GBZ 77-2019Diagnosis of occupational acute toxic multiple organ dysfunction syndrome caused by chemicals (English PDF)

Foreword

Chapter 4 of this standard is mandatory and others are recommended.

This standard is formulated in accordance with the Law of the People's Republic this standard was drafted in accordance with the rules given in GB/T 1.1-2009.

This standard replaces GBZ 77-2002 "Diagnostic Criteria for Occupational Acute Chemical Toxic Multiple Organ Dysfunction Syndrome".

Compared with GBZ 77-2002, the main changes are as follows.

-- Revised the normative reference documents;

-- Deleted the diagnostic principle and adjusted it to the diagnosis basis;

- Modify "diagnostic grading" to "judgment of organ dysfunction";

-- Modified the diagnostic indicators of cardiac dysfunction and removed sudden cardiac death;

-- Revised diagnostic indicators for respiratory dysfunction;

-- Modified diagnostic indicators for renal dysfunction;

-- Revised diagnostic indicators for liver dysfunction;

-- Revised diagnostic indicators for blood dysfunction;

-- Adjusted the content of the processing principles;

-- Revised instructions for the proper use of this standard.

-- Increased or decreased the chemical species of common toxic multi-organ dysfunction syndrome in Appendix B.

This standard was drafted. Shanghai Municipal Institute of Chemical Occupational Diseases, Second Hospital of Shanxi Medical University, Shanghai Branch of Tongji University Hospital (Shanghai Occupational Disease Prevention and Treatment Institute), Huashan Hospital affiliated to Fudan University, Shandong Institute of Occupational Health and Occupational Disease Prevention and Treatment, Fudan University Jinshan Hospital affiliated to the University and Qingdao Occupational Disease Prevention and Treatment Institute.

1 Scope

This standard specifies the principles for the diagnosis and management of occupational acute chemical toxic multi-organ dysfunction syndrome.

This standard applies to the diagnosis and treatment of multiple organ dysfunction syndrome caused by occupational acute chemical poisoning.

2 Normative references

The following documents are indispensable for the application of this document. For dated references, only the dated version applies to this article.

Pieces. For undated references, the latest edition (including all amendments) applies to this document.

GB/T 16180 Labor ability appraisal employee injury and occupational disease disability level GBZ 59 Diagnostic criteria for occupational toxic liver disease GBZ 71 General rules for the diagnosis of occupational acute chemical poisoning GBZ 73 Occupational acute chemical toxicity diagnostic criteria for respiratory diseases GBZ 74 diagnostic criteria for occupational acute chemical toxicity heart disease GBZ 75 Occupational Acute Chemical Toxic Blood System Disease Diagnostic Criteria GBZ 76 diagnostic criteria for occupational acute chemical toxicity neurological diseases Diagnosis of GBZ 79 occupational acute toxic kidney disease

3 Diagnosis basis

3.1 Before the onset, there is a clear history of occupational exposure to a large amount of chemicals in the short term.

3.2 The clinical manifestations of toxic damage in the target organ are present.

3.3 Two or more organ dysfunctions occur simultaneously or sequentially in the course of the disease.

3.4 Organ dysfunction is in accordance with the judgment of this standard.

3.5 Exclude multiple organ dysfunction syndrome caused by non-occupational factors.

3.6 Combine workplace occupational hygiene surveys and the incidence of the same type of work.

3.7 Refer to patient biomarkers or special effect marker tests.

4 Determination of organ dysfunction

5 Processing principles

6 Correct use of the instructions of this standard

See Appendix A.

7 Common chemicals causing acute toxic multi-organ dysfunction and their vulnerable organs

See Appendix B.

Appendix A

(informative appendix) Instructions for the correct use of this standard A.1 Any serious poisoning caused by various chemicals that can cause damage to the target organ or cause a major blow to the body may lead to multiple devices.

The occurrence of official dysfunction.

