摘要：
目的 分析97例急性百草枯中毒患者的临床资料,探讨应用序贯式全胃肠道灌洗法治疗急性百草枯中毒的疗效.方法 将符合研究条件的97例急性百草枯中毒患者,随机分成常规治疗组(48例)和序贯治疗组(49例).常规治疗组给予洗胃机清水洗胃.洗胃后给予蒙脱石散30 g+活性炭30g+甘露醇清除肠道毒物,每天1次,连用5d.序贯治疗组先给予蒙脱石散60 g口服,采用小容量低压人工洗胃,2.5％碳酸氢钠碱性液体作为洗胃液.洗胃后给予活性炭30 g、蒙脱石散30 g、聚乙二醇电解质溶液口服进行全胃肠道灌洗,每天1次,连用5d.两组均给予大剂量糖皮质激素、血液灌流、抗氧化等治疗方案.观察患者第1、3、5、7、10天时血钾、血淀粉酶(AMY)、丙氨酸转氨酶(ALT)、总胆红素(TBIL)、尿素氮(BUN)、血肌酐(Cr)、乳酸(LAC)、氧分压(PaO2)水平,记录两组患者通便时间、病死率和病死患者存活时间.结果 序贯治疗组患者中出现低血钾(＜3.5 mmol/L)、AMY(＞110 U/L)所占比例低于常规治疗组,差异有统计学意义(P＜0.05);ALT(＞80 U/L)、TBIL(＞34.2 μmol/L)、BUN(＞7.2 mmol/L)、Cr(＞177 μmol/L)患者所占比例低于常规治疗组,但差异无统计学意义(P＞0.05);ALT、TBIL、BUN、Cr、Lac的最高值比常规治疗组低,差异有统计学意义(P＜0.05);序贯治疗组患者的PaO2(＜60 mmHg)所占比例、平均通便时间、病死率低于常规治疗组,序贯治疗组死亡患者存活时间高于常规治疗组,差异均有统计学意义(P＜0.05).结论 序贯式全胃肠道灌洗法在急性百草枯中毒早期应用可缩短排便时间,减轻中毒患者肝、肾、肺、胰腺等脏器损伤程度,降低病死率,延长病死患者生存时间.%Objective To explore the clinical efficacy of early application of sequential gastrointestinal lavage in patients with acute paraquat poisoning by analyzing the clinical data of 97 patients.Methods A total of 97 eligible patients with acute paraquat poisoning were divided into conventional treatment group (n=48) and sequential treatment group (n=49).The conventional treatment group received routine gastric lavage with water.Then 30 g of montmorillonite powder,30 g of activated charcoal,and mannitol were given to remove intestinal toxins once a day for five days.The sequential treatment group received 60 g of montmorillonite powder for oral administration,followed by small-volume low-pressure manual gastric lavage with 2.5％ bicarbonate liquid.Then 30 g of activated charcoal,30 g of montmorillonite powder,and polyethylene glycol electrolyte lavage solution were given one after another for gastrointestinal lavage once a day for five days.Both groups received large doses of corticosteroids,blood perfusion,and anti-oxidation treatment.The levels of serum potassium,serum amylase (AMY),alanine aminotransferase (ALT),total bilirubin (TBIL),blood urea nitrogen (BUN),creatinine (Cr),lactate (Lac),and PaO2 of patients were determined at 1,3,5,7,and 10 days.Laxative time,mortality,and survival time of dead cases were evaluated in the two groups.Results The incidence rates of hypokalemia (＜3.5 mmol/L) and AMY (＞110 U/L) were significantly lower in the sequential treatment group than in the conventional treatment group (P＜0.05).There were no significant differences in the incidence of ALT (＞80 U/L),TBIL (＞34.2μmol/L),BUN (＞7.2 mmol/L),and Cr (＞177 μmol/L) between the two groups (P＞0.05).However,the highest levels of ALT,TBIL,BUN,Cr,and Lac were significantly lower in the sequential treatment group than in the conventional treatment group (P＜0.05).Moreover,the sequential treatment group had significantly lower incidence of PaO2 (＜60 mmHg),shorter average laxative time,lower mortality,and longer survival time of dead cases than the conventional treatment group (P＜0.05).Conclusion The early application of sequential gastrointestinal lavage can shorten laxative time,alleviate organ damage in the liver,kidney,lung,and pancreas,reduce mortality,and prolong the survival time of dead cases in patients with acute paraquat poisoning.
