Study On The Lung Injury Of The Long-term Survived Patients With Acute Paraquat Poisoning

Objective：Paraquat（PQ）,the20%solution of which is Gramoxone.At the end of1950s,it was discovered that paraquat has the role of herbicidal whichsubsequently been applied to agricultural production.As the extensive use ofPQ,the rate of paraquat poisoning is also increasing year by year. Also, a largeamount of the poisoning is driven by orally taken or misused, it can be causedthrough skin or respiratory systerm. The injury of lungs is the most obviousand worst change from PQ poisoning.This is been said “paraquat’s lung”.Usually according to the classification for the amount of taking poison,thelight:ingestion of paraquat<20mg/kg;the serious: ingestion of paraquat20-40mg/kg;the fulminant: ingestion of paraquat>40mg/kg.The light haveoppression in chest,short breath,chest pain.The serious havecyanosis,dyspnea,and more serious they can cause death by respiratoryfailure.And the patients of fulminant poisoning will be100percentage ofdeath in1-4days.While the survived patients with the lung injury cause therepair mechanism of organism.In the early period of poisoning（1⁷d）,themainly display is bronchial and vascular thickening,ground-glass shadow;Inthe intermediate period of poisoning（8¹4d）,as the disease increasing, theformation of lung consolidation,pleural effusion and thickening of pleura willoccur;In the late period（>14d）,the mainly feature is pulmonary interstitialfibrosis.Currently, the substantive investigation and feasibility study in terms ofPQ poisoning mechanism, treatment, prognostic factors and lung injury, butquite less studies in terms of the long-term lung recovery of the survivedpatients. This study focuses on the evaluation of the degree of lung injure onbasis of6-months’ followed up of the survived patients who were given the individualized comprehensive treatment after PQ poisoning in our department.Methods：1.The50survived patients,which were the paraquat poisoning patientsand saw a doctor in the Second Hospital of Hebei Medical University fromSeptember2010to July2012,are been selected as the object of thestudy,including27males and23females.50patients receive the individualizedcomprehensive treatment,which includes the gastric lavage,catharsis,andadsorption,hemoperfusion associated with hemodialysis,immunosuppressant,adrenal cortical hormone,and the drug of anti-radicals,the drug ofanti-inflammatory and some kinds of traditional Chinese medicines.Collect50patients’general information,clinical manifestations, pulmonary CT imagingperformance.2. Retrospective study is adopted in this study.The light and the seriousare defined according to the pulmonary CT imaging performance.The light:pulmonary CT imaging performance of patients taking poison within7daysare normal,and patients can have mild gastrointestinal symptoms,or mildhepatic, renal damage. The serious: pulmonary CT imaging performance ofpatients taking poison within7days have paraquat’s lesions,while patientsmay be associated with dyspnea, liver and kidney damage and other multi-system injury. We visit the survived patients after6months.They reviewpulmonary CT and pulmonary function test.Analyse the CT feature in theearly period（≤7d）,the intermediate period（8¹4d）,the later period（>14d） andthe future period（6months later）,and pulmonary function test,thus evaluate thelung injury of the long-term survived patient with acute paraquat poisoning.3. Put to use SPSS13.0software package. The incidence rates of variousof pulmonary CT imaging performances are been compared withχ²test.Whenthe frequency of less than1,we use Fisher probabilities.When comparing twogroups,the test level of P<0.05will be redefinited,P<0.007is consideredstatistically significant.The rate of pulmonary function abnormalities are beencompared withχ²test. When the frequency of less than1,we use Fisherprobabilities. P<0.05is considered statistically significant. All of testing indexs adoptx±S to be statistical description. T-test is used to compare themean between the two groups, when the two groups of date are consistent withnormality and homogeneity of variance.P<0.05is considered statisticallysignificant. Wilcoxon rank sum test is used to compare the mean between thetwo groups, when the two groups of date are not consistent with normality orhomogeneity of variance.P<0.05is considered statistically significant.Results：1.There are5case in the light group,inculding3male cases and2femalescases in the50patients.Their ages is from19to28years old,the mean age is23. There are45case in the serious group,inculding23male cases and22females cases.Their ages is from16to59years old,the mean age is30.Wesummarize pulmonary CT imaging performances of the50patients.The majorperformance include normal,exudative lesions（ground-glass shadow,opacitypatchy flocculent， shadow shadow even consolidation）, pleuraleffusion（in same cases associated with near lung tissue atelectasis）,thickening of pleura,high density cable strip, mesenchyme change and so on，some cases with pericardial effusion,heart density decreases.In the early period:There are normal of pulmonary CT imagingperformances in the light.But all of the serious appear lesions,33cases ofexudation,18cases of pleural effusion,9cases of thickening of pleura,18cases of high density cable