A.2 Occupational acute chemical toxicity multi-organ dysfunction, can be divided into primary (single-phase rapid-onset) and secondary (bipolar delayed).

Primary multiple organ dysfunction is the result of direct action of chemicals, so it appears earlier, systemic inflammatory response (SIRS) may not be significant;

Multiple organ dysfunction is caused by chemicals that cause SIRS first, and then cause distant organ dysfunction on the basis of SIRS.

After birth, there is a period of smooth remission.

A.3 Multiple organ dysfunction is a clinical syndrome that can be caused by various causes. Diagnosis of occupational acute chemical toxicity in multiple organ dysfunction the obstructive syndrome should rule out multiple organ dysfunction caused by serious infection, extensive burns, trauma, acute cerebrovascular disease and other causes.

A.4 This standard classifies the severity of various organ dysfunction into two levels of dysfunction and functional failure, the standard of insufficiency and the functions of each system.

The indicators of moderate poisoning in the diagnosis of industrial acute chemical poisoning are similar, and the indicators of functional failure are similar to those of severe poisoning.

A.5 Determination of cardiovascular dysfunction. cardiovascular dysfunction is not in occupational acute chemical toxicity, multiple organ dysfunction Rare, common myocardial damage, arrhythmia, heart failure or cardiogenic shock. See GBZ 74 for details. Arrhythmia with electrocardiogram or Dynamic electrocardiogram as the main means of examination; myocardial damage, ischemia and myocardial infarction, heart failure, etc. should be combined with clinical symptoms, signs, ECG

Figure and comprehensive evaluation of myocardial enzymology, cardiac ultrasound, and troponin. Mean arterial pressure (MAP) can be (systolic and diastolic pressure × 2) ÷ 3

Calculation. BNP is an objective biological indicator for determining heart failure and its severity. It has been the heart of the European Heart Association (ESC), the United States.

The Association (ACC) and the American Academy of Clinical Biochemistry (NACB) have included the "gold standard" for the diagnosis of heart failure, so they are included as diagnostic indicators.

A.6 Respiratory function needs to be evaluated from ventilation,, perfusion, dispersion, etc., so choose respiratory rate, Pa02, Pa02/Fi02 and chest X Line performance is the main observation indicator. See GBZ 73 for details.

A.7 The commonly used renal function indicators are. serum creatinine, osmolality (Uosm), urinary sodium, filtered sodium excretion rate, kidney imaging Learning and pathology examinations, etc. In recent years, the international nephrology community officially launched an observation period of 48h, comparing the changes of serum creatinine and urine volume.

The method of judging renal damage is more helpful for early detection of damage to renal function. See GBZ 79 for details.

A.8 Acute liver dysfunction is common in occupational acute chemical toxicity multi-organ dysfunction due to exposure to larger amounts of chemistry in the short term Obstruction or decompensation of liver synthesis, detoxification, excretion, and biotransformation, with coagulopathy, jaundice, liver Sexual encephalopathy and the like are the main manifestations of clinical syndrome. Laboratory tests mainly choose serum alanine aminotransferase (ALT), total bilirubin, and clotting Blood zymogen activity, etc. as a diagnostic indicator, please refer to GBZ 59 for details.

A.9 Brain injury is mainly determined by the degree of disturbance of consciousness, the type of mental disorder, the manifestation of increased intracranial pressure and the situation of convulsions.

See GBZ 76 for classification and classification criteria for disturbance of consciousness. For patients with transient coma, the classification should be combined with its clinical manifestations Whether it is brain failure.

A.10 Gastrointestinal dysfunction is mainly based on clinical manifestations, vomit, fecal occult blood test, fiber endoscopy, etc. to observe digestive tract adhesion Membrane ulcer bleeding. Intestinal obstruction and the like can be determined by physical examination, ultrasonic, X-ray and laboratory test indicators.

