the incident rate of ARDS was 51.47% (35 cases). The rate of acute lung injure was 97.1% (66 cases). The mortality was 54.4% (37 cases). There was no significant difference in age and gender between both groups (P > 0.05). The dosages and times from poisoning to rescue were significant different between two groups (P < 0.05, P < 0.01). In the death group, proportion of amounts (> 3) of organs related with MODS was 70.29%, which was significantly higher than that (38.71%) in survived group (P < 0.01). MODS and ALI/ARDS occurred in death group earlier than those in survival group (P < 0.05). On the other hand, cardiac, hepatic and renal damage occurred earlier than the lung injure. CONCLUSION:MODS in APP patients occurred earlier, were more sever, and caused higher mortality. The poisoning dosage and time were important prognostic factors.

Objective To evaluate immunomodulatory effect of combined use ofulinastatin and thymosin α1 in patients with multiple organ dysfunction syndrome(MODS).Methods The patients with MODS were randomly divided into two groups,control group(15 cases) and treatment group(16 cases).In the control group,the patients were treated with regular therapy,and in the treatment group,the combined use of ulinastatin and thymosin α1 was added for 7 d.The acute physiology and chronic health evaluation(APACHE) Ⅱscore and MODS score based on Marshall standard(Marshall score) were calculated and hospitalization days in ICU and 28-day mortality were recorded.The concentrations of tumor necrosis factor alpha(TNF-α) and interleukin-6(IL-6) and the lymphocyte count were determined by enzyme-linked immunosorbent assay and the CD14+ monocyte human leukocyte antigen D-related(HLA-DR) expression was detected by flow cytometry before and after the treatment.Results No significant differences were found in the APACHE Ⅱand Marshall scores,the TNF-a and IL-6 levels,and the lymphocyte count between the treatment group and the control group before treatment(all P>0.05).After 7 d treatment,the APACHE Ⅱscore in the treatment group was much lower,and the Marshall score was much higher than the control group(P<0.05,P<0.01,respectively).In the treatment group,lower levels of TNF-α and IL-6(all P<0.05) and higher lymphocyte count(P<0.01) were found on day 7 as compared to the control group.Patients in treatment group had significantly higher CD14+ monocyte HLA-DR expression than the control group on day 7(P<0.05).The hospitalization days in ICU showed significant different between the two groups(P<0.05),while the 28-day mortality did not(40% in the control group,37.5% in the treatment group,P>0.05).Conclusion The therapy combined use of ulinastatin and thymosin α1 could improve the immune function and shorten the hospitalization daysin patients with MODS in some extent,but could not significantly reduce the 28-day mortality on the basis of the study result.

目的:分析急性百草枯中毒患者早期血清心肌酶的表达水平,探讨其对预测发病后猝死的意义.方法:检测52例急性百草枯中毒患者(中毒时间＜24 h)入院时的心肌酶谱.根据患者的临床结局分为猝死组(生存时间≤1 d)和非猝死组(即生存时间＞1 d).比较两组患者入院时的心肌酶谱和APACE Ⅱ评分.结果:猝死组心肌酶水平显著高于非猝死组(P＜0.01),猝死组的中毒剂量显著大于非猝死组(P＜0.01).结论:急性百草枯中毒猝死组患者的心肌酶活性显著增高,且与中毒剂量相关;中毒后血清心肌酶活性的显著升高可能是发生猝死的一个预警指标.

目的:探讨不同时机给予白陶土胃管灌注对急性百草枯中毒预后的影响.方法:回顾性分析本院收治的39例急性百草枯中毒患者的临床资料,入院后均立即给予洗胃、白陶土胃管灌注、导泻、大剂量激素、护肝及血液净化等治疗.入选病例的中毒剂量、急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分均无统计学差异,P>0.05.根据白陶土胃管灌注时间分为3组,其中灌注时间t≤6 h的A组16例、6 h<t≤12 h的B组12例以及t>12h的C组11例.观察3组患者多器官功能障碍(MODS)的发生时间、例数和1周内的病死率.结果:A组出现MODS 12例,发生MODS时间为(3.21±0.54)d,1周病死6例;B组出现MODS10例,发生MODS时间为(2.53±0.37)d,1周病死5例;C组出现MODS10例,发生MODS时间为(2.61±0.52)d,1周病死5例.A组与B、c两组间MODS发生时间、MODS受损数间差异有统计学意义(P<0.01;P<0.05),1周病死率三组间差异有统计学意义(P<0.05);但B、C两组间差异无统计学意义(P>0.05).结论:早期给予大剂量白陶土胃管灌注能有效减轻或延缓患者病情进展.

