不同浓度氢氟酸对大鼠血钙变化的影响

目的观察不同浓度氢氟酸对皮肤损伤及血钙变化的影响。方法以大鼠为动物模型,设氢氟酸损伤浓度为20％及40％两组,每组40只,并在伤后不同时相点取全血及创面标本行血钙和组织病理学检查。结果 20％浓度氢氟酸即可造成皮肤损伤,较长时间损伤可以导致全身性低血钙而死亡。高浓度氢氟酸(40％)短时间内即可造成皮肤的深层坏死,较小面积烧伤在伤后24小时内即可造成致命性低钙而死亡。结论在治疗氢氟酸烧伤过程中必须争分夺秒,尽早处理,在实验室监测下早期及时地大量补钙,以防止低血钙死亡。     

不同浓度氢氟酸对大鼠血钙变化的影响

OBJECTIVE: To evaluate the effects of different concentration of hydrofluoric acid (HF) on local skin and calcium level of serum. METHODS: SD rats were divided into two groups which were wounded by 20% and 40% percent of HF respectively. Samples of blood and wound tissue were harvested at different postburn time for the analysis of the calcium level of the serum and histological study. RESULTS: It was found that twenty percent of HF was enough to cause a skin damage, and might bring about fatal hypocalcemia after a prolonged contact. High concentration of HF (40%) could cause deep tissue necrosis within a short time, and result in a fatal hypocalcemia within 24 hour even in the case of a small area injury. CONCLUSION: It is important to treat the patient with HF injury as early as possible. Sufficient calcium must be applied guided by laboratory study in order to prevent the fatal hypocalcemia.     

氢氟酸烧伤患者的治疗

1991～ 2 0 0 0年 10年间我科共收治 2 1例氢氟酸烧伤患者 ,深感氢氟酸烧伤的治疗有其特殊性。典型病例 :患者男 ,2 0岁 ,浓度 5 5 %氢氟酸泄漏致双下肢、右眼灼伤 ,伤后 3ｈ入院。诊断 :(1)氢氟酸烧伤总面积 9% ,Ⅲ度 4 %ＴＢＳＡ ;(2 )右眼烧伤。急诊检测血钙 1.5 3ｍｍｏｌ/     

治疗氢氟酸烧伤38例

本组患38例，年龄18～57岁，烧伤面积≤1％TBSA 27例、〉1％且≤2％TBSA 7例、3％TBSA 3例、7％TBSA 1例。     

含钙镁生物敷料对氢氟酸烧伤的疗效

目的观察大鼠及人氢氟酸烧伤后局部应用“含钙镁生物敷料”（吸附钙、镁离子液后与戊二醛交联的绵羊真皮）的疗效，为临床治疗氢氟酸烧伤寻找更好的方法。方法将Wistar大鼠分成对照组（24只）、不治疗组（32只）、湿敷A组（32只）、生物敷料A组（32只）。后3组大鼠制成3cm×3cm的氢氟酸Ⅲ度烧伤模型，设伤后4、8、24、72h为观察时相点（每时相点8只）。生物敷料A组伤后应用“含钙镁生物敷料”覆盖创面并定期更换，湿敷A组、不治疗组、对照组则分别代以“湿敷液”或等渗盐水纱布湿敷。计算各组大鼠死亡率、进行组织病理学观察、测定血钙浓度。将46例氢氟酸烧伤患者分为湿敷B组与生物敷料B组，两组创面参照动物实验进行对比用药并观察疗效。结果对照组、不治疗组、湿敷A组、生物敷料A组大鼠的死亡率分别为0、31．2％、15．6％、6．2％。不治疗组大鼠伤后创面进行性加深，生物敷料A组与湿敷A组相对而言局部损伤略轻。对照组大鼠各时相点血钙浓度均高于其余3组，生物敷料A组各时相点均高于不治疗组与湿敷A组。伤后8、24h，生物敷料A组血钙浓度分别为（2．215±0．008）、（2．216±0．008）mmoL／L，不治疗组为（1．813±0．017）、（1．912±0．013）mmoL／L，湿敷A组为（2．015±0．006）、（2．018±0．010）mmoL／L，生物敷料A组与后两组比较，差异有统计学意义（P＜0．01）。生物敷料B组患者创面用药的镇痛效果及后期愈合情况明显优于湿敷B组。结论“含钙镁生物敷料”可用于氢氟酸烧伤后的急救和局部创面的后续治疗。     

