中毒医学人才的培养是我国医学临床专科培养的重要内容,为了让学生对中毒医学产生兴趣,理解复杂的中毒机制和多系统的临床表现,本文详细分析了 PBL-CBL联合教学法,互联网+Sandwich教学法,并可针对不同章节采用微课和慕课教学法,多元化的教学方式和中毒医学教学实际相结合,能够提高学生的主动性和参与度,培养学生独立思考和探索的能力,提高教学质量和教学效果,适应新时代中毒医学教学的需要,同时本文也对多元化教学模式存在的问题进行了分析和探讨,并提出了相应的对策,多元化的教学模式作为传统教学的融合补充,适合在中毒医学教学领域应用和推广.

对54例煤矿井下工人滑囊炎病例的临床特点进行回顾性分析。患者以采煤工最多,工龄多在10年以上,髌前滑囊最易受损,双侧发病多于单侧,影像学检查和滑囊穿刺抽液检查可辅助诊断,保守治疗或滑囊穿刺抽液后注射糖皮质激素治疗无效时可考虑滑囊切除术。

为指导相关单位做好低温作业人员的职业健康监护,新修订的《职业健康监护技术规范》(GBZ 188)拟在GBZ 188-2014的基础上增加低温作业人员健康监护条款,规定了相应的技术性、规范性意见.针对低温作业人员健康监护的条款、低温作业健康监护的职业禁忌证、低温健康体检应急健康检查条款做一介绍说明,希望对低温作业人员健康监护实施有所帮助.

刮研是指用带柄刮刀以人工方法修整工件的表面形状、粗糙度等,刮研作业作为一个重要的工种,在机床生产、精密加工和维修中具有不可代替的位置.目前从事手工刮研作业工人约占行业一线工人的5％,粗略估计全国目前该作业仍有10万余名从业人员. 钳工在刮研操作时,将平面刮刀刀柄顶住腹股沟部位,双手握住刀具,使平面刮刀与被刮表面形成一定的切削角度,并对刀头施加压力,使平面刮刀刀刃吃紧平面.由于刮研工用髂骨和腰部给刀柄以推力,腹股沟长期顶压刮刀致静脉血管回流不畅、下肢瘀血、压力增高、组织缺氧,可造成下肢静脉血栓综合征、股动脉闭塞症及淋巴管闭塞症,相关的疾病主要包括肌肉骨骼系统疾病、外周血管疾病.

[Objective] To analyze the reasons for the inconsistent results of occupational disease diagnosis and identification in a case of mild occupational noise deafness.[Methods] According to the patient's hearing loss in the noise environment,the reasons for the inconsistency of occupational disease diagnosis and identification were analyzed on the basis of patient's history of occupational exposure and occupational health examination data,and the data of occupational disease diagnosis and identification.[Results] The results that were calculated in accordance with the criteria for the standard A10 e) and f) of the Diagnosis of occupational noise induced deafness (GBZ 49-2014) were as follows:binaural frequency hearing threshold in average (BHFTA) was 46.5 dB HL,while monaural weighted value-left (MTMV-L) and monaural weighted value-right (MTMV-R) was 35.1 dB HL and 38.1 dB HL respectively,and the MTMV-L (35.1 dB HL) should be taken as the measured value.However,there was the difference in diagnosis conclusion between the diagnosis institution and the identification institution.The occupational disease diagnosis of the patient was mild occupational noise deafness.The identification expert group considered that:①the audiological characteristic of noise deafness is dominated by high frequency drop,with symmetrical hearing loss and gradual change in hearing loss,and the binaural hearing loss chart of this patient did not meet the characteristics of noise induced hearing loss.②The dignosis showed inconsistent results in subjective and objective audiometry.③The application of the Diagnosis of occupational noise induced deafness should firstly be based on the correct diagnosis.According to the diagnostic criteria of GBZ 49-2014,the final identification result was no occupational noise induced hearing loss.[Conclusion] According to the diagnostic criteria of the Diagnosis of occupational noise induced deafness (GBZ 49-2014),the final conclusion is no occupational noise induced hearing loss.In the diagnosis of occupational noise induced deafness,it is necessary to correctly understand the diagnostic criteria and invite clinical audiology experts to make the differential diagnosis,to ensure correct diagnosis and appraisal conclusion.