Objective To study the effect of different paraquat(PQ) toxic doses on acute lung injury(ALI) and pulmonary fibrosis(PF) in rabbits. Methods Thirty-six adult New Zealand rabbits were randomly divided into three groups according to different doses of paraquat given via grastric canal:group A(8 mg/kg,n=12) ,group B(16 mg/kg,n=12) and group C(32 mg/kg,n=12) . The animals were sacrificed after 7 d poisoning. The upper lobe of lung was removed for HE and Masson staining. The ALI score and PF condition were analyzed and compared. Results The ALI score in Group A [(8.33±1.03) points] were higher than group B [(9.83±1.17) points,P=0.047] and group C [(11.50±1.38) points,P<0.01]. The difference between group B and C also showed statically significant(P=0.03) . The PF degree in group A(31.09±2.05) % was lower than group B [(34.37±1.62) %,P=0.002] and group C [(36.54±0.44) %,P<0.01]. There is also markedly difference between group B and C(P=0.026) . Pearson correlation analysis showed that different doses of PQ were significantly related with ALI and PF. Conclusions With the toxic dose increasing,the rabbit ALT and the pathological changes of PF become more apparent. PQ doses were closely correlated with ALI and PF.

Objective To analyze the early stage of acute paraquat poisoning in patients with cardiac,liver and renal function changes and their implication in prognosis.Methods 68 cases of patients with acute paraquat poisoning(poisoning time 24 h) were diagnosed for the levels of myocardial enzymes,admission serum alanine aminotransferase(ALT),Total bilirubin(TBil),Blood urea nitrogen(Bun),Creatinine(Cr) and chest X-ray.The toxic dose and exposure time were recorded and convert to APACHE II score.Based on clinical outcomes the patients were divided into sudden cardiac death group(survival time ≤24 h group) and non-sudden cardiac death group(survival time 24 h group).Results Poisoning in patients with sudden death group and non-sudden cardiac death group the time of exposure and poisoning doses have significant differences(P0.05,P0.01),but not for the age,sex ratio and APACHE Ⅱ score(P0.05).The serum levels of ALT,TBil and Cr in the sudden cardiac death group were significantly increased when compared with those in the non-sudden cardiac death group(P0.01).Conclusion Early stage of paraquat poisoning demonstrated myocardial,liver and kidney damage.Protection of the major organs and early intervention should be emphasize in the recurring process.The elevation of serum myocardial enzyme could be the warning symptom of sudden death.

目的分析影响急性百草枯中毒患者猝死的相关因素。方法回顾性分析68例急性百草枯中毒患者的中毒时间、中毒剂量、入院时X线胸片、心肌酶、肝肾功能和外周血白细胞计数以及动脉血气分析等生化指标,将中毒发生后至死亡(生存时间)≤24 h的患者定义为猝死组,自中毒发生后至死亡(生存时间)>24 h的患者定义为非猝死组。结果猝死组中毒时间、中毒剂量分别为[(10.1±3.8)h、(81.3±51.6)ml],与非猝死组[(6.4±1.2)h、(36.2±20.3)ml]比较,差异均有统计学意义(P<0.05或P<0.01)。猝死组患者乳酸脱氢酶(LDH)活力为(368.5±51.2)U/L,α-羟丁酸脱氢酶(α-HBDH)活力为(325.1±46.2)U/L,肌酸激酶(CK)活力为(427.6±59.8)U/L,肌酸激酶同工酶(CK-MB)活力为(54.1±9.3)U/L,丙氨酸转氨酶(ALT)活力为(59.1±20.5)U/L,总胆红素(TBil)、肌酐(Cr)水平及外周血白细胞计数[(61.5±35.3)U/L,(282.1±22.9)μmol/L,(28.3±12.5)×10 9 /L]均明显高于非猝死组,差异均有统计学意义(P<0.01);两组患者的pH、PaO 2 、PaCO 2 、氧合指数间比较,差异无统计学意义(P>0.05),猝死组患者碱剩余(BE)为(-7.8±1.1)mmol/L,明显低于非猝死组,差异有统计学意义(P<0.01)。结论中毒时间长、服毒剂量大以及早期严重的心肌、肝肾功能损害、外周血白细胞升高和严重酸中毒是百草枯中毒患者猝死的危险因素。

Objective:To investigate the effects of high-dose ambroxol on serum TNF-α and IL-6 of patients with pulmonary injury caused by acute paraquat poisoning. Methods:Thirty-one patients with pulmonary injury caused by acute paraquat poisoning were randomly divided into treatment group (n=16) and control group (n=15). Both groups were treated with conventional therapy. Treatment group were given ambroxol 20 mg/(kg·d)intravenously guttae every 12 h for 3 days. Serum TNF-α and IL-6 were measured by ELISA before and after treatment,and lung injury score (LIS) was also assessed in all subjects. Results:Levels of serum TNF-α and IL-6,and LIS in both groups were significantly lower after treatment(P0.01). Furthermore,treatment group showed significantly more lower than control group (P0.05). Conclusion:High-dose ambroxol can inhibit exrpression of serum TNF-α and IL-6,reduce the degree of pulmonary injury caused by acute paraquat poisoning.

百草枯(paraquat,PQ)属季胺类高效广谱除草剂,是目前使用最为广泛、也是毒性最大的除草剂之一[1].中毒事件有逐年增多趋势,可导致多器官功能障碍/衰竭,国内报道的死亡率高达25%～76%[2],国外为85%～95%[3],甚至部分中毒患者呈"闪电样"猝死(sudden cardiac death,SCD).