职业性急性二氯五氟丙烷中毒临床分析

Clinical analysis of occupational acute poisoning of HCFC-255

目的:探讨职业性急性二氯五氟丙烷(HCFC-225)中毒的临床特点及治疗方法。方法:回顾性分析2010年12月一起职业中毒事故中6例急性HCFC-225中毒患者的临床资料。结果:本组6例患者均有明确的急性泄露事故导致吸入HCFC-225的职业接触史,急性起病,均被诊断为职业性急性HCFC-225中毒。多数患者出现头晕、眼花、头痛、乏力、步态蹒跚、胸闷、恶心等,部分患者出现呕吐、咳嗽、咽痛、鼻塞、流涕等,严重者可出现意识障碍。体征方面,所有患者均出现急性病容和四肢肌力下降,5例出现呼吸音增粗,个别呼吸急促,严重者出现烦躁不安、嗜睡、昏睡、昏迷。中枢神经系统症状改变与HCFC-225接触时间呈剂量-效应关系。患者中毒第2日外周血白细胞计数均升高,1例患者胸部X线片示急性支气管炎改变,1例昏迷患者出现脑电图低电压改变,另1例出现动脉血氧分压偏低。糖皮质激素和脱水治疗有效。结论:职业性急性HCFC-225中毒的临床表现以中枢神经系统和呼吸系统的损害为主,及时的脱水治疗和早期、足量、短程糖皮质激素是治疗的关键。

Objective： To study the clinical features and treatments of occupational acute poisoning of HCFC- 225. Methods： Clinical data of 6 patients wtih acute poisoning of HCFC-225 from an industrial accident in December 2010 were analyzed retrospectively. Results： The 6 patients were diagnosed of occupational acute poisoning of HCFC-225 according to acute onset and occupational exposure of HCFC-255 inhalation in an acute leakage accident. Symptoms, such as dizziness, giddiness, headache, fatigue, waddling gait, nausea and chest distress were presented in most patients. Vomiting, cough, sore throat, stuffy and running nose were observed in some patients. Conscious disturbance was also revealed in severe cases. Clinical signs of acute facial features and limb muscle strength decline were observed in all patients. Respiratory harshness was observed in 5 cases, while one of them experienced tachypnea. Dysphoria, somnolence, lethargy and coma were observed in severe cases. The symptom of centre nervous system was correlated with HCFC-225 in a time-dependent manner. Increased white blood cell in peripheral blood was observed in all patients on the 2nd day after the incident. Acute bronchitis change was revealed in one patient in Chest X-ray. Low voltage change of electroencephalogram was observed in one unconscious patient, while declined arterial partial pressure of oxygen was observed in the other unconscious one. Glucocorticoid and dehydration treatments were effective for occupational acute poisoning of HCFC-225. Conclusion： Central nervous system and respiratory system lesions are main clinical manifestations of occupational acute poisoning of HCFC-225. Early dehydration therapy and sufficient dose but short course of glucocosteroid are the key principles of treatment.