strip,22cases of mesenchyme change.In theintermediate period:There are normal of pulmonary CT imagingperformances in the light.There are10cases of the original lesionscompletely absorbed,23cases of exudation,13cases of pleural effusion,8cases of thickening of pleura,15cases of high density cable strip,16cases ofmesenchyme change in the serious.In the later period: There are also normalof pulmonary CT imaging performances in the light. There are17cases ofthe original lesions completely absorbed,14cases of exudation,6cases ofpleural effusion,8cases of thickening of pleura,14cases of high density cablestrip,9cases of mesenchyme change in the serious.In the future period: Thereare also normal of pulmonary CT imaging performances in the light. There are24cases of the original lesions completely absorbed,2cases ofexudation,no case of pleural effusion,2cases of thickening of pleura,11casesof high density cable strip,10cases of mesenchyme change in the serious.The pulmonary CT imaging performances of the light have no significantlesions from the onset of the treatment course to the long-term recovery.Forthe serious,exudation in the future period is different in the early period,theintermediate period and the later period. P<0.007is considered statisticallysignificant; pleural effusion in the future period compared with in the laterperiod is no statistically significant（P>0.007）,but compared with in the earlyperiod and the intermediate period are statistically significant（P<0.007）;thickening of pleura in future period compared with in the earlyperiod,the intermediate period and the later period no statisticallysignificant（P>0.007）; high density cable strip in future period compared within the early period,the intermediate period and the later period is nostatistically significant（P>0.007）; mesenchyme change in the future periodcompared with in the early period is statistically significant,but comparedwith in the intermediate period and the later period is no statisticallysignificant.2. All of50patients do pulmonary function test. VC、TLC、FVC、FEV1.0、FEV1.0/FVC%、TL_COSB are testing indexs. Put to use SPSS13.0software package. The rate of pulmonary function abnormalities are beencompared withχ²test. When the frequency of less than1,we use Fisherprobabilities. P<0.05is considered statistically significant.All of testingindexs adoptx±S to be statistical description. T-test is used to compare themean between the two groups, when the two groups of date are consistent withnormality and homogeneity of variance.P<0.05is considered statisticallysignificant. Wilcoxon rank sum test is used to compare the mean between thetwo groups, when the two groups of date are not consistent with normality orhomogeneity of variance.P<0.05is considered statistically significant.In the light, VC range of84.4to101.3, with an average of93.28±7.11;TLC range of77.9to106.2, with an average of94.86±10.88;FVC range of85.3to101.1, with an average of94.24±7.17;FEV1.0range of87.9to107.6, with an average of96.48±8.85;FEV1.0/FVC%range of86.7to109.1, with an average of97.83±8.20;TL_COSB range of79.1to112.5, withan average of95.48±12.26.In5cases of patients,1patient（20%） combinemild restrictive ventilatory dysfunction with diffusion barriers dysfunction.Inthe serious, VC range of71.7to129.3, with an average of97.13±12.18;TLCrange of75.7to124.4, with an average of97.7±11.15;FVC range of74.8to127.8, with an average of98.94±12.21;FEV1.0range of71.2to125.2, withan average of99.5±12.84;FEV1.0/FVC%range of74.12to109.8, with anaverage of90.18±7.88;TL_COSB range of59.7to108.7, with an average of83.48±11.21. In45cases of patients,1patient（2.2%） is mild restrictiveventilatory dysfunction,3patients（6.7%） are mild obstructive ventilatorydysfunction,15patients（33.3%） are mild diffusion barriers dysfunction,2patients（4.4%） combine mild restrictive ventilatory dysfunction with diffusionbarriers dysfunction.The rate of pulmonary function abnormalities which are been comparedbetween the light group and the serious group are no statistically significant（P>0.05）.FEV1.0/FVC%、TL_COSB is statistically significant,but VC、TLC、FVC、FEV1.0are statistically significant between the two groups.Conclusions：1. With individualized comprehensive treatment, the pulmonary CTimaging performances of the light have no significant lesions from the onsetof the treatment course to the long-term recovery.2. With individualized comprehensive treatment, the pulmonary CTimaging performances of the severe have exudative lesions, pleuraleffusion,pleural thickening,high density cable strip, mesenchyme change inthe early period,and they can be concurrence.There is the progress of thedisease in the middle period.A large area of exudation even consolidation willbe emerge. Exudative lesions and pleural effusion will improve in the laterperiod.For the long-term survival of patients, the high density cable strip andmesenchyme change will be left over in the future period. 3. For the long-term survival of patients, some of them have abnormalpulmonary function.The main injured is diffusion barrier for the light and theserious. A small number of patients have ventilatory dysfunction.4. With individualized comprehensive treatment, the serious are moreserious than the light of obstructive ventilatory dysfunction and diffusionbarriers dysfunction.