前列地尔注射液对百草枯中毒患者肺损伤的影响

中国临床药理学与治疗学 ›› 2012, Vol. 17 ›› Issue (8): 910-913.

前列地尔注射液对百草枯中毒患者肺损伤的影响

吕望¹, 陈新国¹, 金焕治¹, 张雪良²

¹浙江省温州市第三人民医院急诊科,²重症监护室,温州 325000, 浙江

收稿日期:2012-01-31 修回日期:2012-05-11 出版日期:2012-08-26 发布日期:2012-08-14
通讯作者: 张雪良,男,硕士,副主任医师,从事危重病学专业。Tel: 13757723331 E-mail: zhangxueliangsy@163.com
作者简介:吕望,男,本科,住院医师,从事危重病学专业。Tel: 15906879678 E-mail: frank165044@163.com

Effect of alprostadil injection on lung injury in patients with paraquat poisoning

LV Wang¹, CHEN Xin-Guo¹, JIN Huan-Zhi¹, ZHANG Xue-Liang²

¹Department of Emergency, ²Department of Intensive Care Unit, the Third People's Hospital of Wenzhou, Wenzhou 325000, Zhejiang, China

Received:2012-01-31 Revised:2012-05-11 Online:2012-08-26 Published:2012-08-14

摘要/Abstract

摘要： 目的: 观察前列地尔注射液对百草枯中毒患者炎症介质和肺损伤的影响,为临床治疗提供参考。方法: 30例急性百草枯中毒患者随机分为常规治疗组(对照组)和常规治疗+前列地尔注射液组(试验组),每组15例。前列地尔注射液用法:10 μg 加入 100 mL 生理盐水(NS)静脉滴注,1次/d,连用 7 d。分别于入院当天及入院后 7 d 测定患者血浆IL-6、IL-8、基质金属蛋白酶-9(MMP-9)浓度,行动脉血气分析和胸部X线检查,并随访生存情况。结果: 与对照组比较,入院后 7 d 试验组患者IL-6、IL-8、MMP-9浓度降低,急性肺损伤(ALI)及全身炎症反应综合症发生率降低(P<0.05);两组患者病死率差异无统计学意义(P>0.05)。结论: 前列地尔注射液可减轻百草枯中毒患者炎症反应和肺损伤。

关键词: 中毒, 百草枯, 肺损伤, 前列地尔

Abstract: AIM: To investigate the clinical therapeutic effect of alprostadil injection on inflammatory response and lung injury in patients with paraquat poisoning and thus to improve clinical practice.METHODS: Thirty patients with paraquat poisoning were randomized into control and observation group (15 cases in each group), where the patients in control group received routine therapy and additional 10 μg alprostadil injection dissolved in 100 mL saline was administrated intravenously for 7 days in experimental group. Plasma levels of interleukine-6, 8 and matrix metalloproteinase-9 (MMP-9) were detected; arterial blood gas analysis and chest X-ray examination were performed at the first and seventh day of admission, and mortality compared between the two groups.RESULTS: Compare to control group, the levels of plasma IL-6, IL-8 and MMP-9 were decreased, the incidences of acute lung injury and systemic inflammatory response syndrome were lower in experimental group at seventh day of admission (P<0.05). There was no significant differences of mortality between the two groups (P>0.05).CONCLUSION: Alprostadil injection could protect the patients with paraquat poisoning agaist acute lung injury by attenuating inflammatory response.

Key words: Poisoning, Paraquat, Lung injury, Alprostadil

中图分类号:

R595

吕望, 陈新国, 金焕治, 张雪良. 前列地尔注射液对百草枯中毒患者肺损伤的影响[J]. 中国临床药理学与治疗学, 2012, 17(8): 910-913.

LV Wang, CHEN Xin-Guo, JIN Huan-Zhi, ZHANG Xue-Liang. Effect of alprostadil injection on lung injury in patients with paraquat poisoning[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2012, 17(8): 910-913.

