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首页> 外文期刊>Tzu Chi Medical Journal >One-lung circumvention, an interventional strategy for pulmonary salvage in acute paraquat poisoning: An evidence-based review
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One-lung circumvention, an interventional strategy for pulmonary salvage in acute paraquat poisoning: An evidence-based review

机译：单肺规避，急性百草枯中毒的肺救治干预策略：循证研究

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Paraquat is highly toxic to humans. Peak plasma levels are reached within 1 hour after intentional ingestion of this poison, followed by a rapid decline because of its distribution to the extravascular compartment and renal elimination. It induces generation of free oxygen radicals and consumption of intracellular nicotinamide adenine dinucleotide phosphate in a cyclic single-electron reduction/oxidation reaction; consequently, cell death occurs because of lipid peroxidation of the cell membrane. Paraquat selectively accumulates in the lungs, resulting in pulmonary fibrosis, which can eventually lead to respiratory failure in many survivors of the acute phase. It is believed that charcoal hemoperfusion is the best modality for extracorporeal elimination in the acute phase. Afterward, anti-inflammatory and immunosuppressive treatment and even lung radiotherapy have been proposed to alleviate inflammation. Unfortunately, these protocols are unsuccessful in a majority of patients. Because the first hours are critical for treatment and the lungs are the target organs, pulmonary salvage is the aim of the toxicologist. Deep insertion of an endotracheal tube as the first treatment effort can produce alveolar collapse, as well as an arteriovenous pulmonary shunt in one lung. Decreased paraquat uptake, at least in one lung, leads to a reduced inflammatory process in the treated lung after the acute phase of toxicity. Furthermore, preserving a functioning lung is sufficient for life.
机译：百草枯对人类有剧毒。在有意摄入该毒药后1小时内，血浆水平达到峰值，随后由于其分布到血管外腔室和肾脏消除而迅速下降。它在循环单电子还原/氧化反应中诱导自由基的产生和细胞内烟酰胺腺嘌呤二核苷酸磷酸的消耗;因此，由于细胞膜的脂质过氧化而发生细胞死亡。百草枯选择性地在肺中蓄积，导致肺纤维化，最终可能导致许多急性期幸存者呼吸衰竭。可以相信，在急性期，木炭的血液灌流是最佳的体外清除方法。之后，已提出抗炎和免疫抑制治疗，甚至肺放疗来减轻炎症。不幸的是，这些方案在大多数患者中均不成功。由于最初的几个小时对于治疗至关重要，而肺是目标器官，因此肺部抢救是毒理学家的目标。作为第一个治疗措施，将气管插管深度插入可能会导致肺泡塌陷，以及在一个肺中产生动静脉肺分流。至少在一个肺中，百草枯的摄取减少，导致急性毒性阶段后治疗肺部的炎症过程减少。此外，保持功能正常的肺对于生命是足够的。

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