GBZ 13-2002 Diagnostic criteria for occupational acute acrylonitrile poisoning
Some standard content:
ICS 13.100
National Occupational Health Standard of the People's Republic of China GBZ13-2002
Diagnostic Criteria of Occupational Acute Acrylonitrile Poisoning2002-04-08 Issued
Ministry of Health of the People's Republic of China
Implementation on 2002-06-01
Article 6.1 of this standard is recommended, and the rest are mandatory. This standard is formulated in accordance with the "Law of the People's Republic of China on the Prevention and Control of Occupational Diseases". From the date of implementation of this standard, if the original standard GB7799-1987 is inconsistent with this standard, this standard shall prevail. Acrylonitrile (ACN) is an important monomer in synthetic chemical industry and is widely used. Acrylonitrile poisoning may occur due to contact with a large amount of acrylonitrile. In order to effectively prevent and control acute acrylonitrile poisoning, GB7799-1987 was promulgated. Eleven years after the original standard was promulgated, new cases continue to be reported, clinical experience is more abundant, and toxicological research has made certain progress, so it needs to be revised. The revised standard highlights that occupational acute acrylonitrile poisoning is a systemic disease with central nervous system damage as the main manifestation, and may cause damage to the heart, liver, lungs, etc., making the diagnostic classification criteria of this standard clearer and easier to operate. The appendix adds an explanation of the relationship with the general standard of occupational acute chemical poisoning, and the provisions are clearer and more reasonable.
Appendix A of this standard is an informative appendix.
This standard is proposed and managed by the Ministry of Health of the People's Republic of China. This standard was drafted by the Lanzhou Chemical Industry Company Staff Hospital and Jinshan Hospital Affiliated to Fudan University. Ningbo Municipal Health and Epidemic Prevention Station, Anqing Petrochemical General Plant Hospital, Urumqi Petrochemical General Plant Hospital, and Ningbo Zhenhai District Health and Epidemic Prevention Station participated in the drafting. This standard is interpreted by the Ministry of Health of the People's Republic of China. ..comOccupational acute acrylonitrile poisoning diagnostic standard GBZ13-2002
Occupational acute acrylonitrile poisoning refers to a systemic disease with central nervous system damage caused by exposure to a large amount of acrylonitrile in a short period of time during occupational activities, which may be accompanied by damage to organs such as the heart, liver, and lungs. 1 Scope
This standard specifies the diagnostic criteria and treatment principles for occupational acute acrylonitrile poisoning. This standard applies to the diagnosis and treatment of acute poisoning caused by occupational exposure to acrylonitrile. Non-occupational acute acrylonitrile poisoning can be used as a reference.
2 Normative references
The clauses in the following documents become clauses of this standard through reference in this standard. For all dated referenced documents, all subsequent amendments (excluding errata) or revisions are not applicable to this standard. However, the parties to the agreement based on this standard are encouraged to study whether the latest versions of these documents can be used. For all undated referenced documents, the latest versions are applicable to this standard.
GB/T16180
3 Diagnostic principles
Diagnostic standards for occupational skin diseases (general principles)Diagnostic standards for occupational toxic liver diseases
Diagnostic standards for occupational acute chemical poisoningRespiratory system diseases diagnostic standards for occupational acute chemical poisoningHeart diseases diagnostic standards for occupational acute chemical poisoningNervous system diseases diagnostic standards Assessment of the degree of disability caused by work-related injuries and occupational diseases of employeesThe diagnosis can only be made based on the occupational history of exposure to large amounts of acrylonitrile in a short period of time, with central nervous system damage as the main clinical manifestation, combined with a comprehensive analysis of the results of on-site labor hygiene investigations, and excluding similar diseases caused by other reasons. 4 Contact reaction
Headache, dizziness, fatigue, dry throat, conjunctival and nasopharyngeal congestion, etc., which will recover in a short time after leaving contact 5 Diagnosis and classification standards
5.1 Mild poisoning
Headache, dizziness worsens, upper abdominal discomfort, nausea, vomiting, numbness of hands and feet, chest tightness, dyspnea, hyperreflexia of tendons, drowsiness or confusion, and may have elevated serum transaminase, abnormal electrocardiogram or myocardial enzyme spectrum 5.2 Severe poisoning
On the basis of mild poisoning, one of the following occurs: a) epileptic seizure-like convulsions;
b) coma:
..com c) pulmonary edema.
