[1]吴燕燕,黄健,罗杰,等.甲硫酸新斯的明对百草枯中毒的疗效观察[J].第三军医大学学报,2017,39(15):1578-1581.
 WU Yanyan,HUANG Jian,LUO Jie,et al.Therapeutic effect of neostigmine methylsulfate on paraquat poisoning[J].J Third Mil Med Univ,2017,39(15):1578-1581.
点击复制

甲硫酸新斯的明对百草枯中毒的疗效观察(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
39卷
期数:
2017年第15期
页码:
1578-1581
栏目:
临床医学
出版日期:
2017-08-15

文章信息/Info

Title:
Therapeutic effect of neostigmine methylsulfate on paraquat poisoning
作者:
吴燕燕黄健罗杰陶杨鲁力赵金川陈蓉白伟志
重庆市急救医疗中心:急诊科,ICU
Author(s):
WU Yanyan HUANG Jian LUO Jie TAO Yang LU Li ZHAO Jinchuan CHEN Rong BAI Weizhi
Department of Emergency Medicine, ICU, Chongqing Emergency Medical Center, Chongqing, 400014, China
关键词:
百草枯急性中毒新斯的明 
Keywords:
paraquat acute  poisoning neostigmine-methylsulfate
分类号:
R459.7; R453.9
文献标志码:
A
摘要:
目的      探讨甲硫酸新斯的明对百草枯中毒的治疗作用。方法     回顾性分析2014年7月至2016年6月在我院治疗的百草枯中毒患者43例,根据患者是否加用新斯的明治疗分为常规治疗组(n=21)及新斯的明组(n=22)。对比两组患者入院时,入院后48 h的血清TNF-α、IL-6、IL-10水平及急性生理学及慢性健康状况(APACHE Ⅱ)评分、肺损伤评分(lung injury score, LIS);对比两组患者3个月内病死率。结果     两组患者入院当天血清TNF-α、IL-6、IL-10水平相近,差异无统计学意义(P>0.05);治疗2 d后,新斯的明组血清TNF-α、IL-6水平明显低于常规治疗组(P<0.01)。两组患者入院当天APACHEⅡ评分、LIS评分相近,差异无统计学意义(P>0.05);分别治疗2 d后,新斯的明组APACHE Ⅱ评分、LIS评分低于常规治疗组(P<0.05)。两组患者在3 d内病死率差异无统计学意义(P>0.05),但新斯的明组7 d及30 d病死率低于常规治疗组(P<0.05)。结论     百草枯患者早期加用新斯的明治疗,可减少TNF-α、IL-6炎性介质的合成,从而维持各个器官正常功能,减轻肺损伤,提高生存率。
Abstract:
Objective    To evaluate the efficacy of neostigmine methylsulfate in treatment of paraquat poisoning. Methods      The clinical data were collected from 43 patients with paraquat poisoning treated at our center from July, 2014 to June, 2016. Twenty-one of the patients received conventional treatment and 22 received intramuscular injections of neostigmine (2 mg, twice daily for 7 consecutive days), and in both groups, gastrointestinal decontamination, hemoperfusion, glucocorticoid, antioxidant therapy, cyclophosphamide and anticoagulant therapy were administered. The serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-10, APACHE Ⅱ score and lung injury score (LIS) were compared between the 2 groups both upon admission and at 2 d after commencement of the treatments. The mortality rates of the patients within 3 months were recorded and compared between the 2 groups. Results      Before treatment, the serum levels of TNF-α, IL-6, IL-10, APACHE Ⅱ score and LIS were all comparable between the 2 groups. At 2 d after commencement of the treatments, the levels of TNF-α and IL-6, APACHE Ⅱ score and LIS were significantly lower in the neostigmine group than in the conventional treatment group (P<0.05). The  3-day mortality rates were similar between the 2 groups, but at 7 and 30 days, the mortality rates were significantly lower in neostigmine group than in the conventional treatment group (P<0.05). Conclusion     Early intervention with neostigmine can reduce the production of such inflammatory cytokines as TNF-α and IL-6 to maintain the normal functions of the organs and alleviate lung injuries, thus promoting the survival of the patients with paraquat poisoning.

参考文献/References:

 
[1]李海军, 赵兴勤, 谷琳琳, 等. 急性百草枯中毒的研究和治疗进展[J]. 医学综述, 2012, 18(2): 264-266. DOI: 10.3969/j.issn.10062084.2012.02.037.
LI H J, ZHAO X Q, GU L L, et al. Progress of the research and treatment in acute paraquat poisoning[J]. Med Recapitul, 2012, 18(2): 264-266. DOI:10.3969/j.issn.10062084.2012.02.037.
[2]百草枯中毒诊断与治疗“泰山共识”专家组, 菅向东. 百草枯中毒诊断与治疗“泰山共识”(2014)[J]. 中国工业医学杂志, 2014, 27(2): 117-119.
Professional Group of  “Taishan”  Expert Consensus on diagnoses and Treatment in Acute Paraquat Poisoning, JIAN  X D. “Taishan”  Expert Consensus on diagnoses and treatment in acute paraquat poisoning[J]. Chin J Industri Med, 2014, 27(2): 117-119.
[3]菅向东, 刘会敏, 张伟, 等. 百草枯中毒救治“齐鲁方案”[C]. 第十三届全国劳动卫生与职业病学术会议论文集, 2014: 91-91.
JIAN X D, LIU H M, ZHANG W, et al. Qilu scheme on diagnoses and treatment in acute paraquat poisoning[C]. Proceedings of the 13th National Conference on Labor Hygiene and Occupational Diseases of China, 2014: 91-91.
[4]XIE H, WANG R, TANG X, et al. Paraquatinduced pulmonary fibrosis starts at an early stage of inflammation in rats[J]. Immunotherapy, 2012, 4(12): 1809-1815. DOI: 10.2217/imt.12.122.
[5]BOROVIKOVA L V, IVANOVA S, ZHANG M, et al. Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin[J]. Nature, 2000, 405(6785): 458-462. DOI: 10.1038/35013070.
[6]DE JONGE W J, VAN DER ZANDEN E P, THE F O, et al. Stimulation of the vagus nerve attenuates macrophage activation by activating the Jak2STAT3 signaling pathway[J]. Nat Immunol, 2005, 6(8): 844-851. DOI: 10.1038/ni1229.
[7]WANG H, LIAO H, OCHANI M, et al. Cholinergic agonists inhibit HMGB1 release and improve survival in experimental sepsis[J]. Nature Medicine, 2004, 10(11): 1216-1221. DOI: 10.1038/nm1124.
[8]PAVLOV V A, TRACEY K J. The vagus nerve and the inflammatory reflexlinking immunity and metabolism[J]. Nat Rev Endocrinol, 2012, 8(12): 743-754. DOI: 10.1038/nrendo.2012.189.
[9]ULLOA L. The vagus nerve and the nicotinic antiinflammatory pathway[J]. Nat Rev Drug Discov, 2005, 4(8): 673-684. DOI: 10.1038/nrd1797.
[10]LIU Z, WANG Y, WANG Y, et al. Dexmedetomidine attenuates inflammatory reaction in the lung tissues of septic mice by activating cholinergic antiinflammatory pathway[J]. Int Immunopharmacol, 2016, 35: 210-216. DOI: 10.1016/j.intimp.2016.04.003.
[11]GOVERSE G, STAKENBORG M, MATTEOLI G. The intestinal cholinergic antiinflammatory pathway[J]. J Physiol (Lond), 2016, 594(20): 5771-5780. DOI: 10.1113/JP271537.
[12]KOLGAZI M, OZGUR F, BEYAZOGLU O, et al. Role of the cholinergic antiinflammatory pathway in endotoxemiainduced multiorgan damage in the rat[J]. Journal of Marmara University Institute of Health Sciences, 2015: 1. DOI: 10.5455/musbed.20150306053623.
[13]XIANG H, HU B, LI Z, et al. Dexmedetomidine controls systemic cytokine levels through the cholinergic antiinflammatory pathway[J]. Inflammation, 2014, 37(5): 1763-1770. DOI: 10.1007/s1075301499061.
[14]STERNBERG E M. Neural regulation of innate immunity: a coordinated nonspecific host response to pathogens[J]. Nat Rev Immunol, 2006, 6(4): 318-328. DOI: 10.1038/nri1810.
[15]黄祥君, 袁波. 新斯的明临床应用不良反应分析[J]. 中国社区医师(医学专业), 2012, 14(13): 32-33. DOI: 10.3969/j.issn.1007614x.2012.13.028.
HUANG X J, YUAN B. Analysis of adverse reactions in clinical application of neostigmine[J]. Chin Commu Doc (Med Ed), 2012, 14(13): 32-33. DOI: 10.3969/j.issn.1007614x.2012.13.028.

相似文献/References:

[1]成戎川,李黔宁,刘勇,等.6例急性四乙基铅中毒临床表现分析[J].第三军医大学学报,2004,26(11):0.[doi:10.16016/j.1000-5404.2004.11.015 ]
[2]杨宗才,吴燕莉.大剂量阿米替林急性中毒一例报告[J].第三军医大学学报,1984,06(03):0.[doi:10.16016/j.1000-5404.1984.03.028 ]
[3]孙德翔,张远慧,彭罗民,等.催眠安定剂等急性中毒的救治及应用透析疗法的体会[J].第三军医大学学报,1983,05(01):0.[doi:10.16016/j.1000-5404.1983.01.010 ]
[4]孙德翔,张远慧,亓学明,等.催眠安定剂等急性中毒30例救治分析[J].第三军医大学学报,1981,03(02):0.[doi:10.16016/j.1000-5404.1981.02.015 ]

更新日期/Last Update: 2017-08-14