[Hypo-oxygenation in paraquat poisoning. Apropos of 6 cases].
[Hypo-oxygenation in paraquat poisoning. Apropos of 6 cases].
复制标题
[百草枯中毒中的缺氧。
DOI：
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发表时间：
1983
期刊：
影响因子：
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通讯作者：
R. Surugue
中科院分区：
文献类型：
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作者：
A. Chollet;J. Muszynsky;C. Bismuth;J. Pham;M. El Khouly;R. Surugue
除草剂百草枯的毒性与超氧自由基的形成有关，超氧自由基是导致进行性和通常致命的肺纤维化的原因。将自由基引起的膜双分子层脂质过氧化作用视为致病因素，指出氧是百草枯中毒严重程度的一个重要辅助因素。任何超过21%的FiO 2都会加速这一过程，并增加大鼠和人类的死亡率。FiO 2 21%可显著降低大鼠的死亡率（DOUZE 1976）。1978-1879年，我们提出用此法治疗百草枯中毒6例。通过诱导巴比妥酸盐昏迷、低温、固化和低氧（由于辅助通气的氮气辅助，FiO 2约为14%）进行。在5/6例患者中，这些技术并没有阻止向死亡的演变。根据以下预后因素，这种演变实际上是可以预测的：自杀、一口以上的摄入、内窥镜检查发现的食管胃烧伤、器质性肾衰竭、高血浆百草枯水平。相关的消除方法（漂白土，诱发腹泻，呋塞米，血液灌流和血液透析）没有改变早期确定的预后。唯一的幸存者是在无法检测到的百草枯血浆和孤立的口腔烧伤的意外中毒中观察到的：除草剂可能被吐出来了。这种存活率与缺氧无关。我们认为，这种失败并不是决定性的：只有在最小程度的意外中毒可能演变为肺纤维化后才应进行这种治疗。它在大规模自杀性中毒中似乎没有用，很容易导致致命的循环衰竭。
The toxicity of the weed-killer paraquat is related to the formation of superoxyde radicals responsible of a progressive and usually lethal pulmonary fibrosis. Recognition of lipid peroxidation of membrane bilayers by free radicals as the causative factor pointed to oxygen as an important cofactor in the severity of paraquat poisoning. It has been shown that any FiO2 over 21% accelerates this process and increases the the mortality of rats and humans. FiO2 21% gave a significant reduction of mortality in rats (DOUZE 1976). We proposed this therapy (1978-1879) in 6 cases of paraquat poisoning. It was conducted with induction of a barbiturate coma, hypothermia, curarisation and hypo-oxygenation (FiO2 around 14% thanks to the adjunction of nitrogen to assisted ventilation). In 5/6 patients, these technics did not prevent the evolution towards death. This evolution was in fact predicted, according the following prognostic factors: suicide, more than a mouthful ingestion, oesophago-gastric burns detected by endoscopy, organic renal failure, high plasma paraquat level. Associated methods of elimination (Fuller's earth, provoked diarrhea, furosemide, hemoperfusion and hemodialysis) did not change the early established prognosis. The only survival was observed in an accidental poisoning with undetectable plasma paraquat and isolated oral burns: the herbicide had been probably spit out. This survival cannot be related to hypo-oxygenation. This failure is not definitive, according to us: this therapy should be undertaken only after minimal, accidental poisoning possibly evolving to pulmonary fibrosis. It appears unuseful in massive, suicidal poisonings, leading readily to a lethal circulatory failure.