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Objective:To summarize the clinical experience of treating patients with severe acute organic fluorine poisoning using extracorporeal membrane oxygenation (ECMO).Methods:In January 2021, an acute mass organic fluorine gas poisoning incident occurred in Quzhou, Zhejiang Province. The clinical data of 4 severe patients with acute poisoning of organic fluorine treated by ECMO in our hospital were retrospectively analyzed, and the epidemiological characteristics, clinical symptoms, signs, the abnormal laboratory studies/examinations, and treatments of this kind poisoning patients, especially, the treatment pattern, support time, complications, and outcomes of ECMO were collected and analyzed.Results:All the 4 patients were male, with an average age of (52±9) years, and all of them came to the emergency department complaining chest tightness, cough and pharyngeal discomfort 6 h after exposure by inhalation. The patient’s condition progressed rapidly with severe acute respiratory failure and circulatory failure as the prominent manifestations. The mechanical ventilations were performed (13.0±4.8) h after poisoning, and ECMO treatment was performed (15.5±5.3) h after poisoning. Among them, 2 patients were treated using venoarterial (VA) ECMO, and 2 patients using venovenous (VV) ECMO, but 1 patient was converted to VA-ECMO 8 h later. The duration of ECMO support for the patients was (8.8±3.6) d. The duration of mechanical ventilation was (23.0±28.7) d and stay in intensive care unit was (42.0±55.4) d. Among them, one patient was transferred to a specialized rehabilitation hospital after the amputation surgery due to lower limb necrosis after VA-ECMO support, and the remaining 3 patients were discharged after recovery.Conclusions:ECMO support might have the irreplaceable value in the treatment of patients with severe acute organic fluorine poisoning, and should be considered as one of the reserves of regional health care system in dealing with public health emergencies.
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OBJECTIVE To clarify the long-term toxicity to the respiratory system in a rat model of acute lung injury (ALI) induced by a single low-dose of perfluoroisobutylene(PFIB) inhalation expo?sure,and observe the possible beneficial effect of early intervention via Qingkailing(QKL) injection. METHODS Totally 224 male Wistar rats were randomly divided into 4 groups:normal control group in which air exposure was followed by a saline 10 mL · kg-1(ip),QKL control group in which QKL 10 mL · kg-1 was ip given after air exposure,PFIB exposure group in which rats were exposed to PFIB 280 mg·m-3 for 5 min only,and QKL treatment group in which QKL 10 mL·kg-1 was given ip at 1 h after PFIB exposure. Lung functions of rats were measured at 24 h,3,6,12,24,36 and 48 weeks after exposure. The arterial blood gas,lung coefficient,protein content in bronchoalveolar lavage fluid(BALF),hydroxy?proline(HYP) content in lung tissue and plasma,and other indicators were detected or analyzed. RESULTS Within 24 h after PFIB exposure,the lung coefficient and protein content in BALF were increased significantly(P<0.01),whereas the PaO2(P<0.01) and SaO2(P<0.05) indices in arterial blood decreased significantly in PFIB group compared with normal control. The inhalation time , exhalation time,tidal volume(TV),expired volume(EV)and relaxed time were reduced significantly (P<0.01). However,all the above indicators returned to normal in 3 weeks,but TV,EV and peak expiratory flow were significantly lower than in normal group at 48 weeks(P<0.05). HYP contents in lung tissues,compared with normal control(P<0.05),were reduced significantly within 24 h after PFIB exposure,increased significantly in 6 weeks(P<0.05),then returned to normal in 12 weeks. HYP contents in plasma increased significantly compared with normal control(P<0.05) within 24 h after PFIB exposure but returned to normal in 3 weeks. The protein contents in BALF of QKL treatment group were significantly lower than those in PFIB group(P<0.01) within 24 h after PFIB exposure. From 24 h to 24 weeks after PFIB exposure,changes of pulmonary functions were similar to those in PFIB group. At 48 weeks,TV and EV in QKL treatment group were more significantly increased than those in PFIB group(P<0.05). CONCLUSION Rats with ALI induced by a single low dose of PFIB exposure undergo compensatory repair except for pulmonary capacity and pulmonary ventilation functions. Early treatment with QKL reduces protein content of BALF and alleviates pulmonary edema,and has some beneficial effect on lung function recovery later.
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Objective To investigate the changes of serum and urine fluorion organic fluoride poisoning by inhaling, and to probe into the clinical application value of concentrations in different degrees and at different time in patients with acute evaluating the sertm and urine fluorion concentration in acute organic fluoride poisoning by inhaling. Method A study was carried out in 23 patients, who suffered from acute organic fluoride poisoning by inhaling and were admitted Zhejiang Quhua Hospital, from December 2000 to December 2008. According to the occupational acute organic fluoride poisoning diagnostic criteria(GBZ66-2002),23 patients were divided into mild poisoning group,moderate poisoning group and severe poisoning group. Serum and urine fluorion concentration of patients at 1,2,3,4,5 d after poisoning were measured by using Ion-Selective Electrodes. Fluorion concentration of 10 staffs of Fluorine chemical company was also measured at the same period as the control group. The values of serum and urine fluorion concentration were analyzed. Differences in serum and urine fluorion concentration between groups at different time points were compared by repeated measures ANOVA and variability were deemed as statistical significance when P ＜ 0.05. Results Compared with mild poisoning group, there was no statistically significant difference ( P ＞ 0.05) in serum and urine fluorion concentration at the same time point in 1 to 5 days after poisoning in moderate poisoning group, but there was statistically significant differences ( P ＜ 0.05 or P ＜0.01) in severe poisoning group. Compared with moderate poisoning group, there was statistically significant difference ( P ＜ 0.05) in serum and urine fluorion concentration at the same time point in 1 to 5 days after poisoning in severe poisoning group. Serum fluorion concentration in 1 to 5 days after poisoning in each poisoning groupswere statistically higher than those in control group ( P ＜ 0.05), but there was statistically significant elevation ( P＜ 0.05) in urine fluorion concentration only in 1 day in mild poisoning group, in 1 to 3 days in moderate poisoning groups, in 1 to 5 days in severe poisoning group. Conclusions Serum fluorion concentration can be used as the severity index of diagnosis and determine the extent in 5 days after acute organic fluoride poisoning by inhaling,and urine fluorion concentration can also be used as diagnostic indicators of intoxication, but only in earlier stage or severe poisoning.