碳酸钙凝胶在手氢氟酸灼伤处理中的应用

氢氟酸作为一种工业用清洗剂已广泛应用于金属和玻璃行业,长期接触可发生暴露部位皮肤尤其是手的损伤,其特征为迟发性皮肤溃疡,疼痛剧烈,持续时间长。传统的钙剂局部浸润或动脉内注射疗法的缺点是疼痛而常需反复治疗。本文介绍的新方法是局部应用碳酸钙凝胶,经4小时治疗后疼痛缓解,皮肤溃疡不再发展,完全恢复功能。     

153名氢氟酸中毒抢救体会

目的 总结153名氢氟酸中毒患者的急救护理体会。方法 突发事件救护重点:规范院前急救流程、树立急救护理理念、制定氢氟酸救治流程、建立应急预案,形成一套有序而紧张的救护体系、加强护理配合工作。结果 153名患者入院后得到了及时的救护,148名患者在急诊留观4~24小时经临床观察,症状消失后离院,5名患者因病情严重经急诊抢救后收住ICU,其中3名患者经专家积极救治无效死于急性呼吸循环衰竭。结论 合理规范的突发事件救护可以有效提高救治成功率。     

家兔氢氟酸烧伤心肌损害的实验研究

目的　研究氢氟酸烧伤对心肌的影响 ,提高对氢氟酸导致氟中毒的认识。　方法　采用新西兰白兔 2 %TBSAⅢ度氢氟酸烧伤模型 ,观察各时相点心肌和相关酶谱指标的改变 ,以及病理形态学变化。　结果　 ( 1)伤后心肌各项酶含量较伤前明显增高 (P <0 .0 1)。 ( 2 )血清心肌酶含量增高峰值均在 48h以内出现。各时相点心肌酶谱含量的差异均有非常显著性意义 (P <0 0 1)。( 3)血清心肌酶含量以CPK增幅最大 ,增加了 97.5 %。而LDH、AST、CK -MB分别增加了 81.9%、76 .1%和 6 0 .3%。 ( 4)病理形态学检查发现 ,光镜下见心肌纤维颗粒变性、灶性坏死 ,心肌间质出血 ,并伴有中性粒细胞、淋巴细胞浸润。电镜观察心肌细胞内肌原纤维减少或消失 ,细胞水肿严重 ,线粒体肿胀、嵴消失 ,血管内皮细胞肿胀 ,电子密度极低 ,呈大泡状 ,肌细胞核变形。　结论　氢氟酸烧伤后对心肌有一定程度损害 ,心肌和心肌相关酶谱含量的改变 ,反映了氢氟酸致伤后的心肌损伤程度 ,在抢救氢氟酸烧伤、氟中毒时应监测心肌酶谱及心电图等指标 ,注意保护心脏的功能     

Dimethyl sulfoxide but not indomethacin is efficient for healing in hydrofluoric acid eye burns

Introduction

In this study, we aimed to investigate the effect of indomethacin and dimethyl sulfoxide (DMSO), well-known antioxidant and anti-inflammatory agents, to heal eye burns induced with hydrofluoric acid in rabbits.

PCMV4-hTGFβ1在大鼠深Ⅱ度烫伤创面愈合及瘢痕形成中的作用

目的观察与人类巨细胞病毒载体结合的转化生长因子β１（ＰＣＭＶ４ｈＴＧＦβ１）重组质粒裸ＤＮＡ直接注射于深Ⅱ度烫伤大鼠体内后的基因表达规律及对创面愈合的作用,探讨其作为核酸疫苗的可行性,为烧伤的基因治疗提供理论基础和实验依据。方法大鼠随机分为烫伤＋核酸疫苗组;单纯核酸疫苗组;对照组。采用ＥＬＩＳＡ方法检测裸ＤＮＡ注射后血清中中和抗体水平;Ｓｏｕｔｈｅｒｎ杂交、原位杂交检测裸ＤＮＡ注射后在肌肉中存留时间,组织特染法检测组织中Ⅰ／Ⅲ型胶原的变化。结果裸ＤＮＡ肌注７天后血清中可检测出抗ＴＧＦβ１中和抗体,２１天达其峰值,２８天有轻度下降。Ｓｏｕｔｈｅｒｎ杂交显示裸ＤＮＡ注射后,５ｍｉｎ即可检测出高浓度ＴＧＦβ１,１ｈ后浓度开始下降,３ｈ后仍可检测出。原位杂交在肌注５天后,肌肉中还有阳性反应。核酸疫苗组创面愈合速度在前９天较对照组快,差异有显著性意义（Ｐ＜０．０５）,在后期与对照组间差异无显著性意义（Ｐ＞０．０５）,但Ⅰ／Ⅲ型胶原比例明显下降（Ｐ＜０．０１）。结论ＰＣＭＶ４ｈＴＧＦβ１即可加速创面愈合,又可控制Ｉ型胶原合成,控制瘢痕增生。证实了其作为核酸疫苗治疗烧伤创面及控制瘢痕形成是可行的。     

