窒息性气体中毒治疗的若干进展

窒息性气体中毒治疗的若干进展魏文增，绳宗敏，韩俊起天津市１９７９～１９８０年共发生各种急性职业中毒７２９例，其中窒息性气体中毒１０７例占构成的１４．６８％，居第３位［１］。但其危害程度却最严重，１０年内急性职业中毒死亡１４例，而窒息性气体中毒死亡占１...     

14起窒息性气体中毒分析

浙江省１９９４～１９９７年发生１４起４８例窒息性气体中毒，其中死亡２７人。结果显示，造成发病与死亡的毒物以硫化氢为主，事故发生原因以违章作业与设备检修不当造成跑、冒、滴、漏为主。提出了加强设备维修、严格操作规程、加强对职工安全知识教育等预防对策。     

窒息性气体中毒现场诊断与救援

窒息性气体中毒指吸入使机体产生缺氧而直接引起窒息作用的气体后,产生以神经系统为主的多脏器功能损害,窒息性气体中毒的发病特点呈突发性、快速性和高度致命性.本文主要通过首诊病例分析、医学文献数据库查询、专业人员访谈、座谈等研究方式,了解窒息性气体中毒现场救援现状,明确急性窒息性气体中毒的现场急救方法,以期进一步提高窒息性气体中毒的抢救成功率及降低后遗症发生率.     

一起单纯窒息性气体中毒事故的调查

2006年8月15日中午，我中心接到人民医院电话报告，有3人发生不明原因气体中毒入院治疗。我中心领导立即派出调查小组进行调查。     

急性刺激性和窒息性气体中毒特点及疗效观察

本文通过37例急性刺激性气体与窒息性气体中毒临床特点的比较分析,发现刺激性气体中毒的呼吸系统症状及X胸片改变显著高于窒息性气体中毒（P＜0．01或P＜0．05）,而窒息性气体中毒临床表现是以中枢神经系统缺氧症状为主。因此,前者须防治肺水肿,后者治疗的关键为纠正缺氧。根据中毒特点不同,可大致鉴别这两类气体,并及时采取相应的治疗措施,这对于吸入毒性气体种类不明的急性职业中毒或内科急诊病例的救治具有指导意义。     

职业性急性窒息性气体中毒死亡事故案例分析

现将常州地区近年来发生的职业性急性中毒导致死亡的三起案例报道分析如下：１案例介绍１．１案例一１．１．１事故经过１９９７年４月某日,我市某乡镇企业肌醇车间,早上６时３０分,工人向投料池投料（植酸钙加水）、搅拌,通过管道抽入反应釜加热。１０ 时 ５５分操作工李某到投料池底部清理残渣,班长王某在上配合,李某下到池底迅即昏倒,王某下去营救,也昏倒在池底。锅炉工张某路过发现,立即下去,也即刻昏倒。车间发现后,即用鼓风机向池底送风,并组织营救,三位工人被救上后即送医院,其中２人于途中死亡（李某、王某）,张某经…     

急性窒息性气体中毒的临床特点及治疗研究现状

窒息性气体是导致人体缺氧而窒息的气体。窒息性气体中毒病情发展迅猛,死亡率高,且具有群发性。硫化氢（H2S）、一氧化碳（CO）和二氧化碳（CO2）是导致窒息性气体重大急性职业中毒的主要因素。急性窒息性气体中毒的毒性机制包括单纯性氧供给不足、发生特异性化学反应导致组织细胞缺氧、自由基损伤机制、发生急性反应性喉痉挛、反应性延髓呼吸中枢麻痹。急性窒息性气体中毒的临床表现主要是组织器官缺氧症状,并且首要表现为中枢神经系统缺氧的症状。尽早合理氧疗是治疗急性窒息性气体中毒的首要措施,同时视病情给予自由基清除剂及抗感染、镇静、解痉、营养心肌、促进脑细胞代谢等综合治疗,并且要重视急性期过后的损伤。     

一起急性窒息性气体中毒调查

2004—05—26梅县某立窑水泥厂发生1起1人急性窒息性气体中毒致死事故，现就调查情况报告如下。     

酿造厂醋储存池3例窒息性气体中毒报告

在以有机物作为原料的发酵或酿造制品的容器、储存池及发酵池内,由于生物酶及细菌和霉菌的作用,有机物发酵分解的生化反应过程中会产生有害气体,可引起中毒.本文报告发生在酿造厂制醋车间的液体储存池中的3人中毒事故.     

