ABSTRACT
Objective Prone position ventilation is one of the most important Methods for the treatment of acute lung injury/acute respiratory distress syndrome (ARDS). Currently, there are fewer researches on prone position ventilation for ARDS caused by acute paraquat poisoning. This article aims to evaluate the value of prone position ventilation in the treatment of moderate and severe ARDS caused by acute paraquat poisoning.Methods Retrospective analysis the clinical data of 43 patients with acute paraquat poisoning complicated with moderate-to-severe ARDS from January 2016 to December 2017 in the Department of Emergency Medicine, Eastern Theater of the Eastern Theater. The patients were divided into two groups according to whether they were in prone position ventilation: experimental group (prone position ventilation, n=13)and control group(no prone position ventilation, n=30). The gender, age, APACHEII score and plasma paraquat concentration of the two groups were statistically analyzed. The oxygenation index, respiratory rate, carbon dioxide partial pressure and mean arterial pressure were compared between the two groups during the first five days after hospitalization. At the same time, the hospital mortality, hospitalization time, mechanical ventilation time were also compared.Results Compared with control group, the oxygenation index (176±13) and carbon dioxide partial pressure \[(33.6±4.3) mmHg\] in the experimental group were significantly increased from the 2nd day to 5th day after hospitalization(P0.05).Conclusion Prone position ventilation is safe for patients with moderate to severe ARDS caused by acute paraquat poisoning, which improves oxygenation in these patients but fails to improve prognosis. It provides a theoretical basis for prone position ventilation in the treatment of acute paraquat poisoning complicated with ARDS.
ABSTRACT
Objective To study the expression of hypoxia-inducible factor-1 (HIF-1) in the brain tissue after the brain injury caused by acute organophosphate poisoning,and the interventional effect and mechanism of hyperbaric oxygen (HBO) therapy.Methods Sixty healthy male Sprague-Dawley rats randomly divided into a control group (n=6),a poisoning group (n=18),a routine group (n=18) and an HBO group (n=18) according to a random number table.Acute organophosphate poisoning was induced into all rats except those in the control group.The routine group was given penehyclidine hydrochloride and pralidoxime chloride for once,while the HBO group was provided with HBO therapy immediately on the basis of routine treatment.At 1,3 and 7 hours after acute organophosphate poisoning was induced,six rats were sacrificed at each time point and the blood samples were taken from inferior caval vein to measure the content of Malondialdehyde (MDA).The expression of HIF-1α mRNA in the brain tissue was detected by the quantitative real-time PCR,and that of HIF-1 protein was evaluated by immunohistochemical method.Meanwhile,pathologic changes of the brain tissues were observed using hematoxylin-eosin (HE) staining.Results Compared with the poisoning group,the pathological damage to cerebral tissues lessened in the HBO group.The expression of HIF-1 protein and HIF-1 mRNA of the poisoning and the HBO groups was significantly higher than the control group at 3 different time points.After the HBO treatment,the protein expression of HIF-1 lowered from 226.57 ± 57.49,to 205.91 ± 30.36 and further to 187.67 ± 29.25,while the MDA content decreased from 7.74 ± 0.14,to 7.40 ± 0.13 and later to 6.10 ±0.08,both were significantly lower than those of the poisoning group at all time points,with HIF-1 being 1305.67 ± 167.17,2667.83 ± 367.79 and 1709.24 ± 199.07,along with MDA content being 9.48 ± 0.05,11.56 ± 0.13 and 12.26 ± 0.14,and those in the routine group at the time points of 1 and 3 hour later (P ＜ 0.05).A positive correlation was found between the expression level of HIF-1 mRNA and level of MDA in the serum (r =0.909,P=0.000).Conclusion HIF-1 plays an important role in the development of brain injury caused by acute organophosphate poisoning.The efficacy of hyperbaric oxygen intervention against AOPP-induced brain injury is better than that of the routine treatment and its mechanism may be its antioxidation and inhibition of HIF-1 expression.
ABSTRACT
Objective To study the epidemiological characteristics of the acute toxicosis cases in a general hospital of a metropolis. Methods The prospective study was performed from Jan. 1st, 2005 to Dec. 31st, 2006 in acute toxicosis patients admitted during that period. The data analyzed included sex, age, occupation, onset time, poisoning cause, variety of poisons, way of poisoning, emergency diagnosis, emergency treatment, etc. Results There were 315 poisoning patients treated during the study period, accounting for 2.33‰ of the total patients visiting in the emergency department. Among these poisoning patients, the sex ratio (males vs females) was 1∶0.84. The age of most of the patients ranged from 20 to 29 (35.9%) years old. Alcohol was the major cause of poisoning (38.4%), followed in order by poisoning due to drugs (20.6%), food poisoning (18.1%), chemical poisoning (10.2%) and pesticide poisoning (5.7%). There was predominant time of the occurrence of poisoning in a year, but it was more frequent in January, February, June, July, November and December. 85.1% of patients were poisoned by oral route. The occupation of patients was mainly technical personnel (21.0%), followed in order by farmers and the laborers, self-employed businessmen, persons taking care of household chores and the unemployed, etc. 98.1% of patients survived in the hospital. Mortality rate was 1.9%. Conclusions Young persons and technical personnel constitute the high-risk group of patients with poisoning. The main poisons were alcohol, drugs, food and other chemical poisons. The main route of poison intake was the digestive tract. There is no obvious seasonal regularity.