Castro Rui, Prata Catarina, Oliveira Luis, Carvalho Maria João, Santos Josefina, Carvalho Félix, Morgado Teresa
Serviço de Nefrologia, Centro Hospitalar Vila Real, Peso da Régua.
Acta Med Port. 2005 Nov-Dec;18(6):423-31. Epub 2006 Mar 6.
In the northeast of Portugal, paraquat intoxication is common. We report 31 patients, admitted at our institution from April 1997 to June 2004, with suspected paraquat intoxication. Thirty cases had suicidal intention and all have ingested the toxic by mouth. Treatment consisted of skin and digestive decontamination with gastric washing and activated charcoal or Fuller's Earth. The first medical care was performed after 1 h 14 min at median [9 min-11 h 26 min]. By laboratory measurement (n=13) and/or clinical observation (n=11) it was possible to confirm the gastrointestinal absorption of paraquat for 24 patients (17 male-7 female; 49 +/- 17 years). The estimated ingested volume was higher for 15 non-survivors relatively to nine survivors (170 +/- 60 mL vs 25 +/- 10 mL; P<0,001). Initial serum paraquat of seven non-survivors was also higher than the serum level of six survivors (8.3 +/- 6.9 mg/L vs 0.4 +/- 0.3 mg/L; P < 0.01). Remarkably, all patients with serum paraquat higher than 1.7 ml/l did not survived. The paraquat urine level, simultaneous to the first serum determination, was higher for six survivors (38 +/- 37 mg/L) comparing with four non-survivors patients (465 +/- 536 mg/L; P<0.04). Hemoperfusion with activated charcoal was performed after December 1997 until June 2004 for 25 patients. Twenty of the 24 patients confirmed for paraquat intoxication were treated with this technique (12/15 of the non-survivors and 8/9 of the survivors; p=NS). Total number of sessions was identical (2.0 +/- 1.0 vs 1.5 +/- 1.2; P=NS), total time of hemoperfusion was higher (7 h 58 min vs 5 h 37 min; P=0.07) but the beginning of the first session was later (7 h 44 min vs 4 h 18 min; P=0.04) for the survivors. Clinical signs and laboratory analysis were collected at admission trying to detect markers of prognostic survival value. Hypernatremia, hypokaliemia, hyperglycemia and acute renal failure were more frequent for non-survivors (P<0.05) but the variable timing of the first laboratorial determination jeopardize our analysis, perhaps excluding acute renal failure. Rapid evolution to shock, lead to death for seven patients at the first day of admission and to another four deaths at the next day. Median survival of non-survivors was 1.2 days [0.1-13.2]. Evolution to pulmonary fibrosis for the nine survivors was not investigated (median follow-up: 14 days [2-1053]). Paraquat intoxication was highly lethal, leading to a 63% mortality rate of our patients. Hemoperfusion did not reveal any survival advantage for our patients.
在葡萄牙东北部，百草枯中毒很常见。我们报告了1997年4月至2004年6月期间在我院收治的31例疑似百草枯中毒患者。30例有自杀意图，均经口摄入毒物。治疗包括用洗胃、活性炭或富勒土进行皮肤和消化道去污。首次医疗护理在中位数时间1小时14分钟[9分钟 - 11小时26分钟]后进行。通过实验室检测（n = 13）和/或临床观察（n = 11），确诊24例患者（17例男性 - 7例女性；49 ± 17岁）存在百草枯胃肠道吸收。15例非幸存者的估计摄入量高于9例幸存者（170 ± 60毫升对25 ± 10毫升；P < 0.001）。7例非幸存者的初始血清百草枯水平也高于6例幸存者（8.3 ± 6.9毫克/升对0.4 ± 0.3毫克/升；P < 0.01）。值得注意的是，所有血清百草枯高于1.7毫升/升的患者均未存活。首次血清测定时，6例幸存者的百草枯尿水平（38 ± 37毫克/升）低于4例非幸存者患者（465 ± 536毫克/升；P < 0.04）。1997年12月至2004年6月期间，25例患者进行了活性炭血液灌流。24例确诊百草枯中毒的患者中有20例接受了该技术治疗（非幸存者中的12/15和幸存者中的8/9；p = 无统计学差异）。总疗程数相同（2.0 ± 1.0对1.5 ± 1.2；P = 无统计学差异），血液灌流总时间更长（7小时58分钟对5小时37分钟；P = 0.07），但首次疗程开始时间对幸存者来说更晚（7小时44分钟对4小时18分钟；P = 0.04）。入院时收集临床体征和实验室分析结果，试图检测具有预后生存价值的标志物。高钠血症、低钾血症、高血糖和急性肾衰竭在非幸存者中更常见（P < 0.05），但首次实验室测定时间不一影响了我们的分析，可能排除急性肾衰竭。迅速进展为休克，7例患者在入院第一天死亡，另外4例在第二天死亡。非幸存者的中位生存期为1.2天[0.1 - 13.2]。未对9例幸存者的肺纤维化进展情况进行调查（中位随访时间：14天[2 - 1053]）。百草枯中毒致死率很高，导致我们的患者死亡率达63%。血液灌流未显示对我们的患者有任何生存优势。