一起窒息性气体中毒事故调查

2007年3月5日,我中心接到一矿井发生突发性中毒事故的报告,立即组织前往调查,现将结果报告如下。     

Notifications of industrial chemical cyanosis poisoning in the United Kingdom 1961-80

In 325 cases of industrial chemical cyanosis notified to Her Majesty's Factory Inspectorate for 1961-80 the incidence of poisonings showed considerable seasonal variation with substantially greater numbers occurring in the summer months. A correlation between the number of poisonings in any one year and the hotness of that summer was also shown. The vast majority of incidents occurred during the manufacture of chemicals or dyestuffs, and two particular workplaces were responsible for 70% of the cases. Poisoning by amino compounds appear to produce early cyanosis whereas poisoning by nitro compounds tended to produce delayed cyanosis. These latter compounds were also more likely to produce anaemia. Methaemoglobin was determined in 45% of cases with results ranging from less than a few per cent to over 50%. Despite concentrations of MetHb over 50%, several workers complained only of headache and their blue appearance.     

Notifications of industrial chemical cyanosis poisoning in the United Kingdom 1961-80.

In 325 cases of industrial chemical cyanosis notified to Her Majesty's Factory Inspectorate for 1961-80 the incidence of poisonings showed considerable seasonal variation with substantially greater numbers occurring in the summer months. A correlation between the number of poisonings in any one year and the hotness of that summer was also shown. The vast majority of incidents occurred during the manufacture of chemicals or dyestuffs, and two particular workplaces were responsible for 70% of the cases. Poisoning by amino compounds appear to produce early cyanosis whereas poisoning by nitro compounds tended to produce delayed cyanosis. These latter compounds were also more likely to produce anaemia. Methaemoglobin was determined in 45% of cases with results ranging from less than a few per cent to over 50%. Despite concentrations of MetHb over 50%, several workers complained only of headache and their blue appearance.     

Renal damage from industrial arsine poisoning

Uldall, P. R., Khan, H. A., Ennis, J. E., McCallum, R. I., and Grimson, T. A. (1970).Brit. J. industr. Med.,27, 372-377. Renal damage from industrial arsine poisoning. An incident is reported in which three men were accidentally poisoned by arsine (A_s H₃) in an industrial chemical plant. Two mildly affected individuals recovered quickly-without treatment but the third, who was severely poisoned, developed oliguric renal failure. Though this patient recovered after repeated peritoneal dialysis he was left with a legacy of chronic renal insufficiency and hypertension. This severe case drew attention to a previous incident in the same factory involving three other men, the cause of which had not hitherto been suspected.

The previous reports of arsine-induced renal failure treated by dialysis have been reviewed and certain common features are apparent. Dangerous uraemia may persist long after the onset of the diuretic phase. Dialysis provides a high chance for recovery in what was previously a universally fatal condition, but permanent renal interstitial damage is a likely sequel. There are strong reasons for the prompt use of exchange transfusion in the severely affected patient with oliguria.

Mild arsine poisoning unaccompanied by oliguria may remain unrecognized and should therefore be considered in the differential diagnosis of any patient presenting with haematuria or jaundice, particularly if his occupation brings him in contact with acids and metals.

     

突发性中毒事故的应急救援

该文针对常见不同的突发性中毒事故,提出了相应的应采取的应急救援措施,并对以往事故处理中暴露的问题,提出了科学的处理方法.该文对我国职业安全管理体制的完善和化学中毒事故防护以及应急救援能力提高具有一定的借鉴意义.     

化学中毒与救治的研究探讨

回顾性总结某公司在化学中毒事故中,医院及职业病防治所(以下简称职防所)在诊治中的体会,建立和完善行之有效的三级救援网络体系及救治经验.对化学伤害事故所发生的经过及住院抢救病人进行全过程回顾分析,救治各种化学中毒病人486例,死亡12例,总死亡率2.47%.各种化学中毒损伤的救治随着企业、医院、职防所认识提高,充分发挥三级网络作用和化学中毒急救预案的不断完善,以及逐步规范和提高救治水平,有效地保护了化工企业的劳动生产力,为经济发展做出重大贡献.