燃煤污染型砷中毒临床症状体征分析

Analysis of clinical symptoms and signs of arsenism caused by coal burning pollution

目的探讨燃煤污染型砷中毒的临床症状、体征以及流行特点。方法按国家的有关标准进行。结果１００例病人中８０％以上的病人出现皮肤损害前有眼花（７７％）、耳鸣（６６％）、心慌（６４％）、腹痛（４２％）等慢性砷中毒基本症状。调查点居民生活用煤砷含量（３２４．３３±１４９．９１）ｍｇ／ｋｇ。居民日人均总摄砷量（２.０２±１.２３）ｍｇ。其中约５０％由辣椒摄入。尿砷均值（０．１０７±０．０５５）ｍｇ／Ｌ。结论该地存在不同程度的砷污染，砷中毒仍在流行。结果提示：①皮肤损害、总摄砷量与尿砷排泄，皮肤损害与总摄砷量、发病时间之间均呈显著性相关（Ｐ< ０．０００１）。②凡有过燃用高砷煤史，出现眼花、心慌、经常性上腹部疼痛，可诊断为砷中毒轻度患者。③１９７６年至今，３３例（５．８‰）病人已死于癌肿，值得引起重视。

Objective Analyses and probe the clinical symptoms,signs and epidemic characteristic of arsenism caused by coal burning pollution. Methods National standard methods were applied. Results More than 80% had other basic symptoms arid signs of arsenism such as blur version (77% ), tinnitus (66% ), palpitation (64% ) and abdominal pain (42% ) before skin impairment took place. The mean arsenic content in the coal used by the residents in the investigating spots was (324. 33±149. 91 )mg/kg,in which more than 50% came from the consuming of baked chili. The mean urinary arsenic content of the residents was (0. 107± 0.005)mg/L. Conclusions There is various degree arsenic pollution in the investigating spots and over there arsinism is still epidemic. The results indicate: ①There is linear correlation in the relationship between skin impairment and daily urinary arsenic excretion,skin impairment and arsenism symptom occurrence time,arsenic total intake and daily urinary arsenic excretion,and arsenic total intake and arsenism symptom occurrence time (P <0.0001 );②The patient with blur version,palpitation,frequently upper abdominal pain,and with the history of burning consuming of high arsenic coal may be diagnosed as low degree arsenism. ③33 cases died of cancers since 1976 (mortality as high as 5. 8‰) deserve more attention.