Tang Xiao, Sun Bing, He Hangyong, Li Hui, Hu Bin, Qiu Zewu, Li Jie, Zhang Chunyan, Hou Shengcai, Tong Zhaohui, Dai Huaping
a Department of Respiratory and Critical Care Medicine , Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine , Beijing , China.
b Department of Thoracic Surgery , Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine , Beijing , China.
Clin Toxicol (Phila). 2015 Nov;53(9):908-13. doi: 10.3109/15563650.2015.1082183. Epub 2015 Aug 28.
Paraquat is a widely used herbicide that can cause severe to fatal poisoning in humans. The irreversible and rapid progression of pulmonary fibrosis associated with respiratory failure is the main cause of death in the later stages of poisoning. There are infrequent reports of successful lung transplants for cases of severe paraquat poisoning. We expect that this successful case will provide a reference for other patients in similar circumstances.
A 24-year-old female was sent to the hospital approximately 2 hours after ingesting 50 ml of paraquat. She experienced rapidly aggravated pulmonary fibrosis and severe respiratory failure. On the 34th day after ingestion, she underwent intubation and invasive mechanical ventilation. The patient was evaluated for lung transplantation, and veno-venous extracorporeal membrane oxygenation (ECMO) was established as a bridge to lung transplantation on the 44th day. On the 56th day, she successfully underwent a bilateral sequential lung transplantation. Through respiratory and physical rehabilitation and nutrition support, the patient was weaned from mechanical ventilation and extubated on the 66th day. On the 80th day, she was discharged. During the 1-year follow-up, the patient was found to be in good condition, and her pulmonary function improved gradually.
We suggest that lung transplantation may be an effective treatment in the end stages of paraquat-induced pulmonary fibrosis and consequential respiratory failure. For patients experiencing a rapid progression to a critical condition in whom lung transplantation cannot be performed immediately (e.g., while awaiting a viable donor or toxicant clearance), ECMO should be a viable bridge to lung transplantation.
百草枯是一种广泛使用的除草剂，可导致人类严重至致命中毒。与呼吸衰竭相关的不可逆且快速进展的肺纤维化是中毒后期死亡的主要原因。关于严重百草枯中毒病例成功进行肺移植的报道很少。我们期望这个成功案例能为其他类似情况的患者提供参考。
一名24岁女性在摄入50毫升百草枯后约2小时被送往医院。她经历了迅速加重的肺纤维化和严重呼吸衰竭。摄入后第34天，她接受了插管和有创机械通气。对该患者进行了肺移植评估，并于第44天建立了静脉-静脉体外膜肺氧合（ECMO）作为肺移植的桥梁。第56天，她成功接受了双侧序贯肺移植。通过呼吸和身体康复以及营养支持，患者在第66天脱机并拔除气管插管。第80天，她出院了。在1年的随访中，发现患者状况良好，肺功能逐渐改善。
我们建议肺移植可能是百草枯诱导的肺纤维化及随之而来的呼吸衰竭终末期的有效治疗方法。对于病情迅速进展至危急状态且无法立即进行肺移植的患者（例如，在等待合适供体或毒物清除期间），ECMO应是肺移植的可行桥梁。
