二氟一氯甲烷中毒1例报告并文献复习  

A case of chlorodifluoromethane poisoning and literature review

作　　者：龚再良 成小苗 沙新平[3,4] GONG Zailiang;CHENG Xiaomiao;SHA Xinping(Department of Nephrology,Xiangya Changde Hospital,Changde,Hu'nan 415000,China;Department of Nephrology,Xiangya Hospital of Central South University,Changsha,Hu'nan 410008,China;Department of Infectious Diseases,Xiangya Hospital of Central South University,Changsha,Hu'nan 410008,China;Department of Digestive Diseases,Xiangya Changde Hospital,Changde,Hu'nan 415000,China)

机构地区：[1]湘雅常德医院肾内科,湖南常德415000 [2]中南大学湘雅医院肾内科,湖南长沙410008 [3]中南大学湘雅医院感染科,湖南长沙410008 [4]湘雅常德医院消化内科,湖南常德415000

出　　处：《中国热带医学》2024年第1期115-118,共4页China Tropical Medicine

摘　　要：回顾性分析1例于2020年8月在湘雅常德医院肾内科诊断的二氟一氯甲烷(氟利昂22)中毒患者的临床表现、实验室检查及诊疗经过,探讨二氟一氯甲烷中毒案例的临床特点、治疗及预后。患者男性,29岁,从事空调维修工作,急性起病。患者发病当日给客户空调加灌制冷剂二氟一氯甲烷,工作后于轿车内休息,2 h后被发现。发现时出现意识不清、呕吐和大小便失禁,意识清醒后有抽搐、头晕、四肢麻木、肌肉酸痛等症状,双下肢肌力减退。入院检查提示肝肾功能损伤,肌酸激酶明显升高,胸部CT提示左下肺少许渗出,脑电图、肌电图无明显异常。事后排查发现车内钢瓶连接管因高温有裂缝,导致二氟一氯甲烷泄漏。经积极高压氧、激素、营养神经、护肝等治疗后患者好转出院。随访2年,患者目前仍遗留有双下肢轻度麻木。目前二氟一氯甲烷中毒报道较少,且临床表现较为多样,严重者会出现中毒死亡的情况。本文总结并报告1例二氟一氯甲烷患者中毒后的临床表现并文献复习,提高临床医生对此病的认识,及时有效地制定治疗方案。We reviewed a case diagnosed with with chlorodifluoromethane poisoning(Freon-22)admitted to the Department of Nephrology,Xiangya Changde Hospitalin August,2020,focusing on the clinical manifestations,laboratory examination,and course of treatment of patients,as well as discussing the clinical characteristics,treatment and prognosis of chlorodifluoromethane poisoning cases.The patient is a 29 years old male engaged in air conditioning maintenance work,with an acute onset.On the day of onset,the patient refilled chlorodifluoromethane poisoning refrigerant for a client's air conditioner and rested in a small car after work where he was found two hours later.At that time,the patient was experiencing impaired consciousness,vomiting and incontinence.After regaining consciousness,he presented with convulsions,dizziness,numbness of limbs and muscle aches,accompanied by a decrease in limb strength.The initial hospital examination indicated that impaired liver and kidney functionality,significantly elevated creatine kinase levels,and a little exudation in the sitting lung as shown by Chest CT,and no significant abnormalities found in the electroencephalogram(EEG)or electromyogram(EMG).Subsequent investigations revealed that the connecting pipe of the steel cylinder in the car was cracked due to high temperature,which led to the leakage of chlorodifluoromethane poisoning.After active treatment with hyperbaric oxygen,hormone,nerve nutrition and liver protection,the patient's condition improved and he was discharged from the hospital.After two-year follow-up,the patient still has mild numbness in both lower limbs.At present,there are few reports of Freon poisoning,and the clinical presentations can vary greatly,with severe cases even leading to death from poisoning.This paper summarizes and reports the clinical manifestations of a patient with chlorodifluoromethane poisoning,and reviews the related literature,with the aim to improve the clinician's understanding of the disease and make a timely and effective treatment plan.

关 键 词：二氟一氯甲烷 神经系统损伤 高压氧 

分 类 号：R135.14[医药卫生—劳动卫生]