目的:探讨分析血液灌流联合血液滤过强度对百草枯中毒生存状况影响.方法:选取本院收治的百草枯中毒患者50例,随机法分为观察组和对照组,每组各25例,两组均给予血液灌流联合血液滤过治疗,观察组洗胃后进行7次血液灌流,每天1次,每天1次血液滤过,而对照组仅给予1次血液灌流,每天1次血液滤过,对两组患者不同时间段血清百草枯水平进行比较,观察对比两组死亡率.结果:两组在血液灌流前、后即刻血清百草枯水平无明显差异(P>0.05),而血液灌流后24 h、48 h的百草枯水平两组较灌流前均有明显改善,但观察组患者改善程度更高(P<0.05),治疗48 h后观察组血液乳酸、肌酐改善程度优于对照组,观察组的总体死亡率稍低于对照组(P>0.05),且死亡患者生存时间延长.结论:对百草枯中毒患者增加高强度血液灌流联合血液滤过治疗能够改善病情,提高血清百草枯的清除效果,对预后有着明显的改善作用.

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.