收集北京朝阳医院2003-2015年收治的34例急性氨气中毒患者的临床资料,对其发病情况、临床症状和体征、实验室检查指标和急救治疗措施及转归情况进行回顾性分析.

冷损伤是指人体在寒冷环境下，机体热量大量散失引起的局部或全身性损伤。冷损伤是我国寒区和高原地区的常见病，可发生于日常生活和职业生产活动中，致残率和死亡率均较高。为指导今后冷损伤的诊断和治疗，本文对目前国内外对各类冷损伤的发病机制、临床表现、诊断分级和治疗的研究进展情况进行综述。

Sodium 3,5,6-trichloropyridin-2-ol (STCP) is an important intermediate for synthesizing organophosphate insecticide chlorpyrifos. At present, chlorpyrifos is one of the world's largest species of pesticide products. Many studies have focused on the toxicity of chlorpyrifos, but few reports have looked at the toxicity mechanism of STCP. Even fewer studies have looked at STCP poisoning. With increasing production and usage of STCP, the chances of such poisoning will increase. In this study, we present a report on four workers who helped in the industrial manufacture of STCP and who were affected by exposure to it. We hope that these case studies will provide a foundation for further research into STCP.

目的：介绍GBZ 11—2002《职业性急性磷化氢中毒诊断标准》修订的背景及主要修订内容依据。方法查阅国内外相关文献，收集急性磷化氢中毒病例资料并进行分析，对本次标准修订内容进行探讨。结果提出本次标准修订仍沿用原标准中以呼吸系统、中枢神经系统损害的临床表现和损害程度作为职业性磷化氢中毒主要诊断分级指标。分级由原标准的轻度、重度2级细化为轻度、中度和重度；将原标准的观察对象变更为接触反应；删除轻度中毒中的支气管周围炎指标；删除明显心肌损害和明显肝、肾损害条款；重度中毒增加“肺泡性肺水肿”、“急性呼吸窘迫综合征”和“猝死”条款。结论修订后的诊断标准适应职业性急性磷化氢中毒的临床特点。

OBJECTIVE:To investigate the changes in expression of serum cytokines in patients with pneumoconiosis using cytokine antibody chips (CACs).METHODS:The CAC technology was applied to measure the serum levels of 60 cytokines in 12 patients with pneumoconiosis and 3 normal controls.RESULTS:In the patients with pneumoconiosis, the highly expressed serum cytokines included interleukin (IL)-1α, IL-1β, IL-2, ILs 4-16, macrophage colony-stimulating factor, interferon-γ, tumor necrosis factor (TNF)-α, TNF-β, human bone morphogenetic protein-6, fibroblast growth factor-7, neurotrophin-3, and stem cell factor, and the lowly expressed serum cytokines included recombinant human I-309, monocyte chemoattractant protein (MCP)-1, MCP-2, MCP-3, MCP-4, macrophage inflammatory protein (MIP)-1-δ, and MIP-3-α.CONCLUSION:Patients with pneumoconiosis have changes in the expression of most serum cytokines.

目的观察奥氮平治疗急性四乙基铅中毒所致精神障碍症状的临床疗效及不良反应。方法选择本院2004年1月至2010年8月收治的18例急性四乙基铅中毒患者,采用奥氮平治疗2个月。观察患者的精神障碍症状在治疗前后变化情况。采用简明精神病评定量表及副反应量表评定临床疗效和不良反应。结果 18例患者均完成2个疗程的治疗,临床痊愈7例(38.9%),疗效显著5例(27.8%),好转3例(16.7%),无效3例(16.7%,3例重度中毒患者治疗2个月后,因多器官功能衰竭死亡)。治疗总有效率为83.3%。不良反应主要为体质量增加、嗜睡、头晕、口干及便秘。结论奥氮平治疗急性四乙基铅中毒所致精神障碍症状的疗效肯定,不良反应少,安全可靠。

GBZ 11-2002《职业性急性磷化氢中毒诊断标准》自2002年颁布实施以来,对职业性和非职业性急性磷化氢中毒的诊断和处理起到了积极的指导作用.近年来,卫生部职业病诊断标准专业委员会陆续对现有标准进行修订,其中部分条款与现有磷化氢中毒诊断标准存在不一致或不衔接,为保证标准的科学性和先进性,首都医科大学附属朝阳医院受卫生部职业病诊断标准专业委员会委托,联合河南省新乡市职业病防治研究所、江苏省苏州市第五人民医院(苏州市职业病医院)对现有的急性磷化氢中毒诊断标准进行修订(其中苏州五院负责修订重度中毒条款初稿),使其与职业性急性化学物中毒性神经系统疾病、呼吸系统疾病、心脏病、肝病和肾病的诊断总则相衔接,使诊断分级更为明确、合理.

