氯乙酸灼伤中毒及其肌肉超微结构改变

Poisoning by chloroacetic acid burn and the ultrastructural changes in the damaged muscles

目的探索氯乙酸灼伤创面与时限关系及其肌肉的超微结构改变。方法实验观察60只大白鼠(分3组)不同性质灼(烫)伤创面变化,120只大白鼠(分6组)氯乙酸灼伤创面累及进程及其肌肉的超微结构;结合91例氯乙酸灼伤病例和现场调查资料进行研究分析。结果相同灼(烫)伤深度,氯乙酸灼伤比烫伤或硫酸灼伤累及组织要深;随时间延长创面会加深且吸收中毒,并引起肌肉超微结构改变。91例氯乙酸灼伤病例有2例死亡,占2.2%,而且面积不大。1例截除趾末节。3例均为创面冲洗有延误、不彻底所致。结论氯乙酸灼伤有别于其他灼(烫)伤,呈进行性损害且吸收中毒,并致线粒体坏死。立即持续冲洗是减轻创面加深,减少或避免中毒的有效措施。

Objective To study the relationship between the wound and the time limit of chloroacetic acid （CA） burn as well as its ultrastructural changes of the muscles. Methods 60 rats were divided into 3 groups to observe the characteristic changes in the wounds of CA bum, and 120 rats were divided into 6 groups to study the course of the wounds and the ultrastructure of the muscles. Clinical case analysis and on-the-spot survey were also carried out. Results Compared with the bums of scald and sulfuric acid, the damage of CA burn in the tissue of the rats was deeper. With the time prolonging, the depth of the wounds would deepen, poisoning due to CA absorption would happen and the ultrastructure of the muscles would change. Of 91 cases of CA bums, 2 was dead （2. 2% ） although the areas of bums were small. In 1 case, the top ends of the toes had to be cut. All of these 3 cases were observed to have delayed and insufficient washing, while other cases, because of in time and sufficient washing, were all recovered. Conclusion Chloroacetic acid burns are different from other bums and scald, because the wounds would continue to deepen, subsequent poisoning would occur and mitochondria would be damaged. Once bums occur, rapid and continuing washing is effective to avoid the wounds deepen and reduce the absorption of the toxin.