参考文献

[1] 聂屾, 韩继媛. 急性百草枯中毒的药物治疗研究进展[J]. 医药导报, 2009, 28 (10): 1311-1313.
[2] 王文伟, 李军, 蒋懿斐, 等. 脂微球化前列地尔对体外循环诱发小儿肺损伤的影响[J]. 中华麻醉学杂志, 2008, 18(9): 814-816.
[3] de Perrot M, Fischer S, Liu M, et al. Prostaglandin E1 protects lung transplants from ischemia- reperfusion injury: a shift from pro- to anti-inflammatory cytokines[J]. Transplantation, 2001, 72(9): 1505-1512.
[4] Tomita M, Okuyama T, Hidaka K, et al. Early differential gene expression of rat lung after exposure to paraquat[J]. Free Radic Res, 2004, 38(8): 821-829.
[5] 孔庆福, 张华, 王丽, 等. 急性百草枯中毒早期脏器损伤与细胞因子的变化[J]. 中华急诊医学杂志, 2010, 19(7): 710-711.
[6] 邓少雄, 郭南鸥, 郑渊, 等. 替罗非班对急性ST段抬高型心肌梗死并糖尿病患者急诊经皮冠状动脉介入治疗术后血清MMP-9水平的影响及临床意义[J]. 中国临床药理学与治疗学, 2011, 16(7): 807-811.
[7] 韩国强, 邱俏檬, 卢中秋, 等. 二巯丙磺钠对百草枯急性中毒大鼠肺组织基质金属蛋白酶-9 mRNA及其金属蛋白酶组织抑制剂-1 mRNA表达的影响[J]. 中国药理学与毒理学杂志, 2010, 24(1): 25-29.
[8] Wang BL, Tu YY, Fu JF, et al. Unbalanced MMP/TIMP-1 expression during the development of experimental pulmonary fibrosis with acute paraquat poisoning[J]. Mol Med Report, 2011, 4(2): 243-248.
[9] 周毅武, 杜晓冬, 张蜀. 百草枯中毒患者血清基质金属蛋白酶-9水平及其临床意义[J]. 华西医学, 2007, 22 (1): 63-64.
[10] 肖军, 钟荣, 施善阳, 等. 前列腺素E1对猪肺损伤的保护效应研究[J]. 中国危重病急救医学, 2008, 20(6): 345-348.
[11] 李志军, 刘红栓, 王今达. 血必净联合前列腺素E1防治急性肺纤维化的实验研究[J]. 中华急诊医学杂志, 2007, 16(3): 255-259.
[12] 张延卓, 李文志, 李洪波, 等. 前列腺素E1对ALI兔微循环灌注的影响[J]. 中华麻醉学杂志, 2007, 27(12): 1122-1125.
[13] Schutte H, Lockinger A, Seeger W, et al. Aerosolized PGE1, PGI2 and nitroprusside protect against vascular leakage in lung ischaemia-reperfusion[J]. Eur Respir J, 2001, 18(1): 15-22.
[14] Zarhock A, Singbartl K, Ley K, et al. Complete reversal of acid-induced acute lung injury by blocking of platelet-neutrophil aggregation[J]. J Clin Invest, 2006, 116(12): 32l1-3219.
[15] 李利, 方强, 何非方. 前列腺素E1对急性肺损伤肺组织核因子κB表达的干预作用[J]. 中华急诊医学杂志, 2006, 15(4): 328-330.
[16] Sobota RM, Muller PJ, Heinrich PC, et al. Prostaglandin E1 inhibits IL-6-induced MCM expression by interfering specifically in IL-6-dependent ERK1/2, but not STAT3, activation[J]. Biochem J, 2008, 412(1): 65-72.
[17] Mochizuki M, Ishii Y, Itoh K, et al. Role of 15-deoxy delta(12,14) prostaglandin J2 and Nrf2 pathways in protection against acute lung injury[J]. Am J Respir Crit Care Med, 2005, 171(11): 1260-1266.