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目的分析总结百草枯中毒患者早期肺损伤的临床特点和胸部X线或CT表现。方法 2009年1月至2012年6月间云南省第二人民医院急诊内科收治34例口服百草枯中毒患者,均于入院后24 h内给予胸部X线或CT检查,并于入院后48 h、72 h、5 d、7 d、10～14 d复查胸部X线或CT,追踪观察肺部损伤情况及治疗效果。结果经洗胃、导泻,血必净、血液灌流、激素、免疫抑制剂等方法综合救治5～14 d,10例患者各项检查指标恢复正常治愈出院,18例患者肝脏、肾脏、凝血系统功能障碍、肺渗出和早期肺纤维化不同程度改善好转出院,追踪随访6例患者死于呼吸衰竭,占本组病例的17.6%。结论急性百草枯中毒病程变化迅速,病死率高,尽早采取综合抢救措施,可提高早期治愈率,使肺、肾、肝脏功能障碍得到改善和恢复。肺损伤的胸部X线或CT表现与其病理过程有较好的一致性,及时复查对比,对分析临床转归和预后具有积极意义。
Objective To analyze and summarize the clinical features and chest X-ray or CT findings of early lung injury in patients with paraquat poisoning. Methods From January 2009 to June 2012, 34 cases of oral paraquat poisoning were admitted to Department of Emergency Medicine of Second People’s Hospital of Yunnan Province. All cases were given chest X-ray or CT within 24 hours after admission. At 48 hours after admission, 72 h, 5 d, 7 d, 10 ~ 14 d chest X-ray or CT review, follow-up observation of lung injury and treatment. Results After gastric lavage, catharsis, blood purification, hemoperfusion, hormones, immunosuppressive agents and other methods, the patients were treated for 5 to 14 days. All the 10 patients returned to normal and were discharged. 18 patients had liver, kidney and coagulation system Dysfunction, pulmonary exudation and early pulmonary fibrosis improved to varying degrees improved discharge, follow-up of 6 patients died of respiratory failure, accounting for 17.6% of this group of patients. Conclusion The course of acute paraquat poisoning changes rapidly and the mortality rate is high. Comprehensive early rescue measures can be taken to improve the early cure rate and improve and recover lung, kidney and liver dysfunction. Lung injury chest X-ray or CT performance and its pathological process has a good consistency, timely review and comparison, analysis of clinical outcome and prognosis have a positive meaning.