急性有机氟吸入中毒患者血尿氟浓度变化及临床应用价值

目的 观察并比较不同程度急性有机氟吸入中毒患者在不同时间血、尿氟质量浓度的动态变化,探讨血、尿氟质量浓度测定在急性有机氟吸入中毒诊治中的临床应用价值.方法 分析2000年12月至2008年12月间浙江衢化医院收住的23例急性有机氟吸入中毒患者的临床资料,根据职业性急性有机氟中毒诊断标准(GBZ66-2002)分为轻度、中度和重度中毒组,采用离子选择性电极法动态检测中毒后1,2,3,4,5 d的血、尿氟质量浓度,同时测定同期在氟化工公司工作的10例健康员工血、尿氟离子质量浓度作为对照组,分析比较不同组和不同时间点的血、尿氟质量浓度变化.多组均数间的差异性比较采用重复测量方差分析,以P＜0.05为差异具有统计学意义.结果 与轻度中毒组同时间点比较,中度中毒组血、尿氟离子质量浓度在第1～5天差异均无统计学意义(P＞0.05),而重度中毒组血、尿氟离子质量浓度在第1～5天差异均具统计学意义(P＜0.05或P＜0.01).与中度中毒组同时间点比较,重度中毒组血、尿氟离子质量浓度在第1～5天差异也均有统计学意义(P＜0.005).各中毒组血氟离子质量浓度在第1～5天均较对照组有统计学意义的升高(P＜0.05),而尿氟离子质量浓度仅在轻度中毒组第1天、中度中毒组第1～3天和重度中毒组第1～5天有统计学意义的升高(P＜0.05).结论 急性有机氟吸入中毒后的5 d内,血氟离子质量浓度测定可作为诊断和判定严重程度的指标,尿氟离子质量浓度可作为中毒的诊断指标,但仅在中毒早期或重度中毒有意义.

Variation and clinical application value of fluoride concentrations in the serum and urine in patients with acute organic fluoride poisoning by inhaling

Objective To investigate the changes of serum and urine fluorion organic fluoride poisoning by inhaling, and to probe into the clinical application value of concentrations in different degrees and at different time in patients with acute evaluating the sertm and urine fluorion concentration in acute organic fluoride poisoning by inhaling. Method A study was carried out in 23 patients, who suffered from acute organic fluoride poisoning by inhaling and were admitted Zhejiang Quhua Hospital, from December 2000 to December 2008. According to the occupational acute organic fluoride poisoning diagnostic criteria(GBZ66-2002),23 patients were divided into mild poisoning group,moderate poisoning group and severe poisoning group. Serum and urine fluorion concentration of patients at 1,2,3,4,5 d after poisoning were measured by using Ion-Selective Electrodes. Fluorion concentration of 10 staffs of Fluorine chemical company was also measured at the same period as the control group. The values of serum and urine fluorion concentration were analyzed. Differences in serum and urine fluorion concentration between groups at different time points were compared by repeated measures ANOVA and variability were deemed as statistical significance when P ＜ 0.05. Results Compared with mild poisoning group, there was no statistically significant difference ( P ＞ 0.05) in serum and urine fluorion concentration at the same time point in 1 to 5 days after poisoning in moderate poisoning group, but there was statistically significant differences ( P ＜ 0.05 or P ＜0.01) in severe poisoning group. Compared with moderate poisoning group, there was statistically significant difference ( P ＜ 0.05) in serum and urine fluorion concentration at the same time point in 1 to 5 days after poisoning in severe poisoning group. Serum fluorion concentration in 1 to 5 days after poisoning in each poisoning groupswere statistically higher than those in control group ( P ＜ 0.05), but there was statistically significant elevation ( P＜ 0.05) in urine fluorion concentration only in 1 day in mild poisoning group, in 1 to 3 days in moderate poisoning groups, in 1 to 5 days in severe poisoning group. Conclusions Serum fluorion concentration can be used as the severity index of diagnosis and determine the extent in 5 days after acute organic fluoride poisoning by inhaling,and urine fluorion concentration can also be used as diagnostic indicators of intoxication, but only in earlier stage or severe poisoning.