光气不仅是一种危险的窒息化学战剂,也是重要的化工原料,广泛应用于化工生产中。据统计,中国有1000多家光气生产企业,年生产量超过300万吨,员工数十万。因此,一旦在生产过程中发生泄漏事故,储存和运输,它经常造成大量人员伤亡。在过去的20年里,我国光气中毒事故时有发生,由于微弱的刺激,高密度,事故现场有高浓度的光气,它经常导致暴露者的急性高浓度吸入,触发急性肺损伤(ALI),并且很可能进展为急性呼吸窘迫综合征(ARDS),死亡率高达40%-50%。鉴于突发性的特点,质量,隐藏,快速和高度致命的光气,其毒性和致病机理尚不清楚,对于突发性群体光气中毒尚无有效的治疗方法和规范的指导。为了提高临床治疗的有效率,降低死亡率,本文综述了光气中毒的病理生理机制,临床表现,现场处理,研究进展,结合多年来对光气的广泛基础研究和对突发性团块光气中毒的现场治疗的丰富经验,进行创新的临床治疗。本共识旨在为突发群体性光气中毒患者的临床抢救和治疗提供指导,提高治疗水平。
Phosgene is not only a dangerous asphyxiating chemical warfare agent, but also an important chemical raw material, which is widely used in chemical production. According to statistics, there are more than 1 000
phosgene production enterprises in China, with an annual production volume of more than 3 million tons and hundreds of thousands of employees. Therefore, once the leakage accident occurs during production, storage and transportation, it often causes a large number of casualties. In the past 20 years,
phosgene poisoning accidents in China have occurred from time to time, and due to the weak irritation, high density, and high concentration of
phosgene at the scene of the accident, it often results in acute high-concentration inhalation of the exposed, triggering acute lung injury (ALI), and is very likely to progress to acute respiratory distress syndrome (ARDS), with a mortality rate up to 40%-50%. In view of the characteristics of sudden, mass, concealed, rapid and highly fatal phosgene, and the mechanism of its toxicity and pathogenicity is still not clear, there is no effective treatment and standardized guidance for the sudden group phosgene poisoning. In order to improve the efficiency of clinical treatment and reduce the mortality, this paper has summarized the pathophysiological mechanism of phosgene poisoning, clinical manifestations, on-site treatment, research progress, and innovative clinical therapies by combining the extensive basic research on phosgene over the years with the abundant experience in the on-site treatment of sudden mass
phosgene poisoning. This consensus aims to provide guidance for the clinical rescue and treatment of patients with sudden mass phosgene poisoning, and to improve the level of treatment.