Treatment of "hydration therapy" for acute paraquat poisoning / 中华危重病急救医学

Objective:To explore the clinical value of "hydration therapy" in the treatment of severe acute paraquat poisoning (APP).Methods:A prospective historical control observation was conducted. Fifty-eight patients with severe APP admitted to Shouguang People's Hospital Affiliated to Weifang Medical College from February 2014 to June 2019 were enrolled. Twenty-six patients admitted before May 10th, 2016 were enrolled in the standard treatment group. After being admitted to intensive care unit (ICU) from the department of emergency, patients in the standard treatment group were immediately given standard treatment such as repeated gastric lavage, catharsis, adsorption of poison by activated carbon or montmorillonite powder, drug treatment and blood purification. From May 10th, 2016, 32 patients were enrolled in the intensive treatment group. On the basis of standard treatment, "hydration therapy" was carried out, that was, 0.9% NaCl and/or 5% glucose injection were used for continuous intravenous infusion throughout the day, so as to ensure that the total amount of fluid infusion per day reached 200 mL/kg within 48-72 hours after ICU admission. At the same time, furosemide was used to strengthen diuresis to ensure the balance of water and electrolyte. If heart failure or acute pulmonary interstitial edema occurred during the treatment, "hydration therapy" should be stopped immediately. Six months after treatment, all patients were followed up. The patients with normal activity, no complaints of discomfort and no damage of heart, lung, liver, kidney and other organs were regarded as cured. The therapeutic effect of "hydration therapy" was evaluated.Results:There was no significant difference in gender, age, dosage or time from taking poison to ICU between the two groups. In the intensive treatment group, 32 patients did not appear heart failure during continuous rehydration treatment. Follow-up after 6 months showed that the overall cure rate in the intensive treatment group was significantly higher than that in the standard treatment group [59.4% (19/32) vs. 19.2% (5/26), P < 0.05]. In the 6-month follow-up, there was no significant difference in age or time from taking poison to ICU between the two groups, but the dosage in the intensive treatment group was significantly higher than that in the standard treatment group (mL: 54.06±26.03 vs. 23.00±4.47, P < 0.05). After 6 months of follow-up, chest CT showed that the lesions of pulmonary fibrosis of cured patients in both group gradually reduced with time, not completely progressive and irreversible. Conclusion:"Hydration therapy" with intensive diuresis can significantly improve the rescue success rate of patients with severe APP.

Prognosis value of urine paraquat semi-quantitative in the patients with acute paraquat poisoning / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To investigate the relationship between semi-quantification of urine paraquat and the severity of acute paraquat poisoning, and to evaluate the prognostic value of the test in patients with acute paraquat poisoning.</p><p><b>METHODS</b>A total of 179 patients with acute paraquat poisoning were categorized into four groups according to their semi-quantification results of urine paraquat: +group (n = 36), ++group (n = 23), +++ group (n = 25), and ++++group (n = 95). The clinical features, severity of hepatic and renal injuries, respiratory failure, and clinical classification were compared between these four groups. Kaplan-Meier analysis was used to evaluate the survival rate.</p><p><b>RESULTS</b>The 60-day mortality was 45.25% (81/179). The amount of ingestion increased significantly from +group to ++++group (P < 0.05). No patient in +group was found to have serious complications, while most patients in ++++group suffered organ dysfunction or even organ failure. The incidence of acute respiratory failure, renal failure, and hepatic failure in ++++group was significantly higher than that in +group, ++group, and +++group (P < 0.05). The urine paraquat concentration was positively correlated with the clinical severity of acute paraquat poisoning (Spearman correlation coefficient = 0.720, P < 0.01). Kaplan-Meier survival analysis showed that the mortality of ++++group (73.7%) was significantly higher than that of +++group (40%), ++group (4.3%), and +group (0%) (P < 0.05).</p><p><b>CONCLUSION</b>The semi-quantification of urine paraquat is a promising test in evaluating the severity of acute paraquat poisoning. This test can be used to guide therapy and to predict the outcomes of patients suffering acute paraquat poisoning.</p>

Study on the effect using hemoperfusion to treat tetramine poisoned patients / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To evaluate the effect of hemoperfusion on tetramine poisoned patients.</p><p><b>METHODS</b>Three tretramine poisoned cases treated with hemoperfusion were selected. The samples during and after hemoperfusion were collected and analyzed by gas chromatography.</p><p><b>RESULTS</b>Tetramine concentration at the inlet of the artificial kidney kept the same level during hemoperfusion. After hemoperfusion, the tetramine concentration in patient plasma changed little in 72 hours. 1.03-1.55 mg of tetramine was adsorbed by the instrument of hemoperfusion after two hours' hemoperfusion.</p><p><b>CONCLUSION</b>Although hemoperfusion was not so effective to reduce blood tetramine concentration in patients, it could clear about 1 mg tetramine for one time.</p>