A.11 Occupational acute chemical toxicity The blood dysfunction of multiple organ dysfunction is mainly characterized by coagulopathy, toxic hemolysis Anemia, toxic methemoglobinemia, etc., coagulation disorders and fibrinolysis indicators mainly choose platelets, prothrombin time, thrombin time and fibrinogen, etc., for the determination of other damage to the blood system, white blood cells, methemoglobin, and the like are selected. See GBZ 75 for other details.

A.12 The treatment of acute chemical toxic multi-organ dysfunction should first be actively treated according to the principles of detoxification and treatment of different chemical poisoning the primary disease, and the use of comprehensive treatment methods such as symptomatic and organ support, focus on prevention.

A.13 Examples of writing criteria for the diagnosis of occupational acute chemical toxicity multi-organ dysfunction. occupational acute chemicals (XX) Multiple organ dysfunction caused by poisoning [(gastrointestinal failure), respiratory function (incomplete), renal function (incomplete)].

Appendix B

(informative appendix) Common chemicals causing acute toxic multi-organ dysfunction and their vulnerable organs Common chemicals causing acute toxic multi-organ dysfunction and their vulnerable organs are shown in Table B.1.

Table B.1 Common chemicals causing acute toxic multi-organ dysfunction and their vulnerable organs

Chemical cardiovascular lung kidney liver brain blood gastrointestinal tract Lead acetate - - - ( ) Mercuric sulfate - ( ) ( ) - -Mercury chloride ( ) ( ) ( ) ( ) ( ) Organic Mercury ( ) ( ) -Dichromate ( ) ( ) -Nickel carbonyl - - - - -Nickel carbonate ( ) ( ) - -Copper sulfate ( ) - ( ) ( ) Arsenic - -Arsenic trioxide -Arsine- ( ) ( ) Yellow phosphorus ( ) - - ( ) Phosphorus oxychloride ( ) ( ) - ( ) - -Hydrogen sulfide ( ) ( ) - ( ) Methyl mercaptan ( ) - - - ( ) Organic fluorine - ( ) - - -Hydrofluoric acid ( ) ( ) ( ) - ( ) Chlorine - - - - ( ) Phosgene- ( ) ( ) - ( ) Ammonia - ( ) ( ) - ( ) Bromide ( ) - ( ) - -Carbon monoxide ( ) - -Carbonyl chloride - - - ( ) Benzene- ( ) - ( ) Vinyl chloride - - ( ) Chloroform ( ) ( ) - ( ) Carbon tetrachloride - - ( ) Trichlorofluoromethane - - ( ) ( ) - -Dichloroethane ( ) - - -Dibromochloropropane ( ) - - ( ) -Gasoline - ( ) - -Phenylaminonitro compound - - -

Table B.1 (continued)

Ethanol ( ) ( ) - ( ) Methanol ( ) ( ) ( ) - -Phenols ( ) ( ) ( ) ( ) Ethylene oxide ( ) -Glacial acetic acid ( ) ( ) - ( ) ( ) dimethylformamide( ) - ( ) ( ) ( ) Dimethyl sulfate ( ) ( ) - - ( ) Hydroxymethyl acrylamide - ( ) ( ) ( ) -Adiponitrile ( ) ( ) - ( ) - ( ) Organophosphorus pesticides -Paraquat ( ) ( ) -Herbicidal ( ) - - ( ) ( ) -Sodium fluorosilicate - ( ) ( ) 禾大壮 ( ) ( ) - - -2,4-D Butyl Ester ( ) - - -Chloroacetic acid ( ) ( ) - -Trichloroethylene ( ) - ( ) -Nitrogen oxides( ) - ( ) - - -Acryl alcohol - ( ) ( ) -Difluorochloromethane - - ( ) - -O-toluidine - - - -P-chlorocyanobenzyl ( ) - - -Note. 1. The toxic multi-organ dysfunction chemicals in the table are derived from clinical case report data.

2. " " is the primary injury organ, "( )" secondary injury organ, "-" is no damage.