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?????? ??????????????????????????????????? ??????144???????????????????????????(????????)?????????????????????? ????????????????????????????5?????????????????2?????????DIC????? ??????????????????????????????????????????????????????????
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1 ????
1.1 ????
???2007?1??2011?2????????144??????????????135??????????97??????47????0.98-2.5kg?137??????????7??????
1.2 ????
???????????????????????????(???????)?????????????????????????(NCPAP)?
2 ??
2.1 ????
??????????????????????????????[1]????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????;???????????????????????????????????????????????????????????????????????????????????????????????????????????????????24???????????????????????????????????????????????
2.2 ????????????
????????????????????????????????????????????
[2]?[3]??????????????????????????????????????37???
???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????6?8???????????????????
2.3 ???????
????????????????????????????????????????????????????????????????????????????????????????????????????????;???????????????????????????????????;??????????????????????????SaO2???88%-93%?????????????????????????????????????????????????????????????????????????;??????????????????????????????????????????????????????????????
2.4 ??????
??????????????????????????????????????????????????????????????????????????????????????????????24??????????????????????24?????????????????????????????????????????[4]???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
2.5 ????
???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
3 ??
?????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
??????
[1]???????????????.?????????????????[J]??????????2007,14(4)?322-323.
[2]???.???????????????????????[J]????????2009,18(11)?1920-1921.
[3]???.???????????????????????????????[J]??????2009,7(34)?3117-3119.
[4]???????????????.???????????[J]??????2011?32(2)?377-
?????????
??????????????????
??????
??:?????????????????,????????????,????????????????????????????????????????,????????????????,???????????,?????????????????:????;????;???
?????????,????????????2005????????????????:?????????????????????20??30?,??????????????5???[1]?????,??????????????????????????????????????????????????????,80%??????????????????
1 ??????????????????????
????(Doctor-patient Communication) ?????????????,??????????????????????,??????,???????????????????????????????????,????????????????,????????????????????,??????????????????,????????????????????????????????
2????????????????
2.1 ???????????????
????,?????????????????,????????????????,?????????????????????,????????????????????????,???????????????????,??????????????????????,????????????????????????????,?????????????????????
2.2??????????
????,????,??????????????????????????????????????????????????????????????,??????????????????????????????????,?????????????,?????????,??????????????????,???????????,??????????????????????,??????????,????????????????,??????????????
2.3 ?????????
???????,??????????,???????????????????
???????????????????,?????????,?????????,???????????[2]?????????????????????????????????,??????????????????????????,??????????????????????????,??????????????,??????????,???????????,???????????????????
2.4 ??????,?????????
????,????????????????????,?????????????????????????,????????????????????????????????,???????????????????????????????????????,???????????????????????????,??????????????????????,??????????,?????,???????????????????????????????,??????????[3]
2.5???????????????
??(case history)???????????????????,??????????????????????????????????????????,??????????????????????????????????,??????????????????????????????????????,????????????????????????????????????????????????????????????,???????,???????????;??,?????????????????????????;??,???????,?????????????,??????,????;??,???????????,???????????,??????????
2.6 ?????????
????????????????????????????,??????????????????????????,??????????????????????????????,??????????????????????????????,??????????????,?????????????????[4]?
2.7 ??????????
???????????????????????????????,??????,????,??????????????????????????,????????????,???????????????
3 ????*?/?*?*?*?*?*???*?*?*? ????? ??? *1732*986*963
??????????????,???????????????????????????????,?????????,???????????????????????,??????????????????????????????????,???????????????,????????,??????????????????
???
????:
[1]???.??????????????[J].????????,2007,24:21-24.
[2]???.????????????[J].????????,2007,28(5):378-380.
[3]??.???????????????[J].????????,2011,???????:377-378.
[4]??.???????????[J].????,2010,10.
?????????
??
??
????13???????????????
??????????????CT????
?????????????????4?????
??????????MR?????????
?????????10???????????????
???????????????????????????????
??????????????21?????
???13???????????????
???? ?? ???????????????????????? ????2001?7??2009?1?????13???????????????????????????????????????? 13??????????????????????????????????????????????????????????????????????13?????1?28d?3????7??????3??????????? ?????????????????????????????????????????????????????????????????????????????????????????????????????
????? ??? ?? ????
????????????????????
Analysis therapy of thirteen patients about acute paraquat poisoned ?Zhang Hu et al. Emergercy Medical Department?The First Affiliated Hospital?Wenzhou Medical College?Wenzhou 325000?China
?Abstract?Objective To investigate clinical and therapy about acute paraquat poisoned persons. Methods Review from July 2001 to Jan. 2009, thirteen patients about acute paraquat poisoned, to summarize their clinical and therapy. Results After acute paraquat poisoned thirteen patients appearanced oralis indisposition, nausea, vomit, then appearanced multiple organ functional defect, such as dyspnea, oliguria. Treated with gastric lavage, hemoperfusion, glucocorticoid and so on. www.Lunwen.cm Amongst Twelve patients, three patients were cure, seven patients death in hospital, three patients gave up treating then death out of hospital. Conclusion Paraquat toxicity is fierceness, appearance multiple organ failure, Person after paraquat poisoned fatality very high.,We dont have effective methords to Paraquat toxicity till now . Its important to take optimistic therapy,,such as take Hemoperfusion or Hemodialysis as soon as possible, a large doze of hormone.andantioxidant.after Paraquat toxicity
?Key words?paraquat intoxication hemoperfusion
???(paraquat, PQ) ??????????????????????????????????????????????????????2001?7??2009?1?????????????13????????????????????????1 ????
