突发性群体性光气中毒基础研究与临床创新救治  

Basic research and clinical innovative treatment in patients with sudden mass phosgene poisoning

作　　者：岳茂兴 申捷[2] Yue Maoxing;Shen Jie(Trauma Center,Changzhou Second People's Hospital Affiliated to Nanjing Medical University,Changzhou 213161,Jiangsu,China;Emergency and Critical Illness Center,Jinshan Hospital Affiliated to Fudan University,Shanghai 201508,China)

机构地区：[1]南京医科大学附属常州第二人民医院创伤中心TICU,江苏常州213161 [2]复旦大学附属金山医院急危重病中心&核化救治中心,上海201508

出　　处：《中华危重病急救医学》2023年第12期1233-1240,共8页Chinese Critical Care Medicine

基　　金：中国工程院重大咨询项目(200205);国家自然科学基金(82272243,82002027,81471850,81101412);江苏省卫生厅社会发展科技计划项目(Z201013);江苏省常州市应用基础研究计划项目(CJ20140001);上海市科研计划项目(11JC1401900)。

摘　　要：光气既是一种危险的窒息性化学战剂,也是一种重要的化工原料,目前被广泛应用于化工生产。据统计,我国光气生产企业达1000多家,年生产量超过300万吨,从业人员达数十万。因此,一旦在生产、存储和运输过程中发生泄漏事故,往往造成大量的人员伤亡。近20年来,我国光气中毒事故时有发生,由于光气的刺激性弱、密度大,事故现场光气浓度高,往往造成暴露者急性高浓度吸入,引发急性肺损伤(ALI),极易进展为急性呼吸窘迫综合征(ARDS),病死率高达40%~50%。鉴于光气具有突发性、群体性、隐匿性、快速性及高度致命性的特点,而目前国内外对其中毒和致病机制尚不十分清楚,临床上尚无特效的救治方法和针对突发性群体性光气中毒救治的规范指导。为了提高临床救治效率,降低病死率,本文结合多年来对光气进行的大量基础研究和对突发性群体性光气中毒患者现场紧急救治的丰富经验,对光气中毒的病理生理机制、临床表现、现场救治、研究进展、临床创新疗法进行了归纳、总结,旨在为突发性群体性光气中毒患者的临床救治提供指导,提高救治水平。Phosgene is not only a dangerous asphyxiating chemical warfare agent,but also an important chemical raw material,which is widely used in chemical production.According to statistics,there are more than 1000 phosgene production enterprises in China,with an annual production volume of more than 3 million tons and hundreds of thousands of employees.Therefore,once the leakage accident occurs during production,storage and transportation,it often causes a large number of casualties.In the past 20 years,phosgene poisoning accidents in China have occurred from time to time,and due to the weak irritation,high density,and high concentration of phosgene at the scene of the accident,it often results in acute high-concentration inhalation of the exposed,triggering acute lung injury(ALI),and is very likely to progress to acute respiratory distress syndrome(ARDS),with a mortality rate up to 40%-50%.In view of the characteristics of sudden,mass,concealed,rapid and highly fatal phosgene,and the mechanism of its toxicity and pathogenicity is still not clear,there is no effective treatment and standardized guidance for the sudden group phosgene poisoning.In order to improve the efficiency of clinical treatment and reduce the mortality,this paper has summarized the pathophysiological mechanism of phosgene poisoning,clinical manifestations,on-site treatment,research progress,and innovative clinical therapies by combining the extensive basic research on phosgene over the years with the abundant experience in the on-site treatment of sudden mass phosgene poisoning.This consensus aims to provide guidance for the clinical rescue and treatment of patients with sudden mass phosgene poisoning,and to improve the level of treatment.

关 键 词：光气 急性肺损伤 临床救治 创新疗法 

分 类 号：R135.1[医药卫生—劳动卫生]