Yamamoto I, Saito T, Harunari N, Sato Y, Kato H, Nakagawa Y, Inokuchi S, Sawada Y, Makuuchi H
Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Crit Care Med. 2000 Jun;28(6):1877-83. doi: 10.1097/00003246-200006000-00032.
To investigate the hemodynamics and oxygen metabolism of patients with varying degrees of severity of paraquat poisoning.
Prospective, observational, clinical study.
Intensive care unit in a university hospital.
Forty-three consecutive patients with paraquat and/or diquat poisoning were classified into three groups by the severity index of paraquat poisoning (SIPP; hr/mg/L).
Standard treatments included specific respiratory management, fluid resuscitation, and aggressive circulatory support.
Serum paraquat and diquat levels were measured at arrival, and SIPP was calculated. The cardiac index (CI), left ventricular stroke work index (LVSWI), systemic vascular resistance index (SVRI), oxygen delivery index (DO2I), oxygen consumption index (VO2I), and oxygen extraction ratio (O2ER) were measured at 6, 12, 24, 36, 48, 72, and 96 hrs postadmission. A significant inverse correlation between SIPP and survival time was found in 31 fatal cases (r = .85; p < .001). In the SIPP 10-50 group, CI, DO2I, VO2I, and O2ER were maintained at higher levels than in the SIPP group of <10 (p < .05), whereas SVRI decreased significantly (p < .05). In the SIPP group of >50, CI, LVSWI, SVRI, DO2I, and VO2I decreased, whereas O2ER had a tendency to increase progressively. There was a significant correlation between SVRI and SIPP, O2ER and SIPP, and O2ER and SVRI 24 hrs after admission, respectively (p < .001).
Paraquat poisoning is characterized by high oxygen consumption with high oxygen extraction, with the degree of derangement based on the severity index. The development of a marked imbalance between increased oxygen demand and decreased oxygen supply because of myocardial depression might be a possible cause of death in circulatory failure.
探讨不同程度百草枯中毒患者的血流动力学及氧代谢情况。
前瞻性、观察性临床研究。
某大学医院重症监护病房。
43例连续收治的百草枯和/或敌草快中毒患者，根据百草枯中毒严重程度指数（SIPP；小时/毫克/升）分为三组。
标准治疗包括特异性呼吸管理、液体复苏及积极的循环支持。
入院时测定血清百草枯和敌草快水平，并计算SIPP。入院后6、12、24、36、48、72和96小时测量心脏指数（CI）、左心室每搏功指数（LVSWI）、全身血管阻力指数（SVRI）、氧输送指数（DO2I）、氧消耗指数（VO2I）及氧摄取率（O2ER）。在31例死亡病例中发现SIPP与生存时间呈显著负相关（r = 0.85；p < 0.001）。在SIPP为10 - 50组中，CI、DO2I、VO2I和O2ER维持在高于SIPP < 10组的水平（p < 0.05），而SVRI显著降低（p < 0.05）。在SIPP > 50组中，CI、LVSWI、SVRI、DO2I和VO2I降低，而O2ER有逐渐升高的趋势。入院后24小时，SVRI与SIPP、O2ER与SIPP、O2ER与SVRI之间分别存在显著相关性（p < 0.001）。
百草枯中毒的特点是高氧消耗及高氧摄取，紊乱程度基于严重程度指数。由于心肌抑制导致氧需求增加与氧供应减少之间出现明显失衡，可能是循环衰竭死亡的一个潜在原因。
