Clinical Evaluation Of Paraquat Poisoning With Sequential Clearance Of Toxic Substances Therapy

Background: Paraquat (paraquat, PQ) is known as “duicaokuai、yisaoguang”, its20%solution is also called “kewuzong”, it’s chemical nameis1，1’-dimethyl-4，4’-bipyridylium dichloride which belongs to a class ofbipyridine herbicides. Its almost no contamination, so it is widely used. Inrecent years, paraquat poisoning (paraquat poisoning, PQP) morbidity has atrend of increasing year by year. PQP lethal dose is small and clinical progressis rapid and large doses of poisoning due to multiple organ failure rapidly todeath, a smaller dose poisoning often cause of late-onset pulmonary fibrosis,and ultimately died of respiratory failure. Currently PQ is the highest herbicidepoisoning mortality which survivals in the crowd the vast majority of patientswith pulmonary fibrosis and prognosis is poor. Therefore, seeking effectivetreatment measures actively, PQP reversal condition and reducing the mortalityrate is the current emergency field problems.Objective: By retrospective analysis with the clinical data of acute144cases of PQP patients, research on the clinical curative effect of sequentialblood purification treatment and the influence of the prognosis, to provide thetheoretical basis for clinical optimization of therapy.Method: A retrospective analysis of144cases of PQP patients treated inthe ICU of the second hospital in Jilin University and ICU of Jilin CentralHospital from January2005to January2012, according to the differenttreatment methods, it will be divided into conventional treatment group of42cases, blood purification group of59cases, intestinal canal purification groupof18cases, sequential clearance of toxic substances group of25cases.According to the PQP clinical classification criteria for144cases of PQP were divided into mild PQP14patients, moderate-severe PQP117patients, andfulminant PQP13patients. Observation of organ functions (arterial blood gasanalysis, liver function, renal function, myocardial enzyme changes andprognosis in patients with such) of patients with PQP in the first、third、fifth、seventh day, comparative analysis of four groups of PQP patients each viscerainjury severity, survival time and mortality differences. All data usingSPSS13.0software were packaged for statistical analysis. Counting data werecompared with χ2test； Measurement data using the means±standarddeviations(x±s) expresses，compared with independent sample t test betweenthe two groups and compared with single factor analysis of variance betweenthe four groups.Results:1. The conventional treatment group, blood purification group,intestinal canal purification group and sequential clearance of toxic substancesgroup of PQP patients were compared from age, sex, gastric lavage time,dosage, APACHE II score. The difference was not statistically significant (P>0.05); The four groups are comparable.2. Blood purification group andintestinal canal purification group of PQP patients viscera injury severity(PaO2, alanine aminotransferase, total bilirubin, CK-MB, creatinine) werelower than the conventional treatment group, sequential clearance of toxicsubstances group were significantly lower than the other three groups. Thedifference was significant (P <0.05); Blood purification group and intestinalcanal purification group had no significant difference (P>0.05).3. Bloodpurification group and intestinal canal purification group of PQP patients livelonger than the conventional treatment group, sequential clearance of toxicsubstances group were extended longer than the remaining three groups, andthere’s significant difference (P <0.05); Blood purification group andintestinal canal purification group survival time of PQP patients with nodifference (P>0.05).4.144PQP patients overall mortality rate between the four groups, and it’s no statistical difference (P>0.05).5. In the117moderate-severe PQP patients, sequential clearance of toxic substances groupfatality rate is lower than the other three groups, and the difference wassignificant (P <0.05); The conventional treatment group, blood purificationgroup, intestinal canal purification group, compare them one another, and it’sno statistical difference (P>0.05).Conclusion:1. Sequential clearance of toxic substances treatment can protecte viscerafunction of PQP patients (lung, liver, heart, kidney).2. Sequential clearance of toxic substances treatment can prolong thesurvival time of PQP patients.3. Sequential clearance of toxic substances treatment can reduce mortalityin the moderate-severe PQP patients, but cannot change the prognosis offnlminant PQP patients.4. Sequential clearance of toxic substances treatment of moderate-severePQP patients curative effect is superior to conventional treatment group, bloodpurification group, intestinal canal purification group.5. Sequential clearance of toxic substances treatment is recognized as theeffective means of treatment to moderate-severe PQP patients with Multipleorgan dysfunction syndrome (Multiple organ dysfunction syndrome,MODS).