826例化学性皮肤灼伤临床探讨

Clinical studies on 826 cases of chemical skin burns

目的 探讨化学性皮肤灼伤的临床特征及急救处理。方法 分析 82 6例化学性皮肤灼伤的发病行业、致病化学物、诱发因素、诊断分级、几种化学物的特殊皮损形态及急救处理等临床资料。结果 本组化学性皮肤灼伤以仪表和化工行业发病为最高。致病化学物共 133种 ,其中无机酸占病例总数的 6 6 2 % ,氢氟酸及含氢氟酸的混合物占病例总数的 5 1 8%。氢氟酸、酚、一氯乙酸等化学物皮肤灼伤具特殊临床表现。 6 7 8%因个人防护不当和违章操作所致。灼伤面积自 <1%～ 40 % ,灼伤深度Ⅱ～Ⅲ度 ,以轻度灼伤为主。中度和重度灼伤分别占病例总数的 8 7%和0 2 % ,本组 1 3 %合并化学中毒和化学物吸入。结论 无机酸是职业性化学性皮肤灼伤的主要致病化学物。氢氟酸、酚和一氯乙酸灼伤的特殊皮损形态有助于病因诊断。强调及时彻底清除皮肤上存留的致病物。

Objective To explore the clinical characteristics and first-aid treatment of chemical skin burns.Methods Eight hundred and twenty-six cases of chemical skin burns were analyzed based on their clinical data,including occupation,causative chemical agents,inducing factors,diagnostic grade,features of skin lesion caused by several chemicals and their emergency treatment,etc.Results The proportion of cases with chemical skin burns ranked the top in meter manufacturing and chemical industries,involving 133 kinds of causative chemicals,in which inorganic acid accounting for 66% of the total cases and hydrofluoric acid and mixture containing it accounting for 51 8%.Skin lesions caused by chemicals,such as hydrofluoric acid,phenol,monochloroacetic acid,etc.were clinically characteristic.67 8% of chemical skin burns were caused by inadequate personal protection and operation against regulations.The areas of burns ranged from less than 1% to 40% of the body surface,with degrees Ⅱ and Ⅲ in severity,most in mild burns and 8 7%and 0 2%in moderate and severe burns,respectively.1 3% of the cases complicated with chemical poisoning and inhalation.The contaminated skin was washed out promptly and thoroughly in only 17 7% of the cases after exposure to chemicals.Conclusion Inorganic acid was the main agents causing occupational chemical skin burns.Characteristic skin lesion caused by hydrofluoric acid,phenol and monochloroacetic acid was etiologically diagnostic.It is emphasized that promptly and thoroughly clearing out the chemical agents residual on the skin on the spot after exposure to them and strengthening monitoring for chemical burns caused by those agents liable to poisoning absorbed via skin and respiratory tract.