AIM To investigate the effects of Shuxuening Injection (Ginkgo biloba extract) combined with ganglioside on cerebral oxygen utilization coefficient (O2UCc) and lactate clearance rate (LCR) in patients with acute severe carbon monoxide poisoning (ASCOP).METHODS Two hundred and sixty-two patients with ASCOP treated in emergency department of Harrison International Peace Hospital Affiliated to Hebei Medical University from Mar 2011 to Mar 2016 were randomly divided into control group,Shuxuening Injection group,ganglioside group and Shuxuening Injection combined with ganglioside (combined medication) group.The changes were detected in oxygen saturations of carotid blood and jugular blood,arterial blood lactic acid,O2UCc and LCR in all patients before and 6,24 hours,3 days after the treatment.The clinical symptoms,and the mortality and morbidity of delayed encephalopathy after acute carbon monoxide poisoning after two weeks were observed.RESULTS Total effective rate of the combined medication group was higher than that of the other groups.O2 Ucc at 6,24 hours after the treatment in the combined medication group were significantly lower than those in the other groups,so did the mortality and morbidity of delayed encephalopathy after acute carbon monoxide poisoning,but LCR was significantly higher than that in the other groups.All the differences had statistical significances.CONCLUSION The efficacy of combined medication of Shuxuening Injection and ganglioside in ASCOP patients is better than that of applying single administration separately.

Objective:To investigate the clinical significance of soluble growth stimulating expression gene 2 protein (sST2) combined with neutrophil/lymphocyte ratio (NLR) in the prediction of nosocomial cardiovascular adverse events in patients with acute carbon monoxide poisoning (ACOP) myocardial injury.Methods:Patients with ACOP myocardial injury from January 2017 to December 2019 in Emergency Ward and EICU of Harrson International Peace Hospital, Hebei Medical University were enrolled. NLR was calculated by routine blood examination on admission, and sST2 (T 0sST2, T 3dsST2) was detected by ELISA on admission and at 3 days after admission. According to the occurrence of cardiovascular adverse events, the patients were divided into the event group and the non-event group. Logistic regression was used to analyze the risk factors of in-hospital cardiovascular adverse events. ROC curve was used to analyze the value of sST2, NLR, sST2 and NLR combined in predicting the occurrence of in-hospital cardiovascular adverse events in patients with ACOP myocardial injury. Results:Totally 255 patients with ACOP myocardial injury were included in the final analysis. NLR was (13.38±4.33) in the event group and (9.57±4.22) in the non-event group, T 3dsST2 was (61.59±22.67) ng/mL in the event group and (40.52±13.14) ng/mL in the non-event group, with statistically significant differences (all P<0.01). T 0sST2 was (265.34±89.95) ng/mL in the event group and (242.43±93.09) ng/mL in the non-event group, with no statistically significant difference ( P=0.333). Logistic regression analysis showed that NLR ( OR=1.270, 95% CI: 1.125-1.434, P<0.01) and T 3dsST2 ( OR=1.082, 95% CI: 1.052-1.114, P<0.01) were independent risk factors for nosocomial cardiovascular adverse events in patients with ACOP myocardial injury. The optimal cutoff value of T 3dsST2 was 44.5 ng/mL, and of NLR was 12.08. The sensitivity and specificity of dual T 3dsST2 and NLR in predicting nosocomial cardiovascular adverse events was 79.3% and 82.7%, respectively (AUC 0.857, Youden index 0.620). Conclusions:T 3dsST2 and NLR are independent risk factors for the nosocomial cardiovascular adverse events in patients with ACOP myocardial injury. The predictive cutoff values are 44.5 ng/mL for T 3dsST2 and 12.08 for NLR. Combination of T 3dsST2 and NLR has a practical predictive value for nosocomial cardiovascular adverse events in patients with ACOP myocardial injury.

