Combined methylprednisolone and dexamethasone therapy for paraquat poisoning
Combined methylprednisolone and dexamethasone therapy for paraquat poisoning
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DOI：
10.1097/00003246-200211000-00030
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发表时间：
2002-11-01
影响因子：
8.8
通讯作者：
Huang, YK
中科院分区：
文献类型：
--
作者：
Chen, GH;Lin, JL;Huang, YK
目的：报道一例百草枯中毒患者经甲基强的松龙反复冲击治疗成功的病例。设计：案例研究。地点：台湾台北林口医学中心大学医院。患者：60岁，百草枯中毒合并严重急性肾功能衰竭(服药后10小时血肌酐为11.8 mg/dL，百草枯为3.66 mg/ml)和严重低氧血症(PaO(2)，66.6 mm Hg)。干预：重复3天甲基强的松龙冲击治疗，一个疗程2天的环磷酰胺。大剂量地塞米松治疗33天。测量和主要结果：定期进行动脉血气分析。每周拍一次胸部X线片。经抗炎药和环磷酰胺反复冲击治疗后，动脉血氧分压从66 mm Hg上升到97 mm Hg，胸片明显改善。结论：反复甲基强的松龙冲击治疗和延长地塞米松治疗时间，成功救治了1例重度百草枯中毒患者。这一病例表明，百草枯中毒患者亚急性期致死性低氧血症的主要原因是肺部的严重炎症，而不是纤维化，并证实了我们之前的假设。显然，使用抗炎疗法治疗百草枯中毒患者需要进一步评估；然而，在标准疗法失败后，抗炎疗法可能是一种有效的治疗方法。
Objective: To report a severe case of paraquat poisoning successfully treated with repeated-pulse therapy of methylprednisolone.Design: Case study.Setting: University Hospital, Lin-Kou Medical Center, Taipei, Taiwan, Republic of China.Patients: A 60-yr-old man with paraquat poisoning with severe acute renal failure (serum creatinine level of 11.8 mg/dL and serum paraquat level of 3.66 mug/mL at 10 hrs after ingestion) and severe hypoxemia (Pao(2), 66.6 mm Hg).Intervention: Repeated 3-day pulse therapy with methylprednisolone, one course of 2-day cyclophosphamide, and a high dose of dexamethasone for 33 days.Measurements and Main Outcome: Arterial blood gas analysis was obtained regularly. A chest radiography was obtained every week. The arterial blood oxygen concentrations dramatically elevated from 66 mm Hg to 97 mm Hg, and the chest radiographs markedly improved after repeated-pulse therapy with anti-inflammatory agents and cyclophosphamide.Conclusions: We successfully treated a severe paraquat poisoned patient with repeated methylprednisolone pulse therapy and prolonged dexamethasone treatment. This case demonstrates that the severe inflammation, not the fibrosis, of the lungs plays a major role in the lethal hypoxemia of patients with paraquat poisoning during the subacute period and confirms our previous hypotheses. Clearly, the use of anti-inflammatory therapy to treat paraquat-poisoned patients needs further evaluation; however, anti-inflammatory therapy may be an effective treatment after failure of standard therapies.