1.1 ????
???????????13???6???7???????3510.5???11??????2??????4??????????????????1????2???????????1?????????2??????11????20%???????????6???10?20ml?7???21?60ml?????????8h??????12??1?2d???1??2?7d???1??11????????????1.2 ???????
13?????1?2d ??????????????????????????????
?????????????2???15.38%????4???30.77%????6???46.15%????20????10?20ml?6????1?????????????????????20????21?60ml?7???3d??????????????1.3????
????11??????????11.1?40.9 U/L???????11?????????????PaO2?38.7?79.5mmHg??????13???????180?1181?mol/L??11????????8.4?41.2mmol/L??????6???????2.63?3.37mmol/L??????7????????(186?735u/L)????????68?200?mol/L???????5?CK?87?175u/L??CK-MB?67?137u/L???????7????175u?1365u/L???????4?PT>15????CT???13??????????????????????????????3???????????1????????????????1.4 ??
1.4.1 ??????????11????????????????????2?????
?????????????????????????
1.4.2 ??????? 13???????(HP)???? ?YTS-200g??????????150?200ml/min???1?2??????2?3h???6?????????6?10??7??????????????1?5???????????????????(HD)?????(HF)?
1.4.3???? ?????????????80?240 mg/d??????????????????????C2.0?8.0g??1???????E0.2g??3????3?????????0.125mg??3?/d ????????6?????0.2?2.0g/d????
1.4.4 ???????? ??????????????????????????????????????????????????????????????????????????????????????????????????2 ??
13???10????3????20%???10?20ml?6???????3????3?????3??????????????????????????????????CT???????????3???<334?mol/L ????<20.0 mmol/L?????????????????????????????15?22d???????10?20ml?6??????3????21?60ml?7??????10??????????????????????????????1?5d????????3???3?5d??????????????????????7???????????MODS???
3 ??
???????????????????????????30????????????????????????????????????????????????????????13??????????????????????????????????????????????????????????????????????????????????
[1]
????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????
???????????????????????????????1?6g???????????????????????????????????????????????????????3????????????????????????????????????????????????????????????????????????????????????3???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????6?12h?????????2-3 h??1????????????????????????????????????????????????????????????????????3??????????????????????????6?10?????????????????????????????????????????????????????????????????????????????????????????????3??????????????????160?240mg/d??????????????????11?14????????????C??????????????????????Hong Saeyong?????C?????????????????????????????C????5?40?mol/L?????????????????????3???????C??6.0?8.0g/d???6?15??????????????????????????????????????????????????-???????????????????????????????????????????????-???????????????????LD50??????????????????13?????3???????????0.125 mg??3?/d??????1????2?????1?????20ml????????????????????13?????????????????2?????3??4??????????????????????????????????????????????????????????????????????????????????????????????
??????????????????????????????????????????????????????????????????????????????
[7][5][4][8][9][3][2]
???????????????????????????????????????? ????
[1] ???. ?????.? 11 ?. ???????????2002?763-764.
[2] Kaetsu A?Fukushima T?Inoue S?et al. Role of heat shock protein 60
(HSP60) on paraquat intoxication J Appl Toxicol?2001?21(5)?425-430.
[3] Lee SK?Ameno K?In SW?et al. Levels of paraquat in fatal intoxications. Int
J Legal Med?1999?112(3)?198-200.
[4] Hong SY?Yang JO?Lee EY?et al. Effect of haemoperfusion on plasma paraquat
concentration in vitro and in vivo.Toxicol Ind Health?2003?19?1??17-23.
[5] Sae Yong Hong?Jong Oh Yang? Eun Young Lee?et al . Effects of
N-acetyl-L-cysteine and Glutathione on antioxidant status of human serum and 3T3 fibroblasts. J Korea Med Sci?2003?18?5??649-654.
[6] Eddleston .M?Wilks .M.F?Buckley. N.A. Prospects for treatment of
paraquat-induced lung fibrosis with immunosuppressive drugs and the need for better prediction of outcome?a systematic review.Q J Med?2003 ?96?11?? 809-824.
[7] ????????????.??????????????????????[J].
?????????2005?15(2)?124-127.
[8] ???????????????????????????[J]?????????
??2004?16(7)?420?
[9] ??????????????113??????????[J]??????????
2006?26 (7)?542543?
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发表于 2019-9-13 23:46:11