酞菁蓝废液池刺激性气体中毒并呼吸衰竭3例救治分析  

Treatment and Analysis of 3 Cases Irritating Gas Poisoning by Phthalocyanine Blue Wastewater Tank and Respiratory Failure

作　　者：王良 岳鹏 张辉 王雪 WANG Liang;YUE Peng;ZHANG Hui;WANG Xue(Emergency Department,Zibo City The Firsty Hospital,Zibo,Shandong 255200)

机构地区：[1]山东省淄博市第一医院急诊科,山东淄博255200

出　　处：《智慧健康》2023年第4期176-179,188,共5页Smart Healthcare

摘　　要：目的 分析酞菁蓝废液二级沉淀池中3名工人晕倒的原因,并探讨酞菁蓝生产废液误吸后对各器官系统的影响,总结劳动防护及临床救治经验。方法 通过回顾分析3例患者中毒过程、临床表现及辅助检查结果,分析酞菁蓝废液池气体中毒的原因及酞菁蓝生产废液误吸对人体各系统的毒性特点。结果 酞菁蓝废液池存在窒息性气体,工业生产劳动中应注意防护;酞菁蓝废液池内废气及废液误吸可以导致急性呼吸衰竭,胸部CT表现为斑片状渗出及实变影,在本案例中未见气道黏膜明显腐蚀,恢复期未导致气道狭窄及肺纤维化表现。酞菁蓝废液对人体心功能、肝肾功能影响较小,3例患者超敏肌钙蛋白T峰值(108.4pg/mL、5.86pg/mL、45.88pg/mL,参考值0~14pg/mL),N端-B型钠尿肽前体峰值(1412pg/mL、105.5pg/mL、1512pg/mL,参考值0~300pg/mL),天门冬氨酸氨基转移酶峰值(151U/L、24.8U/L、38.3U/L,参考值15~40U/L),血肌酐峰值(74.9umol/L、75.6umol/L、60.9umol/L,参考值57~97umol/L)。结论 酞菁蓝废液池存在有毒气体,可迅速导致人体意识丧失及化学性肺炎,酞菁蓝废液池内废气废液误吸以肺部损伤为主要表现,对其他器官毒性反应较低,临床治疗以呼吸支持治疗为重点。Objective To analyze causes of three workers fainting in secondary sedimentation tank for phthalocyanine blue waste liquid,and explore effect of accidental inhalation of phthalocyanine blue production waste liquid on various organ systems,and summarize labor protection and clinical treatment experience.Methods The paper reviewed and analyzed poisoning process,clinical manifestations,and auxiliary examination results of 3 patients,analyzed gas poisoning causes of phthalocyanine blue wastewater tank and toxic characteristics of accidental inhalation of phthalocyanine blue production wastewater on various human systems.Results There is asphyxiating gas in phthalocyanine blue waste liquid tank,it is necessary to pay attention to protection during industrial production and labor;aspiration of waste gas and liquid in phthalocyanine blue wastewater tank may cause acute respiratory failure,with chest CT findings of patchy exudation and consolidation.In the case,there was no significant erosion of airway mucosa,during recovery period,there was no airway stenosis or pulmonary fibrosis.Phthalocyanine blue waste liquid had little effect on human heart function,liver and kidney function.For three patients,peak T value of hypersensitive troponin was(108.4 pg/mL,5.86 pg/mL,45.88 pg/mL reference value 0 to 14 pg/mL),peak N-terminal B-type natriuretic peptide precursor was(1412 pg/mL,105.5 pg/mL,1512 pg/mL reference value 0 to 300 pg/mL),and peak aspartate aminotransferase was(151U/L,24.8 U/L,38.3 U/L reference value 15 to 40 U/L),peak blood creatinine was(74.9 umol/L,75.6 umol/L,60.9 umol/L reference value 57~97 umol/L).Conclusion Toxic gases in phthalocyanine blue waste liquid tank can quickly cause consciousness loss and chemical pneumonia in human body,main manifestation of accidental aspiration of waste gas and waste liquid in phthalocyanine blue waste liquid tank is lung injury,with low toxic reactions to other organs,and respiratory support is main clinical treatment.

关 键 词：酞菁蓝 气体中毒 化学性肺炎 

分 类 号：R595.1[医药卫生—内科学] R563.8[医药卫生—临床医学]