Objective: To observe the effect of rhubarb as the main composition in the therapy for patients with acute paraquat poisoning (AP).
Methods: A prospective randomized controlled trial was conducted. 128 patients with APP admitted to Harrison International Peace Hospital from March 2011 to December 2013 were randomly divided into western medicine control group (n = 64) and western medicine and traditional Chinese medicine (TCM) combination group (n = 64). All the patients were treated with repeated gastric lavage and oral kaolin. The patients in western medicine control group were given 20% mannitol and (or) magnesium sulfate for catharsis, early ( within 8 hours of admission ) hemoperfusion HP), and also given the routine combined therapy. In TCM combination group, in addition to the above treatment patients were given oral paraquat poisoning detoxification prescription No.1 every 2 hours for catharsis, which was composed of rhubarb 10 g, glauber salt 12 g, agrimony 12 g, and licorice 6 g. When green stool disappeared, detoxification therapy was changed to No. 2 compound once a day for 14 days, which was consisted of rhubarb 10 g, ginseng 6 g, agrimony 15 g, rhizoma chuanxiong 10 g, licorice 6 g. The poison volume, first dose of oral drug, time for the first HP, time of the first defecation, the time of last green stool, decontamination time, white blood cell count ( WBC ), C-reactive protein ( CRP ), arterial blood gas analysis, blood lactic acid ( Lac ), liver and kidney functions, myocardial enzyme spectrum, chest CT, adverse reaction, days of hospitalization, and mortality rate were observed in both groups. The levels of paraquat in plasma and urine were determined before treatment and 12 hours after poisoning in both groups. Sixty days after discharge, chest CT was taken for observation of pulmonary fibrosis.
Results: There were no significant differences in the poison volume, ingestion time and the time for the first HP between the two groups. Compared with western medicine control group, the first defecation time (hours: 3.94 ± 1.14 vs. 6.17 ± 1.52), the last time of green stool (hours: 36.90 ± 4.10 vs. 51.6 3 ± 4.91), and poison clean-up time from plasma (hours: 19.48 ± 3.63 vs. 23.84 ± 3.29) in combination with TCM group were significantly earlier (all P < 0.01). WBC, CRP, alanine aminotransferase (ALT), blood urea nitrogen (BUN), and serum creatinine (SCr) levels were gradually increased after admission in combination with TCM group, and they peaked on 5th day [WBC ( × 10⁹/L) : 15.35 ± 2.17 vs. 17.47 ± 2.09, CRP (mg/L): 32.62 ± 2.76 vs. 39.51 ± 2.45, ALT (U/L): 270.88 ± 11.06 vs. 334.67 ± 7.85, BUN (mmol/L): 13.29 ± 1.90 vs. 17.63 ± 1.42, SCr (μmol/L): 203.54 ± 18.40 vs. 251.53 ± 14.38, all P < 0.05 ], and then they declined; Lac after admission was gradually increased, and peaked at 7 days (mmol/L: 3.53 ± 0.21 vs. 3.82 ± 0.14, P < 0.05 ), and then it was decreased. Myocardial enzyme spectrum was increased after admission, and peaked on 3rd day [creatine kinase (CK, U/L): 192.09 ± 16.26 vs. 216.20 ± 11.96, creatine kinase isoenzyme enzyme ( K-MB, U/L): 39.03 ± 3.75 vs. 47.22 ± 5.84, both P < 0.05 ), and then they declined gradually. Arterial partial pressure of oxygen (PaO₂) and base excess (E) were gradually decreased after admission, down to trough on the 7th day after admission [PaO₂(mmHg, 1 mmHg = 0.133 kPa): 87.04 ± 2.37 vs. 84.93 ± 2.44, BE (mmol/L): -7.31 ± 2.31 vs. -9.18 ± 2.49, both P < 0.05 ], and then they were increased. At 12 hours after poisoning, paraquat contents in plasma and urine in combination with TCM group were significantly lower than those of the western medicine control group [plasma (ng/L): 0.83 ± 0.08 vs. 0.96 ± 0.10, urine (ng/L): 0.88 ± 0.09 vs. 0.97 ± 011, both P < 0.05]. The injury to lung tissue was significantly improved in combination with TCM group compared with that in the western medicine control group, and no serious adverse reactions was found, and the hospital stay time (days: 20.46 ± 6.07 vs. 29.73 ± 9.16) was significantly shortened (P < 0.01), and the mortality rate [ 35.9% (23/64) vs. 45.3% (29/64) ] was significantly lowered compared with western medicine control group (P < 0.05). In the combination with TCM group pulmonary fibrosis was lighter than that in the western medicine control group during the 60-day follow-up.
Conclusions: The sequential treatment of No. 1 and No. 2 detoxification of APP, using rhubarb as the main drug, can effectively eliminate paraquat, reduce absorption of the toxin, prevent the development of multiple organ dysfunction syndrome (MODS) induced by the toxin, shorten the hospital stay days, and improve the prognosis of APP.