广西常见突发化学中毒事件应急救治综合疗法的研究

目的:探索更为有效的突发化学中毒事件应急救治技术方案和关键技术,以提高突发化学中毒事件应急救治水平.方法:运用循证医学方法,对过去13年来广西常见突发化学中毒事件进行回顾性调查,总结应急救治所取得的成功经验,优化应急救治技术方案,探索突发化学中毒应急救治新理论、新方法、关键抢救技术.结果:"毒鼠强解毒鸡尾酒疗法"应急救治技术应用于1 133例急性毒鼠强中毒患者的抢救,无一例死亡;"非特异综合解毒急救疗法"抢救了7种急性化学中毒患者372例,全部获得抢救成功;"特异性解毒急救疗法"抢救3种急性化学中毒患者101例,全部获得抢救成功.结论:本研究总结出的3种应急救治疗方法应用于1 606例急性化学中毒患者的抢救,证明可有效降低化学中毒患者病死率.     

还原型谷胱甘肽滴眼液联合黄芪注射液治疗职业性三硝基甲苯白内障45例疗效观察

目的 了解还原型谷胱甘肽滴眼液联合黄芪注射液治疗职业性三硝基甲苯(TNT)白内障的临床疗效.方法 对45例职业性TNT白内障治疗前后进行疗效观察并对比分析.结果 用药3个疗程后检查,视力有所提高(73.33％),其中E字母增进≥1行有56.67％、增进＜1行有16.67％,显示较好的效果.治疗后眼部血流动力学明显改善,与治疗前比较,差异有统计学意义(P＜0.05).6％眼晶状体混浊形态有不同程度改善.结论 治疗职业性TNT白内障必须着重改善眼周围微循环障碍,同时以抗氧化清除氧自由基联合治疗,才能提高疗效.     

急性毒鼠强中毒的救治研究

目的总结探讨急性毒鼠强中毒的症状特点及救治经验。方法对8例急性毒鼠强中毒的临床资料及救治经过进行回顾性总结分析。结果 8例中毒患者均成功救治,1例出现二次中毒。结论经口毒鼠强中毒的潜伏期短,临床主要表现为惊厥、全身抽搐。早期彻底洗胃、防治脑水肿和控制癫痫发作是治疗成功的关键,苯巴比妥使用要早,减量要慢,配合血液灌流和综合治疗能取得较好疗效。     

广西某焦化厂作业工人脂肪肝患病率调查

脂肪肝是指脂肪在肝细胞内过度沉积所引起的一种疾病,脂肪肝临床上没有特异性表现,少数仅有右上腹不适感,易被忽视。随着人们生活水平的提高,膳食结构及生活方式的变化,脂肪肝呈逐年增加的趋势,应引起足够的重视,普通人群脂肪肝的患病率为5．2％～11．4％,并有明显低龄化趋向。焦化作业人员由于在工作中接触焦化逸散物（COE）,使这一特殊职业人群脂肪肝的检出率高于普通人群,为进一步证实焦化作业人员脂肪肝的患病情况与COE的关系,2008-2009年,我们对广西某焦化厂工人的B超检查资料进行了统计分析,现报道如下。     

常规MRI和1H-MRS在职业性锰暴露致中枢神经损害中的应用价值

Objective MRI and MR hydrogen proton spectroscopy (1H-MRS) were used to detect the abnormal signal and alteration of metabolites, in order to explore the efficacy of these method in evaluating the damages of central nervous system (CNS) induced by occupational manganese exposure.Methods Eighteen workers exposed to manganese without any manganism symptoms, 12 workers with slightly chronic manganese poisoning, and 19 healthy workers were scanned using routine MRI sequence and 1H-MRS.The blood manganese concentration was also collected for each subject.On cerebral axial T1 WI,the signal intensities of ipsilateral globus pallidus and frontal white matter were measured in the visually brightest area (try to select the signal homogeneous region), and the globus pallidus index (PI) was then calculated.The 1H-MRS data was calculated to get the values of the peak height of N-acetylaspartate (NAA), choline (Cho), inositol (mI) and creatine (Cr) and the ratios of NAA/Cr, Cho/Cr, and mL/Cr were also calculated.One way ANOVA was used to compare the values of PI, NAA/Cr, Cho/Cr, mI/Cr and MnB among the three groups, and the correlations between PI and the time span of manganese exposure or blood manganese concentration were analyzed by Pearson correlation analysis.Eight workers exposed to manganese were followed up one year, and their PI , NAA/Cr before and after follow-up were compared by t test.Results Fourteen of 18 cases exposed to manganese without any manganism symptoms showed symmetrically high intensity signal on T1 WI, while the T2 WI were normal.No high signal intensity was observed on T1WI in any of the healthy workers or manganese poisoning workers.We found that the average PI in manganese exposed group (1.16 ±0.09) was significantly higher (F =24.79 ,P =0.O00)than those of the poisoning ( 1.05 ± 0.07 ) and control groups ( 1.01 ± 0.05 ).The blood manganese concentration in manganese exposed group, the poisoning group and the control group were (0.051 ±0.024), (0.047 ±0.018 ), ( 0.043 ± 0.020 ) μg/ml respectively, which was not significantly different ( F = O.623, P =0.541 ) and did not exceed the upper limit of normal reference value ( < 0.10 μg/ml ).There was a significantly correlation between PI and the time span of manganese exposure ( r = 0.67, P = 0.002 ),however, there was no correlation between PI and blood manganese concentration ( r = 0.20, P = 0.427 ).Furthermore, the NAA/Cr ratio decreased variously in the manganese poisoning group ( 1.22 ± 0.07 ) which was significantly lower( F = 4.120, P = 0.023 ) than those of the poisoning( 1.33 ± 0.13 ) and control groups ( 1.31 ±0.13).No statistical significanees were found in the ratios of Cho/Cr and mI/Cr among these three groups(P>0.05).No obvious changes of the PI and NAA/Cr were found in the 8 manganese exposed workers after 1 year follow-up.Conclusion Manganese exposure could lead to the high intensity signal on T1 WI, therefore the increased PI may be the biomarkers of central nerve system damages caused by the occupational manganese exposure.     