通过CNKI全文数据库对2003年1月—2012年12月近10年关于冻伤的文献进行检索,对病例资料全面的10篇文献397例冻伤病例进行回顾性分析。寒冷季节户外活动为冻伤的主要原因,冻伤部位多发生在手、足、耳廓、鼻和颜面部,Ⅲ度冻伤病例较多,重度冻伤患者截肢率较高。提示冻伤危害巨大,给患者造成身心痛苦,应积极预防冻伤的发生,早期诊断和治疗,最大程度减少因冻伤导致的致残率。

<正>磷化氢(PH3)属高毒类,为无色气体,有腐鱼样臭味,常态PH3溶于水,微溶于乙醇、乙醚。易自燃,当空气中浓度达到2%～8%时,可发生爆炸。可产生PH3的物质有磷化铝(AlP)、磷化锌(Zn3P2)等,元素磷只在特定的还原条件下才会产生PH3。PH3主要经呼吸道进入人体造成呼吸系统为主的多脏器损伤;口服AlP、Zn3P2者在胃内遇酸生成PH3,胃肠道症状发生早而且重。国内这方面研究较少,现对其作一综述。

收集近年国内文献报道的具有详细临床资料的急性磷化氢中毒病例184例,对其进行总结分析。结果显示,磷化氢中毒的潜伏期和临床表现可因毒物侵入途径和剂量不同而有较大差异,与剂量呈相关性。临床表现主要涉及神经系统、呼吸系统以及消化系统,主要有头晕、头痛、乏力、胸闷、恶心、呕吐、咳嗽、咳痰,严重者有中毒性精神症状、脑水肿、肺水肿、肝肾及心肌损害,心律紊乱,心电图、肝功能、肾功能检查阳性率较高。提示磷化氢对人体具有高度毒性,职业中毒以急性多见,中毒以神经系统、呼吸系统症状为主,突出表现为意识障碍和呼吸系统损害,且与病情严重程度相一致,其发生和损害程度可作为诊断分级的主要指标。

OBJECTIVE:To investigate the application of auditory brainstem response (ABR) and 40 Hz auditory event related potential (40 Hz AERP) to the diagnosis of occupational noise-induced hearing impairment and to provide the evidence for diagnosis of occupational deafness.METHODS:Pure tone audiometry, ABR and 40 Hz AERP were performed in 54 workers occupationally exposed to noise. The thresholds of higher frequency band, 3 kHz and 4 kHz were compared with the threshold of ABR. The thresholds of auditory frequency ban and 0.5 kHz were compared with the threshold of 40 Hz AERP.RESULTS:A better correlation was found between thresholds of ABR and higher frequency pure tone audiometry. There was a significant difference of thresholds between 40 kHz AERP and pure tone audiometry. The correction values of thresholds between 40 kHz AERP and pure tone audiometry in the light noise-induced hearing impairment group and the moderate noise-induced hearing impairment group were (16.43 ± 1.08) and (11.80 ± 1.12) dBn HL, respectively.CONCLUSION:In diagnosis of occupational noise-induced hearing impairment, the threshold of ABR can be used to estimate the hearing threshold of pure noise higher frequency. Because there is the significant difference of the thresholds between pure tone audiometry and 40 Hz AERP, the response threshold can not be served as the audiometry threshold, and the behavioral hearing thresholds can only be obtained by adjusting the response threshold with respective correction value.

