GBZ 74-2002 Diagnostic criteria for occupational acute chemical poisoning heart disease
Some standard content:
ICS 13.100
National Occupational Health Standard of the People's Republic of China GBZ74-2002
Diagnostic Criteria of Occupational Acute Toxic Cardiopathy Caused by Chemicals2002-04-08 Issued
2002-06-01 Implementation
Ministry of Health of the People's Republic of China
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 there is any inconsistency between the original standard GB17057-1997 and this standard, this standard shall prevail. In various occupational activities, people may be exposed to some high-concentration and highly toxic chemicals in a short period of time, which may cause acute poisoning. These chemicals may be known species, or their exact pathogenic species may not be known for a while after poisoning has occurred. Some species are listed in the "Occupational Disease List", while others are not yet included: some have independent diagnostic standards, while others have not yet developed independent diagnostic standards. However, all acute poisoning diseases have common pathogenesis patterns, and it is possible and necessary to formulate common rules to be followed when diagnosing acute poisoning. The various rules specified in this series of standards involve the diagnosis of occupational acute chemical poisoning. These rules are used to ensure the unification of the diagnostic system of occupational acute chemical poisoning. Regardless of whether the cause is known or hidden, and regardless of which target organ is damaged by the poisoning, the diagnosis can be made according to the rules specified in this standard. Under the general title of "Diagnosis of Occupational Acute Chemical Poisoning", it includes the following 10 parts: Part 1 Diagnostic Criteria for Occupational Acute Chemical Poisoning (General Principles): Diagnostic Rules for Occupational Acute Hidden Chemical Poisoning: Part 2
Part 3
Part 4
Part 5
Part 6
Part 7
Diagnostic Criteria for Multiple Organ Dysfunction Syndrome due to Occupational Acute Chemical Poisoning; Diagnostic Criteria for Occupational Acute Chemical Sudden Death; Diagnostic Criteria for Occupational Acute Chemical Poisoning Nervous System Diseases: Diagnostic Criteria for Occupational Acute Chemical Poisoning Respiratory System Diseases: Diagnostic Criteria for Occupational Acute Toxic Liver Disease; Part 8
Diagnostic Criteria for Occupational Acute Toxic Nephropathy: Part 9
Diagnostic Criteria for Occupational Acute Chemical Poisoning Cardiac Diseases: Part 10 Diagnostic Criteria for Occupational Acute Chemical Poisoning Hematological Diseases: Appendix A of this standard is an informative appendix, and Appendix B is a normative 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 Second Affiliated Hospital of Shanxi Medical College, and Tianjin Institute of Occupational Disease Prevention and Treatment: Xi'an Central Hospital, Shanghai Sixth People's Hospital, and Shanghai Zhabei District Central Hospital participated in the drafting. This standard is interpreted by the Ministry of Health of the People's Republic of China. Diagnostic Standard for Occupational Acute Chemical Toxicity Heart Disease GBZ74-2002
Occupational acute chemical toxicity heart disease is a disease caused by chemicals damaging the heart and affecting its pump function, autonomy or conductivity during various occupational acute chemical poisoning. Scope
This standard specifies the general diagnosis and treatment principles for occupational acute chemical toxicity heart disease. This standard is applicable to heart diseases caused by various occupational acute chemical poisoning. For the diagnosis of heart diseases caused by non-occupational acute chemical poisoning, this standard can also be referred to. 2 Normative References
The clauses in the following documents become the clauses of this standard through reference in this standard. All subsequent amendments (excluding errata) or revisions to dated references are not applicable to this standard. However, parties that reach an agreement based on this standard are encouraged to study whether the latest versions of these documents can be used. For undated references, the latest versions apply to this standard.
3 Diagnostic principles
Diagnostic criteria for occupational acute chemical poisoning (general principles) Diagnostic rules for occupational acute latent chemical poisoning Based on the occupational exposure history of high concentrations of chemical poisons in a short period of time, clinical manifestations and on-site investigations, combined with the results of electrocardiograms, myocardial enzymes, and chest X-rays, it can be diagnosed only when it meets the requirements of toxic heart disease and excludes similar diseases caused by other reasons. Clinically, it can be divided into two categories: acute toxic myocardial damage and arrhythmia. The former is mainly diagnosed based on changes in electrocardiogram ST-T and myocardial enzymes, while the latter can show various arrhythmias on electrocardiograms. Both types of clinical manifestations can also occur at the same time.
4 Observation subjects
After confirmation of acute occupational poisoning, one of the following conditions occurs: a) Mild elevation of myocardial enzyme spectrum;
b) Prolonged QT interval on electrocardiogram;
c) Occasional premature beats.
5 Diagnosis and classification standards
5.1 Mild toxic heart disease
One of the following conditions occurs:
a) Significant increase in myocardial enzyme spectrum;
b) Various common arrhythmias, such as frequent premature beats, supraventricular tachycardia; 1st degree atrioventricular block;
d) Electrocardiogram shows mild abnormal changes in ST-T. 5.2 Moderate toxic heart disease
One of the following conditions occurs:
More serious arrhythmias, such as atrial fibrillation or flutter, ventricular tachycardia;a)
b) ⅡI degree atrioventricular block;
c) Electrocardiogram shows myocardial damage, ischemia or myocardial infarction-like changes. 5.3 Severe toxic heart disease
Anyone who meets any of the following conditions:
a) Myocardial infarction;
Torsades de pointes, ventricular fibrillation or flutterb)
First degree atrioventricular block;
d) Cardiogenic shock or congestive heart failure;
Sudden cardiac death.
