突发群体性氯气中毒1539例临床救治  

Treatment of 1 539 cases of sudden mass of chlorine poisoning

作　　者：岳茂兴[1,2] 夏锡仪[2] 李瑛[2] 尹进南[2] 周培根[2] 郝冬琳[2] 郑琦函 蔡爱敏[2] 朱晓瓞 黄晞[2] 王金兰[2] 黄琴梅[2] Yue Maoxing;Xia Xiyi;Li Ying;Yin Jinnan;Zhou Peigen;Hao Donglin;Zheng qihan;Cai Aimin;Zhu Xiaodie;Huang Xi;Wang Jinlan;Huang Qimei(Center for Special Medical and Center of General Surgery,306th hospital of the PLA,Beijing 100101,China;Emergeney departments in Affiliated Wujin Hospital of Jiangsu University,Changzhou 213002,China)

机构地区：[1]解放军第306医院特种医学中心,北京100101 [2]江苏大学附属武进医院,常州213002

出　　处：《中华卫生应急电子杂志》2018年第3期145-151,共7页Chinese Journal of Hygiene Rescue(Electronic Edition)

基　　金："十二.五"国家支撑计划项目(NO. 2014BAL05B06)分课题;江苏省卫生厅重大课题(Z201013;苏卫科教【2010】11 号);常州市基础应用研究(CS20121003)

摘　　要：目的总结突发群体性氯气中毒的诊治体会并探讨其疾病特点与有效应对策略。方法回顾性总结分析2009年6月至2017年5月,发生的4次突发性化工厂氯气泄漏事故所致的群体性氯气中毒抢救案例,总计1 539例,其中男性746例,女性793例;年龄7 d^90岁,平均(43.8±0.69)岁。根据患者的症状、体征、影像学检查(胸部X线片及胸部CT)及动脉血气分析等实验室检查结果诊断并分级。对重症急性肺水肿患者,在综合治疗基础上,采用20AA复方氨基酸联用维生素B_6及短程山莨菪碱联用地塞米松冲击疗法,病情平稳后结合中药"柴黄参祛毒固本汤"辅助调理治疗。观察总结中毒初期及重症患者疾病进展过程中的临床表现、胸部X线片及胸部CT、实验室检查(血常规、血生化、动脉血气分析)的特点;计算抢救成功率,评价上述创新治疗方法对急性氯气中毒患者的治疗有效性。结果 1 539例急性氯气中毒患者中,1 041例(67.6%)出现轻度刺激反应,394例(25.6%)轻度中毒,79例(5.1%)中度中毒,25例(1.6%)重度中毒。重度氯气中毒患者治疗96 h内,症状开始好转,并逐渐进入恢复期,经2周左右持续治疗基本痊愈。1 539例患者均治愈,无1例死亡;对25例重症急性化学性肺水肿患者进行长期随访,未出现肺纤维化或肿瘤等远期效应。结论氯气中毒病情发展快,防治肺水肿是治疗的关键。在综合治疗的基础上,采用20AA复方氨基酸联用维生素B_6、短程山莨菪碱联用地塞米松冲击疗法及柴黄参祛毒固本中药方剂有良好疗效。Objective To summarize the experience in diagnosis and treatment of sudden collective chlorine poisoning and discuss the characteristics of the disease and effective coping strategies. Methods To retrospectively analyze the cases of collective chlorine gas poisoning caused by four sudden chemical plant chlorine leakage accidents,which were organized and participated in the rescue by the authors from June2009 to May 2017. A total of 1 539 patients,of which 746 were males and 793 women,aged from 7 d to 90 years old,mean age（43. 8 ± 0. 69） years old. The patients were diagnosed and classified according to the symptoms,signs,imaging examinations（ chest X-ray and CT） and laboratory results of arterial blood gas analysis and other tests. For patients with severe acute pulmonary edema,on the basis of comprehensive treatment,an innovative therapy of 20 AA combined amino acid combined with vitamin B_6 and short-range anisodamine combined with dexamethasone shock therapy was used. As soon as the condition is stable,the traditional Chinese medicine ＂Chaihuangshenquduguben ＂ was put to use for an auxiliary conditioning treatment. the characteristics of clinical manifestations,chest X-ray and chest CT,laboratory examinations（blood routine,blood biochemistry,and arterial blood gas analysis） during the early phase of poisoning and disease progression in critically ill patientswere observed and summarized. Successrate of rescuewascalculated and the effectiveness of the above-mentioned innovative treatment methods for patients with acute chlorine poisoningwas evaluated. Results Among the 1 539 acute chlorine poisoning patients,1 041（67. 6%） had mild irritative reactions,394（25. 6%） were mildly poisoned,and 79（5. 1%） were poisoned,a total of 25 cases（ 1. 6%） severe poisoning. The progression of acute pulmonary edema in patients with severe chlorine poisoning is divided into stimulation phase,latency phase,episodes of pulmonary edema and recovery phase. There are obvious differences in symptoms,sign

关 键 词：氯气 中毒 20AA复方氨基酸 维生素B6 

分 类 号：R595.1[医药卫生—内科学]