在抢救光气中毒患者中医务人员二次中毒的临床分析

Clinical analysis of medical workers suffering from secondary phosgene poisoning after rescuing the patients with acute phosgene poisoning

目的探讨光气二次中毒的临床特征及发生原因。方法以《职业性急性光气中毒诊断标准》为诊断标准,对比分析二次中毒患者与原发患者的临床表现、实验室检查及胸部X线片。结果本组25例二次中毒患者临床表现为：咳嗽14例(56．0%),咽刺激13例(52．0%),胸闷10例(40．0%),气促2例(8．0%),眼痛1例(4,0%)。各主要症状发生率与收治的410例原发患者比较,差异无显著性(P＞0．05)；25例肺部体检均无阳性体征。胸部X线表现异常率占100%,表现为典型的支气管炎或支气管周围炎。根据《职业性急性光气中毒诊断标准》全部患者均属轻度急性光气中毒。经对症治疗,全部患者7～10 d后均恢复良好。结论医护人员在抢救急性光气中毒患者时应增强防护意识,落实防护措施,以防发生二次中毒事件。

Objective To explore the clinical features and the cause of secondary phosgene poisoning after rescuing the patients with acute phosgene poisoning. Methods According to the diagnostic criteria of occupational acute phosgene poisoning, the differences of clinical manifestation, laboratory results and chest X-ray between secondary poisoning patients and primary patients were compared. Results Among the 25 patients with secondary phosgene poisoning, 14 （56.0%） had cough , 13 （52.0%） had throat stimulus, 10 （40.0%） had chest stuffiness, 2 （8.0%） had polypnea, 1 （4.0%） had pain in the eye. There was no significant difference in clinical manifestation between the secondary and primary patients. No positive sign was found after the examination of pulmonary function in the 25 patients, but all of them had abnormal chest X-ray, and typical bronchitis could be found . According to the diagnostic criteria, the 25 patients had slight acute phosgene poisoning, and recovered after treatment for 7 to 10 days. Conclusion To prevent the secondary phosgene poisoning after treating the patients with acute phosgene intoxication, medical workers should enhance protection awareness and take some necessary measures.