不同部位注射金属汞所致中毒的临床表现和治疗原则  

Clinical manifestations and treatment principles of poisoning caused by metallic mercury injection at different sites

作　　者：许乐谊 江嘉欣[2] 张莹[2] 陈嘉斌 XU Leyi;JIANG Jiaxin;ZHANG Ying;CHEN Jiabin(不详;School of Public Health,Guangzhou Medical University,Guangzhou,Guangdong 511436,China)

机构地区：[1]广州医科大学公共卫生学院,广东广州511436 [2]广东省职业病防治院,广东广州510399

出　　处：《中国职业医学》2024年第4期466-471,共6页China Occupational Medicine

基　　金：广东省医学科学技术研究基金(C2021020,C2021021)。

摘　　要：在不同的部位注射金属汞造成健康损害的表现和程度各异,且与一般汞中毒不同。本研究复习既往经不同部位注射金属汞所致中毒的文献报道,综述了其健康损害及对应的治疗原则。事故原因多为故意伤害或自杀、自残,少部分为封建迷信、文身和不规范治疗等其他原因。在皮下、肌肉深层组织注射金属汞,早期主要引起皮肤局部炎症反应;眼球内注射可导致炎症、组织坏死和失明;静脉注射可引起局部或全身的急性反应。如不及时清除金属汞,可对局部注射部位造成损伤,对呼吸系统、神经系统、泌尿系统和循环系统等亦可造成伤害,甚至影响生殖健康。治疗方面,在皮下、肌肉或深层组织注射的,优先进行负压封闭引流术、广泛性切除沉积物;对于眼球内注射金属汞者,需要及时手术去除汞滴,必要时摘除眼球;经静脉注射金属汞者,除清创手术外,还可利用血浆置换、血液灌流、血液透析和支气管肺泡灌洗等方法治疗。不同部位注射金属汞所致中毒均建议给予驱汞及对症支持治疗,并辅以心理治疗。The appearance and degree of damage caused by metallic mercury injection at different sites were disparate,and different from common mercury poisoning.This study reviewed literature on poisoning caused by injection of metallic mercury in different body parts,summarized the health impairments and corresponding treatment principles.The causes of such accidents were mostly intentional injury or suicide,self-harm,with a minority due to feudal superstition,tattoos,and improper treatment.Subcutaneous or deep intramuscular injection of mercury primarily caused local inflammation reactions in the early stages.Intraocular injection might lead to inflammation,tissue necrosis,and blindness.Intravenous injection might lead to local or systemic acute reactions.The injection at local sites might cause harms to respiratory,nervous,urinary,and circulatory systems and reproductive health if individuals fail to boost mercury excretion promptly.For mercury treatment,the vacuum sealing drainage and extensive removal of deposits were preferred for mercury subcutaneous,muscular,or deep tissue injected individuals.For mercury intraocular injected individuals,the prompt surgical removal of mercury drops and,if necessary,enucleation of the eyeball were preferred.For mercury intravenous injected individuals,in addition to debridement surgery,treatment such as plasma exchange,hemoperfusion,hemodialysis,and bronchoalveolar lavage could be used.For mercury poisoning caused by injection in different body parts,mercury expulsion and symptomatic treatment are recommended,in addition to psychological therapy.

关 键 词：汞 金属汞 注射 健康损害 临床表现 治疗原则 汞中毒 

分 类 号：R135.1[医药卫生—劳动卫生]