Objective To study the changes of serum enzymes and electrolytes in rats with acute carbon dioxide(CO2) poisoning after different oxygen therapies,which includes hyperbaric oxygen treatment,high concentration of atmospheric oxygen treatment and low concentration of atmospheric oxygen treatment. Methods 60 healthy male SD rats were randomized into normal control group(group A),CO2 exposure group(group B),after exposed hyperbaric oxygen treatment group(pressure 2 ATA,FiO2 100%)(group C),after exposed high concentration of atmospheric oxygen treatment group(FiO2 50%)(group D),after exposed low concentration of atmospheric oxygen treatment group(FiO2 33%)(group E).After the acute CO2 poisoned rats were treated with different oxygen,serum troponin I(CTNⅠ),creatine kinase(CK),aspartate aminotransferase(AST),potassium,sodium and chloride were detected respeetively. Results CTNⅠ,CK and AST in group B、D and E were higher than those of group A(P<0.05).There were no significant differences of CTNⅠ,CK and AST between group C and group A(P>0.05).Serum potassium levels in group B,D and E were higher than that of group A(P<0.05),but without significant difference between group C and group A(P>0.05).Serum sodium and chloride levels of group B,D and E were lower than those of group A(P<0.05),while there were no significant differences of serum sodium and chloride between group C and group A(P>0.05). Conclusion Hyperbaric oxygen treatment was better than other oxygen treatments on reduce serum enzymes and correct electrolytes disturbances in rats with acute carbon dioxide poisoning.

OBJECTIVE:To Evaluate the effects of different oxygen therapies on the rats with acute nitrogen asphyxia and to study the best oxygen therapic protocol for patients with acute nitrogen asphyxia on the spot.METHODS:Sixty healthy male Wistar rats were divided into 5 groups: control, exposure to nitrogen, 33% oxygen treatment, 50% oxygen treatment and hyperbaric oxygen treatment groups. The behavioral performance, arterial oxygen pressure (PO2), carbon dioxide partial pressure (PCO2) and oxygen saturation (SPO2), biochemical changes in liver and kidney function and myocardial enzymes in 5 groups were measured.RESULTS:The rats exposed to nitrogen firstly were excited then inactive symptoms, but consciousness was recovered after oxygen therapy. The PO2 and SPO2 in nitrogen exposure group were (79.67 +/- 9.12) and (94.92 +/- 2.78) mm Hg, respectively, which were significantly lower than those in control group (P<0.01). The PO2 and SPO2 of 3 oxygen treatment groups were (94.75 +/- 7.24), (94.92 +/- 8.98), (104.58 +/- 7.12)mm Hg and (97.17 +/- 0.83), (96.92 +/- 1.16), (97.42 +/- 0.67)mm Hg, respectively, which were significantly higher than those in nitrogen exposure group (P<0.05). The PO2 in hyperbaric oxygen treatment group was significantly higher than those in other 2 oxygen treatment groups (P<0.05). The SPO2 in hyperbaric oxygen treatment group was (51.42 +/- 6.60) mm Hg which was significantly higher than that [(44.58 +/- 3.42)mm Hg] in 50% oxygen treatment groups (P< 0.05). AST [(270.50 +/- 49.05 )U/L], ALT [(122.67 +/- 55.44 )U/L], BUN [(7.31 +/- 0.93 )mmol/L], Cr[(28.32 +/- 4.35) micromol/L], CK [(1808.42 +/- 582.05)U/L] and CtnI [(22.52 +/- 14.29 )ng/ml] in nitrogen exposure group were significantly higher than those in control group (P<0.05). AST [(165.25 +/- 30.87) U/L], HBDH [(350.83 +/- 103.00)U/L] and CtnI [(11.23 +/- 5.38) ng/ml] in hyperbaric oxygen treatment group were significantly lower than those in other 2 oxygen treatment groups (P<0.05).CONCLUSION:Timely and effective oxygen therapy can significantly increase arterial pressure of oxygen and oxygen saturation in the rats with acute nitrogen asphyxia, and can improve liver function and cardiac damage. The hyperbaric oxygen chamber can significantly increase the therapeutic effects on rats with acute nitrogen asphyxiation.

