[目的]探讨碳酸氢钠溶液洗胃和后继的胃肠道碱化以及血液内环境碱化治疗急性百草枯中毒的疗效.[方法]选取本院47例百草枯中毒患者,依据其就诊时间分为两组.对照组16例应用常规清水洗胃,碱化组31例应用综合性碱化疗法.两组均给予血液灌流、肾上腺皮质激素等基础治疗.观察比较两组患者口腔溃疡、纵隔气肿的发生率和24 h、48 h、72 h,5d,7d,10 d,14 d的肝功能、肾功能、动脉血气、病死率的变化.[结果]碱化组口腔溃疡、纵隔气肿发生率低于对照组(P＜0.05)；在不同时间段的血肌酐、血清总胆红素水平明显低于对照组(P＜0.05).碱化组患者的动脉血氧分压的下降水平和速度较对照组平缓.碱化组患者各个时间段病死率和总病死率较对照组低.[结论]在百草枯中毒早期使用综合性碱化疗法可以促进患者胃肠道以及血液内环境中残余百草枯的分解,减轻百草枯对器官功能的损害,降低其病死率.%[Objective]To explore the efficacy of gastric lavage with sodium bicarbonate, subsequent gastrointestinal and blood internal environmental alkalization in the treatment of acute paraquat poisoning. [Meth-ods] A total of 47 patients with paraquat poisoning in our hospital were selected and divided into two groups by treatment time. The control group( n = 16) was treated with conventional gastric lavage, while the alkalization group( n =31) was treated with comprehensive alkalization therapy. Both groups were given basic treatments including hemoperfusion and adrenal corticosteroids. The incidences of mouth ulcer and pneumomediastinum and the variable trends of liver function, kidney function, arterial blood gase and the mortality at 24h, 48h, 72h, 5d, 7d, l0d and l4d in patients of two groups were observed and compared. [Results]The incidence of mouth ulcer and pneumomediastinum in alkalization group was lower than that in control group( P <0. 05). Serum creatinine and jaundice index at different time in alkalization group were obviously lower those in control group( P <0. 05). The decreasing amplitude and velocity in alkalization group arterial partial pressure of oxygen were milder than those in control group. Total fatality rate at different time in alkalization group was lower than that in control group. [Conclusion] Early comprehensive alkalization therapy for paraquat poisoning can promote the breakdown of residual paraquat in gastrointestinal tract and blood internal environment of patients, and reduce the damage of paraquat on organ functions and decrease the fatality rate.
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