腐鱼搬运工急性砷化氢中毒的救治体会

目的 分析总结腐鱼搬运工急性中毒的病因及其诊治经验.方法 对2例因搬运腐鱼引起的以急性溶血为主要临床表现的急性中毒患者的临床资料进行分析.结果 根据患者的临床表现,排除急性硫化氢中毒后予以控制溶血、防治肾功能不全等治疗后痊愈出院.结论 海鱼腐败后体内的有机砷可水解生成砷化氢,应加强作业防护;控制溶血、防治肾功能不全是救治的关键.     

常规MRI和1H-MRS在职业性锰暴露致中枢神经损害中的应用价值

Objective MRI and MR hydrogen proton spectroscopy (1H-MRS) were used to detect the abnormal signal and alteration of metabolites, in order to explore the efficacy of these method in evaluating the damages of central nervous system (CNS) induced by occupational manganese exposure.Methods Eighteen workers exposed to manganese without any manganism symptoms, 12 workers with slightly chronic manganese poisoning, and 19 healthy workers were scanned using routine MRI sequence and 1H-MRS.The blood manganese concentration was also collected for each subject.On cerebral axial T1 WI,the signal intensities of ipsilateral globus pallidus and frontal white matter were measured in the visually brightest area (try to select the signal homogeneous region), and the globus pallidus index (PI) was then calculated.The 1H-MRS data was calculated to get the values of the peak height of N-acetylaspartate (NAA), choline (Cho), inositol (mI) and creatine (Cr) and the ratios of NAA/Cr, Cho/Cr, and mL/Cr were also calculated.One way ANOVA was used to compare the values of PI, NAA/Cr, Cho/Cr, mI/Cr and MnB among the three groups, and the correlations between PI and the time span of manganese exposure or blood manganese concentration were analyzed by Pearson correlation analysis.Eight workers exposed to manganese were followed up one year, and their PI , NAA/Cr before and after follow-up were compared by t test.Results Fourteen of 18 cases exposed to manganese without any manganism symptoms showed symmetrically high intensity signal on T1 WI, while the T2 WI were normal.No high signal intensity was observed on T1WI in any of the healthy workers or manganese poisoning workers.We found that the average PI in manganese exposed group (1.16 ±0.09) was significantly higher (F =24.79 ,P =0.O00)than those of the poisoning ( 1.05 ± 0.07 ) and control groups ( 1.01 ± 0.05 ).The blood manganese concentration in manganese exposed group, the poisoning group and the control group were (0.051 ±0.024), (0.047 ±0.018 ), ( 0.043 ± 0.020 ) μg/ml respectively, which was not significantly different ( F = O.623, P =0.541 ) and did not exceed the upper limit of normal reference value ( < 0.10 μg/ml ).There was a significantly correlation between PI and the time span of manganese exposure ( r = 0.67, P = 0.002 ),however, there was no correlation between PI and blood manganese concentration ( r = 0.20, P = 0.427 ).Furthermore, the NAA/Cr ratio decreased variously in the manganese poisoning group ( 1.22 ± 0.07 ) which was significantly lower( F = 4.120, P = 0.023 ) than those of the poisoning( 1.33 ± 0.13 ) and control groups ( 1.31 ±0.13).No statistical significanees were found in the ratios of Cho/Cr and mI/Cr among these three groups(P>0.05).No obvious changes of the PI and NAA/Cr were found in the 8 manganese exposed workers after 1 year follow-up.Conclusion Manganese exposure could lead to the high intensity signal on T1 WI, therefore the increased PI may be the biomarkers of central nerve system damages caused by the occupational manganese exposure.     

前列腺素E1治疗扩张型心肌病合并心力衰竭80例疗效观察

前列腺素E1(PGE1)为近年被医学界逐步认识并广泛应用于临床的生物活性物质.作者于1998年2月～2005年4月用PGE1治疗扩张性心肌病合并心力衰竭80例,取得了满意的疗效,现报道如下. 1临床资料     

磁共振成像和氢质子磁共振波谱在铅神经毒性研究中的应用

铅具有神经毒性，但是由于中枢神经系统的不可介入性，给临床诊断与治疗带来一定的困难。近年来，随着神经影像学在铅神经毒性研究中的应用，使人们对磁共振成像（MRI）和磁共振波谱（MRS）的认识不断加深，尤其是氢质子（^1H）核自然丰度最高，且氢质子磁共振波谱（^1H-MRS）灵敏度好，是目前研究活体组织器官、代谢、生化改变及化合物定量分析惟一的无创性方法，故其在神经变性疾病的研究中应用最广泛。     

50例三硝基甲苯作业人员眼晶状体混浊的临床观察

通过对某厂50例三硝基甲苯(TNT)作业人员眼晶状体混浊的临床观察,了解其发病规律,对其住院的临床资料进行分级诊断.结果 显示,所有病例均诊断为职业性三硝基甲苯白内障,其中一期白内障30例,二期白内障17例,三期白内障3例,肝脏、血液、神经系统改变不明显.提示,眼晶状体混浊是TNT作业工人最常见、出现最早的和最具特异性...