Objective To investigate the changes and significance of cerebral oxygen utilization coefficients (O2UCc) in patients with acute carbon monoxide poisoning (ACOP) after treatment with Danshen Chuanxiongqin injection combined with ganglioside.Methods A prospective study was conducted.Two hundreds and six patients with ACOP admitted to the Department of Emergency in Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2011 to January 2016 were enrolled,and they were divided into Danshen Chuanxiongqin group,ganglioside group and Danshen Chuanxiongqin injection combined with ganglioside group (combined treatment group) by random number table.The changes in oxygen saturation of internal carotid artery blood (SaO2) and oxygen saturation of internal jugular vein blood (SjO2) were detected by blood gas analysis for all the patients before and 6 hours,1 day,3 days after treatment,and then according to the rate of oxygen utilization formula [O2UCc=S(a-j)O2/SaO2],O2UCc wascalculated.Before and after treatment,the changes of O2UCc in three groups were compared;after treatment for 14 days,the improvement of clinical symptoms,the incidence of delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) and the 28-day mortality were observed.Results The total therapeutic effective rate of combined treatment group was significantly higher than that in either Danshen Chuanxiongqin injection group or ganglioside group [91.67％ (66/72) vs.77.27％ (51/66),77.94％ (53/68),both P ＜ 0.05].Before treatment,there were no differences in levels of O2UCc among three groups (P ＞ 0.05);after treatment for 6 hours and 1 day,the level of O2UCc in combined treatment group was obviously lower than either that of Danshen Chuanxiongqin injection group or of ganglioside group [6 hours:(38.13±7.95)％ vs.(42.96±7.58)％,(42.30±9.87)％,1 day:(28.42±5.41)％ vs.(33.27±7.53)％,(32.64 ± 6.76)％,all P ＜ 0.05],and the levels of O2UCc at 6 hours and 1 day after treatment had no statistical significant differences between those in Danshen Chuanxiongqin injection group and ganglioside group (P ＞ 0.05);after treatment for 3 days,the percentages of O2UCc levels were very close in Danshen Chuanxiongqin injection group,ganglioside group and combined treatment group [(23.87 ± 6.06)％,(22.38±6.09)％,(23.68 ±4.34)％,respectively,all P ＞ 0.05];The incidence of DEACMP and the 28-day mortality after treatment in combined treatment group were lower than those in Danshen Chuanxiongqin injection group or ganglioside group [the incidence of DEACMP:2.78％ (2/72) vs.12.12％ (8/66),14.71％ (10/68),the 28-day mortality:2.78％ (2/72) vs.13.64％ (9/66),16.18％ (11/68),both P ＜ 0.05];while the incidence of DEACMP and the 28-day mortality after treatment had no statistical significant differences between Danshen Chuanxiongqin injection group and ganglioside group (all P ＞ 0.05).No adverse reactions occurred in the three groups.Conclusion The treatment of Danshen Chuanxiongqin injection combined with ganglioside in treatment of ACOP patients can effectively reduce the O2UCc,decrease the occurrence of DEACMP and 28-day mortality,thus it may improve the prognosis,and the clinical curative effect is distinct.

ObjectiveTo observe the effect of rhubarb as the main composition in the therapy for patients with acute paraquat poisoning (APP).MethodsA 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. ResultsThere 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. 51.63±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 (allP< 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, allP< 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 (CK-MB, U/L):39.03±3.75 vs. 47.22±5.84, bothP< 0.05), and then they declined gradually. Arterial partial pressure of oxygen (PaO2) and base excess (BE) 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, bothP< 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, bothP< 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. ConclusionThe 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.

Objective To observe the impact of ginkgo biloba extract(Ginaton) on nerve functioninpa-tients withdelayed encephalopathy after acute carbon monoxide poisoning(DEACMP). Methods 96 patients with DEACMP treated in our hospital from April 2011 to February 2017 were randomly divided into a control group and a study group. The control group received hyperbaric oxygen ,control of intracranial pressure ,and improvement of brain cell metabolism;while the study group receivedintravenous injection of Ginaton 70 mg(adding into 250 mL of 0.9% sodium chloride) once daily fora 2-week therapeutic course. MRIand EEGwere used forexamination in DEACMP patients within 24 h after onset and 14 days after treatment. Changes in MRI and EEG examination , clinical symptoms ,mini-mental state examination (MMSE) score ,Barthel index (BI),and Montreal cognitive assessment(MoCA)were assessed before and after treatment between the two groups. Results The therapy wasef-fective in 39 patients in the study group,with a total effectiveness rate of 81.25%;and in 29 patients in the control group,with a total effectiveness rate of 60.42%. There was significant difference between the two groups (χ2 =5.042,P = 0.025). Inadmission,there were no differences between the two groups in the abnormal signals of MRI,abnormal rate of EEG,and the scores on MMSE,BI,andMoCA(P>0.05). After a 14-day treatment,the abnormal signals of MRI,abnormal rate of EEG,andthe scores on MMSE,BI,and MoCA score were improved better in the study than in the control group(P < 0.05). The MMSE score was negatively correlated with disease severity in DEACMP patients(r=-0.832,P=0.000). Conclusions Early treatment with Ginaton can effectively improvethe cerebral lesions on MR,the abnormal rate of EEG,andthe scores on MMSE,BI,and MoCA. It has certain clinical efficacy.

