职业性急性重度中毒性脑病2例死亡病例报道

Two cases of fatal occupational acute severe toxic encephalopathy

目的分析2例职业性急性重度中毒性脑病死亡病例的发病与临床救治经过,提出防治重点策略。方法回顾性分析2例职业性急性重度中毒性脑病死亡病例的基本情况、现场职业卫生调查和临床资料等。结果2例病例均有在作业过程中未全程佩戴或未佩戴个人防护装备而导致在短期内接触较大量化学物的职业史,出现以神经系统损害为主的临床表现,救治过程中均出现重度意识障碍,临床诊断“中毒性脑病”明确,结合头颅计算机断层扫描、脑电图、头部磁共振等检查结果和现场职业卫生调查资料,排除其他原因所致类似疾病后,均诊断为职业性急性重度中毒性脑病。1例死于多脏器功能衰竭,1例死于中毒性脑病。结论职业性急性重度中毒性脑病发病凶险,进展迅速,死亡率高;个体防护装备的正确佩戴是保护劳动者健康的有效途径;需加强对小微企业的职业卫生监督管理,防止同类职业性化学中毒事故的发生。

Objective To analyze the onset and clinical treatment of two cases of occupational acute severe toxic encephalopathy deaths and to propose key strategies for prevention and treatment.Methods The basic information,on-site occupational health investigation and clinical data of two cases of occupational acute severe toxic encephalopathy deaths were retrospectively analyzed.Results Both cases involved a history of occupational short-term exposure to a large amount of chemicals,due to not wearing personal protective equipment(PPE)throughout the entire process or not wearing PPE at all.The clinical symptoms of patients were primarily related to neurological damage.Both patients developed severe consciousness disorders,leading to a clear clinical diagnosis of toxic encephalopathy during treatment.Combined with the results of cranial computed tomography,electroencephalogram,head magnetic resonance and other examinations and information from the on-site occupational health survey,both patients were diagnosed as occupational acute severe toxic encephalopathy after excluding similar diseases due to other causes.Multiple organ failure and toxic encephalopathy were the causes of death of these two patients.Conclusion Occupational acute severe toxic encephalopathy is characterized by a rapid onset,quick progression,and high mortality.Proper use of PPE is an effective measure to protect workers'health.Strengthening occupational health supervision in small and micro enterprises is necessary to prevent similar occupational chemical poisoning incidents.