急性氯气中毒眼部并发症的临床研究

Clinical research on eye complications of acute chlorine poisoning

摘要:

目的：观察急性氯气中毒患者眼部并发症的发生情况。

方法：回顾性分析2009-02/2013-02就诊于临沂市人民医院的急性氯气中毒患者121例，其发生眼部刺激症状、干眼及其它一些眼部并发症的情况。

结果：在121例患者中，有117例(96.7%)并发有眼部刺激症状及角结膜上皮的损伤，随着氯气中毒程度的加重，眼表损伤也加重。在115例随访患者中，出院3，6mo后分别有32，7例患者存在干眼。1例轻度氯气中毒患者在激素治疗肺部并发症过程中并发泡状视网膜脱离，经停用激素和加用促进液体吸收药物治疗后，症状及体征逐渐好转。1例重度氯气中毒伴有昏迷患者在治疗过程中出现角膜溃疡，药物+结膜瓣遮盖术溃疡愈合，但留下永久性角膜白斑。

结论：急性氯气中毒会导致角结膜上皮损伤及干眼发生，在激素治疗过程中要警惕与激素应用相关的眼部并发症，比如泡状视网膜脱离。对于一些重度中毒的患者，在抢救生命治疗中，重视眼部角结膜上皮损伤的治疗，以免造成不可挽回的后果。

Abstract:

AIM: To observe the eye complications in the cases of acute chlorine gas poisoning.

METHODS: A retrospective review of 121 cases of acute chlorine gas poising with eye irritation, dry eye and other eye complications in Linyi People's Hospital from February 2009 to February 2013 was performed.

RESULTS: Among 121 patients, 117 cases(about 96.7%)had complications of eye irritation and conjunctival and corneal epithelial damage, and the ocular surface damage was aggravated with the increasing level of chlorine gas poisoning. After 3, 6mo being discharged, 32 and 7 patients respectively occurred dry eye among 115 patients followed up. One mild chlorine poisoning patient, during the hormonotherapy of pulmonary complication, complicated with bullous retinal detachment, of which symptoms and physical signs had been improved after stopping hormonotherapy and adding drugs facilitating fluid absorption. One severe chlorine poisoning patient with loss of consciousness during the treatment, had corneal ulcer and after ulcer being healed with drug and conjunctival flap covering surgery, was left permanent leukoma cornea.

CONCLUSION: Acute chlorine poisoning can cause corneal and conjunctival epithelial damage and dry eye. Ocular complications like bullous retinal detachment associated with hormone application should be paid more attention to in the hormonotherapy. For some patients with severe poisoning, the therapy of corneal and conjunctival epitheliums should be taken seriously in case of irreparable damage in rescuing patient's life.