Objective To investigate the relationship between soluble CD14-st (Presepsin)and assessment,prognosis in patients with acute paraquat poisoning (APP).Methods A total of 82 patients with APP treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2013 to January 2016 were divied into three groups:mild poisoning group (n =20),moderate poisoning group (n =36)and severe poisoning group (n =26).According to the outcomes,patients were divided into survivor group (n =28)and non-survivor group (n =54).Another 50 healthy subjects were selected as control group.In control group,samples of 3 mL venous blood from 50 healthy subjects were collected for laboratory examination.Samoles of 10 mL venous blood from all patients were collected before and 72 hours,7 days after treatment to detect presepsin,C reactive protein (CRP), tumor necrosis factor α(TNF-α),interleukin-6 (IL-6)and interleukin-10 (IL-10).Before and 72 hours, 7 days after treatment,the change of Acute physiology and chronic health evaluation (APACHE)Ⅱscore and the outcomes in 28 days were observed.The variance analysis of repeated measures was used for comparison among multiple groups,and the t test was used to compare changes of detected biomarkers between two groups,and the outcomes in 28 days between two groups were compared with chi square test. Pearson correlation test was used to analyze the correlation between Presepsin in patients with APP and the survival rate.Results APACHE Ⅱ scores and the serum level of prespsin,CRP,TNF-α,IL-6 at admission and 72 hours,7 days after treatment in three poisoning groups were significantly increased compared with control group,IL-10 were decreased compared with control group (P <0.05 ),and there were significant differences in those biomarkers between moderate group and mild group,and between severe group and mild group,moderate group (P <0.05).At admission,72 h,7 d after admission,APACHEⅡscore and the serum levels of presepsin,CRP,TNF-α,IL-6 in non-survivor group were higher than those in survivor group,and IL-10 in non-survivor was lower than that in survivor group (P <0.05).The mortality rates of these 3 groups were 25.00%,69.44% and 92.31%,demonstrating significant differences among three groups (P <0.05).The AUCs were 0.862 and 0.731 for presepsin and APACHEⅡscore respectively at admission.The predictive capability of presepsin for 28-day mortality was superior over that of APACHEⅡscore (P <0.05).The level of serum presepsin in patients with APP was negatively correlated with the survival rate (r =-0.285,P =0.009).Conclusions The detection of prespsin has important clinical value in the severity assessment and prognosis in patients with APP.It is an important guidance for early therapeutic strategy.

ObjectiveTo observe the effects of extract of Ginkgo biloba, Ginaton, on cerebral oxygen utilization coefficients (O2UCc) and lactate clearance rate (LCR) in patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP).Methods The 196 patients with DEACMP admitted to Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2011 to March 2016 were enrolled, and they were randomly divided into a control group and an observation group, 98 cases in each groups. The control group received routine treatments such as hyperbaric oxygen, measures to prevent and treat cerebral edema, and promote brain cell metabolism, etc routine therapies: while in the observation group, besides the above routine treatments, additionally intravenous drip of Ginaton 70 mg (with 0.9% sodium chloride injection 250 mL added), once a day, for consecutive 2 weeks to complete one therapeutic course. At ambient air, before treatment and 6, 24 and 72 hours after treatment, the O2UCc and LCR and the changes of mini-mental state examination (MMSE) score, clinical efficacy and hospital mortality were observed and compared between two groups. Pearson correlation test was used to analyze the correlations between O2UCc, LCR and MMSE score.Results On the day of admission before treatment, there were no differences in O2UCc, lactate and MMSE score between the two groups (allP > 0.05). At 6 hours, 24 hours after treatment, the levels of O2UCc in observation group were obviously lower than those in control group [6 hours: (40.64±9.50)% vs. (45.78±7.94)%, P = 0.000; 24 hours: (30.51±6.76)% vs. (33.34±8.19)%,P = 0.009], while the levels of LCR were significantly higher than those in control group [6 hours: (14.93±2.27)% vs. (11.45±1.88)%,P = 0.000; 24 hours: (19.86±3.42)% vs. (13.73±2.35)%,P = 0.009]. There were no statistical significant differences in O2UCc and LCR at 72 hours after treatment between the two groups (P > 0.05). The MMSE scores at 6, 24 and 72 hours after treatment in observation group were higher than those in control group (6 hours: 15.52±3.61 vs. 11.60±2.49, 24 hours: 20.05±5.79 vs. 14.85±5.71,72 hours: 23.87±5.96 vs. 18.07±6.97, allP < 0.05). The total effective rate in observation group was significantly higher [77.55% (76/98) vs. 61.22% (60/98),P < 0.05], and the mortality [3.06% (3/98) vs. 10.20% (10/98),P < 0.05] was obviously lower than their own counterparts in control group. The correlation analysis showed that at different time points, the levels of O2UCc were negatively correlated to the corresponding MMSE scores (r6 h = -0.153,r24 h = -0.158, P6 h = 0.032,P24 h = 0.027), and there were positive correlations between the levels of LCR and MMSE scores (r6 h = 0.473, r24 h = 0.242,P6 h = 0.000,P24 h = 0.001) in patients with DEACMP.Conclusions The treatment of Ginaton in patients with DEACMP can effectively elevate the LCR and MMSE score, reduce O2UCc, decrease mortality and improve the prognosis, thus the clinical curative effect is distinct.