Comparison of skin effects of immediate treatment modalities in experimentally induced hydrofluoric acid skin burns

Hydrofluoric acid (HF) burns cause immediate damage and painful long‐term sequellae. Traditionally, chelating agents have been used as the initial treatment for such burns. We have introduced epidermal growth factor (EGF) into an HF model to compare EGF with Ca²⁺ and Mg²⁺ treatments; 40 Sprague Dawley rats were divided into five groups. Each rat suffered a 6 × 4 cm² burn induced by 40% HF. Group 1 had no treatment, group 2 had saline injected beneath the burn, group 3 received magnesium sulphate injections, group 4 received calcium gluconate and group 5 received EGF. Specimens were evaluated via planimetry and biopsy at intervals of 4, 8, 24 and 72 hours. Fluid losses were significantly less in the Mg²⁺ and EGF groups. The EGF group had the smallest burn area, least oedema, least polymorphonuclear granulocyte (PMN) infiltration, most angiogenesis and highest fibroblast proliferation of any group (P < 0·005). EGF limited HF damage morphologically and histologically more effectively than Ca²⁺ or Mg²⁺. This finding indicates that HF treatment via growth factors may be an improvement over chelation therapy.     

Application of calcium nebulization for mass exposure to an accidental hydrofluoric acid spill

PurposeTo determine the long-term prevalence and characteristics of acute hydrofluoric acid (HF) exposure in 2223 patients during the first 30 months after a mass-casualty exposure, and to confirm the antidotal effect of nebulized calcium on inhalation burns caused by HF.MethodsThis observational cohort study included patients after an HF spill in the Republic of Korea on September 27, 2012; registered patients were followed until April 2015. We assessed toxic effects, distance from spill, degree of acute poisoning, and the effect of nebulized calcium in HF-exposed individuals.ResultsOverall, 2223 patients received emergency management or antidote therapy for 20 days. Seventy-four of 134 patients with dermal toxicity received calcium–lidocaine gel, and 368 individuals with bronchial irritation signs received calcium gluconate via nebulizer nCG. A total 377 ampoules 786 g of calcium gluconate were used in the nCG formulation. Calcium administration did not cause adverse reactions during the observation period. Long-term cohort observation showed that 120 patients (120/2233, 5.4%) returned to medical facilities for management of HF-related symptoms within 1 month; 18 persons (18/1660, 1.1%) returned 1–3 months later with chronic cough and respiratory symptoms; and 3 patients (3/1660, 0.2%) underwent medical treatment due to upper-airway toxic symptoms more than 2 years after HF exposure.ConclusionRespiratory toxicity after mass exposure to an HF spill was successfully treated by calcium nebulizer. Based on our experience, detoxification processes and the amounts of antidote stocked are important when planning for future chemical disasters at the community level.     

血小板活化因子在烧伤合并内毒素血症早期肺损伤中的作用及意义

目的　探讨血小板活化因子（ＰＡＦ） ,肿瘤坏死因子（ＴＮＦ）等在烧伤合并内毒素血症早期肺损伤中的作用及意义。方法　采用２０ ％ ＴＢＳＡⅢ度烧伤合并内毒素注射复制大鼠早期肺损伤模型,检测血浆ＰＡＦ、ＴＮＦ含量等,观察肺组织病理形态学变化并应用ＰＡＦ受体拮抗剂防治早期肺损伤。结果　ＰＡＦ是烧伤合并内毒素血症早期先于ＴＮＦ出现变化的炎症介质,血浆ＰＡＦ浓度与早期肺损伤程度呈正相关,注射ＰＡＦ受体拮抗剂ＢＮ５０７３９ 可使肺损伤程度减轻。结论　ＰＡＦ在烧伤合并内毒素血症早期肺损伤中起重要致病作用