Handling principles
6.1 Treatment principles
6.1.1 Leave the scene quickly, take off the contaminated clothes, and rinse the contaminated skin parts thoroughly with clean water. 6.1.2 Those who have been exposed should be closely observed, and those with more severe symptoms should receive symptomatic treatment. Those with mild poisoning can be given intravenous sodium thiosulfate: those with severe poisoning can use methemoglobin formers and sodium thiosulfate. Sodium thiosulfate can be used repeatedly according to the condition. 6.1.3 Oxygen administration, and hyperbaric oxygen therapy can be used according to the condition. 6.1.4 Symptomatic treatment, if cerebral edema occurs, glucocorticoids, dehydration, diuresis and other treatments can be used. 6.2 Other treatments
6.2.1 After treatment, those with mild poisoning can resume their original work after proper rest. 6.2.2 If the neurological symptoms and signs of severe poisoning are not fully recovered, they should be transferred from their original work, and they need to continue to rest or arrange light work according to the recovery of their condition. If the labor capacity assessment is required, it should be handled in accordance with GB/T16180. Instructions for the correct use of this standard
See Appendix A (Informative Appendix).
..comAppendix A
(Informative Appendix)www.bzxz.net
Instructions for the correct use of this standard
A.1 This standard applies to acute poisoning caused by contact with a large amount of acrylonitrile in a short period of time. A.2 The contact reaction is a transient reaction and does not belong to poisoning. It usually recovers within 24 hours after the contact is removed. A.3 The incubation period of poisoning is about 0.5 to 24 hours, so those who have contact reactions should be observed for at least 24 hours. A.4 According to the clinical characteristics of central nervous system damage after poisoning, those with drowsiness or confusion are classified as mild poisoning, and those with coma and convulsions are classified as severe poisoning, referring to the diagnostic criteria for acute chemical poisoning nervous system diseases. A.5 Clinically, some cases may have pulmonary edema, so those who have dyspnea, moist rales in both lungs, patchy shadows on X-ray examination, and meet the criteria for alveolar pulmonary edema can also be classified as severe poisoning according to GBZ73-2002 "Diagnostic Criteria for Occupational Acute Chemical Poisoning Respiratory Diseases". A.6 Acute poisoning patients may experience mild liver damage, such as abnormal liver function. Mild heart damage may also occur, manifested as changes in the ST segment and T wave of the electrocardiogram, but recovery is fast, so it is a mild poisoning. Severe toxic liver disease and severe toxic heart disease are rare in clinical practice. If heart or liver damage occurs, its diagnosis, classification and treatment shall refer to GBZ59 and GBZ74. A.7 Propylene has a strong irritating effect on the skin and mucous membranes, and skin damage of varying degrees may occur after several hours of contact. However, it does not fall within the scope of acute acrylonitrile poisoning. If it occurs, it can be diagnosed and treated in accordance with GBZ18. A.8 Treatment instructions
A.8.1 At present, nitrite and sodium thiosulfate are still the first choice antidote for acute acrylonitrile poisoning at home and abroad, and the efficacy is reliable. For patients with mild poisoning, 5-10g of sodium thiosulfate can be injected intravenously, and no methemoglobin forming agent is needed. For patients with severe poisoning, 5-10ml of 3% sodium nitrite can be injected intravenously or 2ml of 10% 4-dimethylaminophenol can be injected intramuscularly, and then 10-15g of sodium thiosulfate can be injected intravenously. If the condition has not been alleviated 30 minutes after medication, 5-10g of sodium thiosulfate can be repeatedly applied. A.8.2 Actively give oxygen, and those who have the conditions can be given hyperbaric oxygen therapy according to the condition. A.8.3 While using special antidote drugs, patients with severe poisoning should use glucocorticoids in an early, short-term and sufficient amount to help prevent and treat cerebral edema and other injuries.
A.9 Urine thiocyanate determination can be used as an indication of acrylonitrile exposure, and is only for diagnostic reference, so its determination method is not included in the appendix of this standard; there are many determination methods in China, and the pyridine-barbituric acid colorimetric method is generally used. ..com
Tip: This standard content only shows part of the intercepted content of the complete standard. If you need the complete standard, please go to the top to download the complete standard document for free.