OBJECTIVE:To study therapeutic effects by using different oxygen therapies in rats with acute carbon dioxide poisoning, to select the best oxygen therapy technology for patients with acute carbon dioxide poisoning on the spot. METHODS:Sixty healthy male Sprague-Dawley rats were randomized into normal control group, carbon dioxide exposure group, hyperbaric oxygen treatment group (pressure 2 ATA, FiO(2)100%), high concentration of atmospheric oxygen treatment group (FiO(2)50%), low concentration of atmospheric oxygen treatment group (FiO(2)33%). After treated with different oxygen in rats with acute carbon dioxide poisoning, arterial pH, PO2 and PCO2 of rats were detected, in addition observe pathological changes of lung tissue and brain tissue. RESULTS:The arterial pH (7.31 ± 0.06) and PO2 [(68.50 ± 15.02) mm Hg] of carbon dioxide exposure group were lower than those of control group [pH (7.42 ± 0.02) and PO2 (92.83 ± 8.27) mm Hg], PCO2 [(71.66 ± 12.10) mm Hg] was higher than that of control group [(48.25 ± 2.59) mm Hg] (P < 0.05); the arterial pH (hyperbaric oxygen treatment group 7.37 ± 0.02, high concentration of atmospheric oxygen treatment group 7.39 ± 0.03, low concentration of atmospheric oxygen treatment group 7.38 ± 0.02) and PO2 of oxygen treatment groups [hyperbaric oxygen treatment group, high concentration of atmospheric oxygen treatment group, low concentration of atmospheric oxygen treatment group were (82.25 ± 12.98), (84.75 ± 11.24), (83.75 ± 16.77) mm Hg, respectively] were higher than that of carbon dioxide exposure group, PCO2 [hyperbaric oxygen treatment group, high concentration of atmospheric oxygen treatment group, low concentration of atmospheric oxygen treatment group were (52.25 ± 4.95), (51.75 ± 4.82), (52.66 ± 5.61) mm Hg, respectively] was lower than that of carbon dioxide exposure group (P < 0.05); there was no significant difference of the arterial pH, PO2 and PCO2 between oxygen treatment groups and control group (P > 0.05); there was no significant difference of the arterial pH, PO2 and PCO2 among oxygen treatment groups (P > 0.05). There was large area of bleeding of lungs in rats with carbon dioxide poisoning, the bleeding of lungs in rats with high concentration of atmospheric oxygen treatment and low concentration of atmospheric oxygen treatment was better than the rats with carbon dioxide poisoning, there was no abnormal appearance of lungs in rats with hyperbaric oxygen treatment. The light microscope observation showed that there were diffuse bleeding and exudation of lungs in rats with carbon dioxide poisoning, the bleeding and exudation of lungs in rats with high concentration of atmospheric oxygen treatment and low concentration of atmospheric oxygen treatment were better than the rats with carbon dioxide poisoning, there were only minor bleeding and exudation of lungs in rats with hyperbaric oxygen treatment. There was no difference of brain in anatomy and microscopy among all groups, there were no significant bleeding, edema, cell degeneration and necrosis. CONCLUSIONS:Lung pathology in acute carbon dioxide poisoning rats with hyperbaric oxygen treatment is better than the rats with high concentration of atmospheric oxygen treatment and low concentration of atmospheric oxygen treatment, there is no significant difference of effect between high concentration of atmospheric oxygen treatment group and low concentration of atmospheric oxygen treatment group, however, the results of blood gas analysis and lung pathology than the exposure group improved, so qualified medical unit for hyperbaric oxygen therapy as soon as possible, hyperbaric oxygen treatment facilities in the absence of circumstances, the emergency treatment of early oxygen is also a good measure.

目的探讨直接数字X射线摄影(DR)胸片在尘肺病诊断中的可行性。方法根据接尘工人健康档案的高千伏X射线胸片,选择尘肺及非尘肺接尘工人共92例,同时进行高千伏胸片与DR胸片摄影,对2种胸片的总体密集度、各个肺区密集度、诊断分期进行一致性及相关分析;并比较各肺区密集度平均分值、总体密集度平均分值及诊断分期平均分值。结果 92例高千伏X射线胸片和DR胸片总体密集度、各肺区密集度和诊断分期kappa值分别为0.480、0.443、0.651,诊断一致性好,相关系数分别为0.756、0.893、0.713,有正相关关系。DR胸片总体密集度平均分值、肺区密集度平均分值、诊断分期平均分值均高于高千伏X射线胸片,差异有统计学意义(P<0.01)。结论 DR胸片在诊断尘肺病上与高千伏X射线胸片的一致性较好,是可行的,但依据GBZ 70—2009《尘肺病诊断标准》,目前尚未合适作为尘肺病诊断,应尽早研制数字化摄影胸片的尘肺病诊断标准及标准片。