Objective:To investigate the value of combined detection of neutrophil gelatinase-associated lipocalin(NGAL), cystatin C(CysC)and heme oxygenase-1(HO-1)in the early diagnostic of acute kidney injury(AKI)caused by acute paraquat poisoning(APP)in elderly patients.Methods:One hundred and two elderly APP patients admitted to the emergency department of our hospital from May 2015 to June 2019 were assigned to the observation group, and 50 patients who took physical examinations served as the control group.The observation group was divided into the AKI sub-group(n=59)and the non-AKI sub-group(n=43)based on whether AKI occurred within 72 h of admission.Serum levels of NGAL, CysC, HO-1 and creatinine(Scr)were detected in all APP patients at 0 h(admission), 12 h, 24 h, 48 h and 72 h. Measurements of the same parameters were made on the day of physical examination for the control group.The correlations of serum levels of NGAL, CysC and HO-1 with the occurrence of AKI were analyzed.Relative operating characteristic curve(ROC)was drawn to analyze the diagnostic value of NGAL, CysC, HO-1 and the combination of the three for the early diagnosis of renal injury in APP patients.Results:Serum levels of NGAL, CysC, HO-1 and Scr at admission showed no significant difference between the AKI sub-group, non-AKI sub-group and control group( P>0.05). After admission, all the parameters showed an upward trend in the observation group.Serum levels of NGAL, CysC and HO-1 at 12 h after admission( P<0.05)and Scr levels at 72 h after admission( P<0.05)were significantly different between the AKI sub-group and the non-AKI sub-group.Correlation analysis showed that serum NGAL, CysC and HO-1 levels were positively correlated with the occurrence of AKI in APP patients at 12 h, 24 h, 48 h and 72 h after admission, with the best correlation at 48 h after admission(NGAL: r=0.203, 0.545, 0.707 and 0.560, P<0.05; CysC: r=0.242, 0.340, 0.754 and 0.467, P<0.05; HO-1: r=0.249, 0.536, 0.677 and 0.509, P<0.05). The area under ROC curve predicted by NGAL, CysC, HO-1, Scr and NGAL+ CysC+ HO-1 for AKI at 48 h after admission was 0.777, 0.718, 0.888, 0.602 and 0.969, respectively. Conclusions:Serum levels of NGAL, CysC and HO-1 are significantly elevated at 12 h after admission in elderly APP patients, and reach the peak at 48 h after admission.Each of them can give an earlier diagnosis for AKI than Scr, and the combination of the three provides a higher diagnostic accuracy for AKI.

