| Background:Paraquat can quickly kill the green vegetation, quickly lost to the soil, almost to the atmosphere, water, soil and so no residue, and no residue into the subsequent cultivation of agricultural products. China is the paraquat production big country, the in our country has unique application value:increase the multiple cropping index and crop rotation:, intercropping interplanting, protective tillage, weeding in forests, increase soil biodiversity. Paraquat is currently on the market destroy selective herbicide in the best cost-effective products and has a good economic benefit in agricultural production, including China, many in Asia, the Americas and other agricultural countries is widely used in agricultural production. At present, almost everybody can very easily buy paraquat and the lack of awareness of paraquat toxicity, in agricultural production in the door, improper operation, there are some paraquat manufacturer causes the paraquat poisoning in our country is not only a medical problem, but a complex social problems. The multiple poisoning clinical treatment of paraquat poisoning toxicity mechanism of basic research and clinical treatment work has never stopped, the paraquat poisoning mortality decreased gradually, more and more patients get effective treatment. Paraquat can be distributed almost all the tissues and organs in the whole body through the blood circulation. Paraquat damage to the body of the clinical manifestations in accordance with the different severity of poisoning, poisoning, a huge amount of people can quickly die. No matter what the way paraquat was absorbed by the body, paraquat concentrations in the lungs can be several times more than other organs, and can be much higher than the blood concentrations of the same period. The active uptake and accumulation of paraquat in lung tissue is one of the important reasons of paraquat induced lung injury. Paraquat can be distributed almost all the tissues and organs in the whole body through the blood circulation. Paraquat damage to the body of the clinical manifestations in accordance with the different severity of poisoning, poisoning, a huge amount of people can quickly die. No matter what the way paraquat was absorbed by the body, paraquat concentrations in the lungs can be several times more than other organs, and can be much higher than the blood concentrations of the same period. The active uptake and accumulation of paraquat in lung tissue is one of the important reasons of paraquat induced lung injury. " Taishan expert consensus " in the course of paraquat poisoning in the D-dimer changes, lung injury degree, the relationship between the microcirculation disturbance. This study to " Taishan expert consensus " as the starting point, of paraquat poisoning patients clinical data were observed and analyzed, the key dynamic observation of D-dimer body in paraquat poisoning the development law of the patients during the course of the disease in different periods of variation and chest CT changes and investigate the effects of anticoagulant therapy in the important significance in the treatment of paraquat poisoning. There is no independent study on the correlation of the D-dimer accumulation of paraquat poisoning.Objective:The clinical data were analyzed on paraquat poisoning patients clinical data were observed and analyzed, the key dynamic observation of D-dimer body in paraquat poisoning the development law of the patients during the course of the disease in different periods of variation and chest CT changes and investigate the effects of anticoagulant therapy in the important significance in the treatment of paraquat poisoning.Method:Materials and methods one:in 2015 from January to December in Shandong University Qilu Hospital poisoning and occupational diseases treatment of paraquat poisoning patients, choice of treatment improved survival of patients with 69 cases, to detect the D-dimer for poisoning group values. In addition, we selected 69 cases of normal physical examination in our hospital during the period from cases of D-dimer. All cases of poisoning in first days, third days, seventh days, fourteenth days, twenty-first days of the determination of D-dimer, after discharge in January, when the re inspection of D-dimer. Detection of all D-dimer was completed in the Department of laboratory, Qilu Hospital, Shandong University. Normal reference value of 0-0.5 mg/ ml, greater than 0.5 mg/ml for D-dimer increased, the data used spss22.0 statistical software for statistical analysis, measurement data using mean± standard deviation (SD) said, to P< 0.05 were considered statistically significant. Poisoning group different test date of D-dimer value and control group were compared and of poisoning groups of different test date D-dimer between the values were statistically analyzed, and the Pearson correlation analysis test poisoning group D-dimer values correlated with the number of days.Materials and methods two:All poisoning were divided into two D-dimer in normal group and abnormal group two D-dimer. By grouping, two D-dimer in patients with normal group for 30 cases, two D-dimer group with abnormal for 39 cases. The changes and differences of CT signs in the course of disease in two groups of patients were compared. Taking the normal and abnormal D-dimer as the factors, the analysis of the variance of the single factor analysis of the chest CT performance.Result:1.①poisoning 1st day group D-dimer was obviously higher than that of control group D-dimer value. The 3 days group D dimer value is significantly greater than the control group D-dimer value.1 months group D-dimer value is significantly smaller than that of the control group of D-dimer values, the difference is statistically significant (P<0.05); the group of 7 days and 14 days group, the 21st day of group D-dimer value and control group D-dimer values showed no significant difference (P> 0.05).②Complex Ⅱ poisoning the 1 day group and the 3 days group D-dimer body value had no significant difference (P> 0.05); 7 days group D-dimer bulk value are significantly less than the 3 days group D-dimer body value, the difference was statistically significant (P< 0.05). The 14 day group D-dimer values were significantly greater than the 7 days group D-dimer value, the difference was statistically significant (P< 0.05). The 14 day group, the 21st day group D-dimer body value compared with significant difference (P< 0.05), and the 21st day group and 1 month review of group D-dimer body value compared with significant difference (P< 0.05), from the 14th day group, D-dimer body value decreased to 1 month investigation team dropped to lower than that of the control group.③There was a significant negative correlation between the value of D-dimer and the number of days in poisoning group, that is, with the increase of time, the value of D-dimer polymer of poisoning group had a significant overall downward trend.2.①The D-dimer in patients with normal group chest CT performance than D-dimer severe group with abnormal low level D-dimer was positively correlated with D-dimer levels in patients with lung injury in paraquat poisoning.②The degree of lung injury in paraquat poisoning and the absorbed dose was positively correlated.③With D-dimer in abnormal pulmonary fibrosis lesion occurred in paraquat poisoning.④Pulmonary fibrosis in patients with paraquat poisoning have the recoverability. Conclusion:In the course of paraquat poisoning patients, D- dimer was significantly elevated in the early stage of poisoning, and the degree of lung injury in patients with paraquat poisoning was positively correlated with the value of D- dimer. With the progress of treatment, the patient’s condition improved, poisoning patients with D-dimer values are apparent in the overall downward trend, this and paraquat poisoning survival in patients with chest CT signs of development and change in consistent, with patient global disease progression and prognosis. Poisoning in paraquat induced lung injury, two D- dimer abnormal pulmonary fibrosis lesion occurred earlier than. D-dimer increased on behalf of the coagulation and fibrinolytic fibrinolytic disorder is not accompanied by the appearance of alveolitis and pulmonary fibrosis lung injury, and of paraquat induced pulmonary damage occurrence, the development process played a very important role. This makes us realize that, through the anticoagulant therapy to prevent and delay the occurrence of lung injury, reduce the incidence of pulmonary fibrosis. Dissolution mechanism is very complex coagulation and fibrinolysis in patients with paraquat poisoning, still need a lot of basic and clinical research work. |
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