Study On The Progress Of The Lung Injury With Acute Qaraquat Poisoning Under Combined Therapy

Objective: Paraquat, which is used widely as a potent herbicide, is poisonous. Paraquat poisoning has caused a large number of human fatalities because there is no pharmacological antagonist or chelating agents and its irreversible pulmonary fibrosis. The lung is the primary target organ of paraquat. In the early period it shows acute lung injury, in the late period it shows pulmonary firbrosis. So chest radiographic tests have important significance in conduction of clinic therapy, evaluation of prognosis. Rensently, the combined therapy of paraquat poisoning is effective, which includes adrenal cortical hormone, cyclophosphamide, hemoperfusion and hemodialysis. The progress of the lung injury with acute paraquat poisoning under this combined therapy is no reported. So to analyze the progress of the lung injury with acute paraquat poisoning under combined therapy may help to judge the prognosis and to guide the treatment of adrenal cortical hormone and cyclophosphamide.Methods:The data of 73 patients with paraquat poisoning from February 2009 to December 2010 were reviewed retrospectively. The date includes CT, clinical data and the treatment of adrenal cortical hormone and cyclophosphamide. All 73 patients were famers. They took PQ orally and were treated within 12 hours and received the combined therapy. The combined therapy includes the gastric lavage, catharsis, and adsorption, hemoperfusion associated with hemodialysis, immunosuppressant, adrenal cortical hormone, and the drug of anti-free radicals, the drug of anti-inflammatory and some kinds of traditional Chinese medicines. 73 cases were divided into 3 types and 3 periods.Results: There were 6 cases in the light, included 4 male cases and 2 female cases, and the age was from 16 to 28 years old (mean 23). There were 49 cases in the medium and heavy, included 31 male cases and 18 female cases, and the age was from 14 to 59 years old (mean 30). There were 18 cases in the fulminant, included 8 male cases and 10 female cases, and the age was from 19 to 54 years old (mean 31). The main CT features include normal, exudation (ground-glass, opacity cloudy, opacitypatchy consolidation even consolidation), high density cable strip, hydrothorax, pleural thickening and so on. Most cases were accompanied by low-density in cardiac chambers, pericardial effusion. Small cases were accompanied by pneumothorax, mediastinal emphysemain.As follows①t he early period: cases in the light all showed normal. In the medium and heavy, no cases showed normal, 38 cases of exudation, 18 cases of hydrothorax, 20 cases of pleural thickening, 26 cases of high density cable strip. In the fulminant, no cases showed normal, 17 cases of exudation, 5 cases of hydrothorax, 6 cases of pleural thickening, 2 cases of high density cable strip, all patients died in the early period.②the middle period: in the light, 5 cases showed normal, 1 case of the image of fiber cord. In the medium and heavy, 7cases showed normal, 30 cases of exudation, 19 cases of hydrothorax, 16 cases of pleural thickening, and 23 cases of the image of fiber cord③the late period: in the light, all cases showed normal. In the medium and heavy, 18 cases showed normal, 23 cases of exudation, 4 cases of hydrothorax, 4 cases of pleural thickening, 14 cases of the image of fiber cord.2 cases in the medium ande heavy died in the late period.The days and dosage of methylprednisolone and cyclophosphamide were represented by x|ˉ±s. In the light: the days of methylprednisolone were 19.8±5.1 and the dosage was 4.89±1.51g. The days of cyclophosphamide were 10.3±2.5, and the dosage was 3.27±0.77g. In the medium and heavy: the days of methylprednisolone were 24.5±7.6, and the dosage was 5.58±2.21g. The days of cyclophosphamide were 11.7±3.8, and the dosage was 4.13±1.18g. In the fulminant the days of methylprednisolone were 4.6±1.7 and the dosage was 2.07±0.64g. The days of cyclophosphamide were 4.6±1.7, and the dosage was 2.61±0.85g. The mortalities of the three types are 0%, 4.1%, 100%.Conclusion: Under the combined therapy, most cases in the light show normol. Individuals show high density cable strip in the middle period, and soon back to normol. All cases were cured. Most cases in the medium and heavy show exudation or high density cable strip, get worse in the middle period, and then get better in the late period. Most patients survived. Almost all cases in the fulminant show exudation, and get worse quickly .About 3 days later the ground-glass could change to pervasive exudation even the consolidation. All cases in the fulminant died in the early period.