Objective:The predictive value of LCR and BIS monitoring for delayed encephalopathy in acute severe carbon monoxide poisoning.Methods:Ninety-four patients with acute severe carbon monoxide poisoning treated in the Harrison International Peace Hospital Affiliated to Hebei Medical University between January 2017 and March 2019 were selected. According to whether DEACMP occurred within 60 days after discharge, the patients were divided into the DEACMP group ( n=33) and good prognosis group ( n=61). LCR and BIS of the two groups at different time points were compared, and the correlation between LCR and BIS was analyzed. The predictive value of LCR, BIS and the combination of the two for DEACMP was analyzed by receiver operating characteristic (ROC) curve. Results:The LCR and BIS of the DEACMP group at day 1t, 3 and 5 were significantly lower than those of the good prognosis group ( P<0.05). Pearson correlation analysis showed that there was a positive correlation between BIS and LCR in the DEACMP group at day 1, 3 and 5 ( r=0.371, P<0.05). There was also a positive correlation between LCR and BIS in the good prognosis group at day 1, 3 and 5 ( r=0.373, P<0.05). ROC curve analysis showed that the areas under the curves of LCR, BIS and the combination of the two for predicting the occurrence of DEACMP in patients with ASCOP were 0.803 (95% CI: 0.707~0.897), 0.941 (95% CI: 0.886~0.997), and 0.949 (95% CI: 0.879~1.000), respectively. Conclusions:LCR combined with BIS is of high predictive value for the occurrence of DEACMP in patients with ASCOP.

Objective To investigate the clinical value of type Ⅲ procollagen peptide (P Ⅲ P) in sequential treatment with Rheum officinale Ball.as a main agent in a traditional Chinese medicine recipe in patients with acute paraquat poisoning (APP).Methods A total of 104 patients with APP treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from March 2013 to December 2016 were divied into three groups:A group (n =30,routine therapeutic agents coupled with a single hemoperfusion),B group (n =34,treated by Rheum officinale Ball.as a main agent in a traditional Chinese medicine recipe coupled with a single hemoperfusion),C group (n =40,treated by Rheum officinale Ball.as a predominant agent in a traditional Chinese medicine recipe and sequential continuous hemoperfusion).Before and 3 days and 7 days after treatment,tumor necrosis factor t (TNF-α),interleukin-18 (IL-18),maleic dialdehyde (MDA),superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) of patients were detected,and the change of sequential organ failure assessment (SOFA) scores were observed.Before and 3 days,7 days,10 days and 14 days after treatment,PⅢP were detected,and the changes of lung CT in three groups were observed before and 7 days,14 days after treatment.Pearson correlation test was used to analyze the correlation between P Ⅲ P in patients with APP and the concentration of paraquat,and the outcomes in 28 days were compared with chi square test.Results At admission,there were no differences in the levels of plasma TNF-α,IL-18,MDA,P Ⅲ P,SOD,GSHPX and SOFA scores among three groups (P ＞ 0.05).At 3 days after treatment,the levels of plasma TNF-α,IL-18,MDA and SOFA scores were elevated in three groups compared with those at admission,especially in group A were increased significantly,whereas the activity of plasma SOD and GSH-PX were decreased in thress groups,especially in group A decreased most significantly (P ＜ 0.05).At 7 days after treatment,the levels of plasma TNF-α,IL-18,MDA and SOFA scores were lower than those at 3 days after treatment in three groups especially those in group C decreased most significantly (P ＜ 0.05),whereas the activities of plasma SOD and GSH-PX were higher than those at 3 days after treatment especially in group C decreased most significantly (P ＜0.05).At 3 days,7 days,10 days,14 days after treatment,the level of P Ⅲ P were increased gradually in three groups,especially in group C increased most slowly with statistically significant difference between the groups (P ＜ 0.05).At admission,there were no statistically significant difference in the features of lung CT among three groups (P ＞ 0.05).At 7 days after treatment,lung CT mainly manifested ground glass lesions in C group.At 14 days after treatment,lung CT mainly manifested small size of the exudative changes and the irregular line of pleura in C group with higher proportion of those changes than that in A,B group,while pulmonary interstitial changes were found in the lung CT of A and B groups with higher proportion of these changes than that in C group,and those A group was higher than those in B group (P ＜ O.05).The level of serum P Ⅲ P in patients with APP was positively correlated with the concentration of paraquat (r =0.310,P =0.001).The mortality rate of three groups were 53.33％,44.12％ and 25.00％,respectively,with significant difference among three groups (P ＜ 0.05).Conclusion The clinically therapeutic effect of sequential treatment with Rheum officinale Ball.as a main agent in a traditional Chinese medicine in patients with APP was distinct.It could decrease the levels of PⅢ P,TNF-α,IL-18 and MDA,enhance the expression of SOD and GSH-PX,reduce pulmonary fibrosis in patients and the mortality rate of patients.The P Ⅲ P is the evaluation index of pulmonary fibrosis and can provide useful clinical value for the treatment of patients with APP.