职业性急性对硝基氯苯中毒特点及诊断分级探讨

Clinical characteristics and diagnosis of occupational acute nitrochlorobenzene poisoning

目的对文献报道及本院收治的急性对硝基氯苯中毒病例进行分析研究,总结其临床特点,为修订职业性急性对硝基氯苯中毒诊断分级标准提供依据。方法通过检索数据库及收集本院的病历资料,对数据进行统计分析。结果本研究显示,急性对硝基氯苯中毒潜伏期多为数分钟至72 h,最长可达24 d,临床表现主要为神经系统症状、发绀和酱油色尿,伴网织红细胞升高、血红蛋白下降、高铁血红蛋白阳性、海因氏小体阳性等实验室指标异常,肝酶和尿常规异常者也较常见。结论急性对硝基氯苯中毒主要靶器官是血液系统,亦可影响肝脏及泌尿系统;以高铁血红蛋白血症和急性血管内溶血为主要临床特点。建议将高铁血红蛋白血症、溶血性贫血及肝肾功损害程度作为急性对硝基氯苯中毒的主要诊断和分级依据。

Objective To collect and analyze the acute nitrochlorobenzene poisoning cases from our hospital and references,summarize their clinical characteristics,thereby provide some basis for revising the diagnostic criteria of occupational acute nitrochlorobenzene poisoning. Methods Through the retrieval of database and collection of our hospital＇s medical records,the cases of acute nitrochlorobenzene poisoning were collected,then,analyzed all the data. Results The results showed that the latent period of acute nitrochlorobenzene poisoning might be from few minutes to 72 hours; the main clinical manifestations were nervous system symptom,cyanosis,soy sauce color urine with increased reticulocyte count,decreased hemoglobin level and positive examination results of methemoglobin and Heinz body,additionally,the liver enzymes and urinary routine results might be always abnormal. Conclusion The results suggested that the primary target organ of acute nitrochlorobenzene poisoning mainly are blood,liver and urinary system,methemoglobinemia and acute intravascular hemolysis should be the primary clinical characteristics. Therefore,it should be reasonable to propose that methemoglobinemia,hemolytic anemia,liver damage and kidney function damage should be taken as the main evidences for the diagnosis and grading of acute nitrochlorobenzene poisoning.