Treatment principles
Treatment principles
According to the treatment principles in GBZ71, rescue acute poisoning. Take specific treatment measures according to the cause.
The patient should absolutely rest in bed, correct hypoxia in time, maintain water, electrolyte and acid-base balance, and have reasonable nutrition. 6.1.4 Treatment of myocardial damage
Give drugs that improve myocardial cell nutrition and metabolism, such as potassium magnesium aspartate, polarizing solution, coenzyme Q10, 1,6-diphosphate fructose (FDP), vitamin C, vitamin B, etc.: b)
Use sufficient glucocorticoids as early as possible:
Drugs that improve coronary circulation, such as nitrates, calcium antagonists, low molecular weight dextran, etc., can be used with caution in congestive heart failure. Digitalis drugs, diuretics, and dopamine can be used with caution. d)
6.1.5 Treatment of arrhythmia
Correct hyperkalemia or hypokalemia;
For rapid arrhythmia, such as atrial beat or flutter, supraventricular tachycardia, vertigo can be used; for ventricular tachycardia, lidocaine can be used; potassium-magnesium mixture has a good effect on torsades de pointes; when drugs are ineffective for atrial fibrillation, electric defibrillation can be considered;
For slow arrhythmia with atrioventricular block, atropine, ephedrine or isoproterenol, glucocorticoids can be used, and temporary pacemakers can be used when necessary: d
Other treatment principles are the same as those for internal medicine. www.bzxz.net
6.2 Other treatments
6.2.1 After the subjects and patients with mild toxic heart disease have fully recovered from treatment, they can return to their original jobs. 6.2.2 Moderate toxic heart disease
After treatment and recovery, the patient can generally engage in normal work. 6.2.3 Severe toxic heart disease
After treatment, the patient can arrange work or rest according to the recovery situation. 7 Instructions for the correct use of this standard
See Appendix A (Informative Appendix).
Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A.1 This standard applies to the diagnosis, classification and treatment of heart disease caused by occupational acute chemical poisoning, and can be used as a reference for heart disease caused by acute poisoning in daily life. A.2 Common causes of disease
a) Asphyxiating gases: carbon monoxide, hydrogen sulfide, cyanide, methane, nitrogen, carbon dioxide. b)
Pesticides: lindane, DDT: thiamethoxam: fluoroacetamide, sodium fluoroacetate: chlorpyrifos, phorate, aphidicide, DDV, methamidophos, cypermethrin, dimethoate, trichlorfon, malathion, phosphamidon: pyrethroids (cypermethrin, deltamethrin, etc.); insecticide; carbamate; propanil, etc. Metals and non-metals: mercury, arsenic, arsine, lead, antimony, barium, cobalt, phosphorus, etc. c
Irritant gases: ammonia, chlorine, phosgene, nitrogen dioxide, dimethyl sulfate, methyl chloroformate, organic fluorine, hydrogen fluoride d)
acid, phosphine, phosphorus trichloride, chloromethyl ether, monomethylamine, carbonyl nickel. Halogenated hydrocarbons: tetrachloroethylene, vinyl chloride, ethyl chloride, trichloroethane, tetrachloroethane, trichloropropane, ethylene oxide, ethyl bromide, propyl bromide, chloroform.
Organic solvents: benzene, toluene, gasoline, carbon tetrachloride, carbon disulfide. Methemoglobin formers: aniline, nitrite. g)
Others: phenol, fluoroacetic acid, sodium azide, allylamine, ethyl gasoline, borane, etc. A.3 Pathogenesis
a) Direct toxic effects of poisons on the myocardium and (or) conduction system. b) Indirect causes such as hypoxia, electrolyte disorders, and acid-base imbalance after poisoning. A.4 Clinical features of occupational acute toxic heart disease All have a history of short-term exposure to high concentrations of chemicals. a)
Have clinical manifestations unique to the chemical poisoning. The clinical and electrocardiographic changes of acute toxic heart disease are non-specific and are often masked by the critical symptoms of poisoning and are easily overlooked.
Myocardial damage often occurs 1 to 7 days after poisoning, and some even occur during the recovery period of poisoning.d
The more severe the poisoning, the more chances of myocardial damage, the earlier it occurs, and the more severe the degree.e)
Most patients can gradually return to normal as the poisoning situation improves. 5 Clinical manifestations of toxic heart disease
Symptoms: palpitations, shortness of breath, weakness, chest tightness, and dyspnea. Sometimes due to the serious condition, the patient is in a coma without any a)
complaint.
Physical signs: purple, decreased blood pressure, enlarged heart, faster or slower heart rate, low and dull heart sounds, arrhythmia, severe b)1
patients can hear diastolic gallop rhythm and moist rales in both lungs. Electrocardiogram: common QT interval prolongation, ST-T changes, atrioventricular block of varying degrees, various types of arrhythmias.
d) X-ray chest film: heart enlargement can be seen. Pulmonary edema caused by irritant gas poisoning can be seen with prominent pulmonary artery segments, and the lung fields show dot, flake or butterfly-shaped shadows. e)
Others: elevated myocardial enzyme spectrum, abnormal examinations such as cardiac color ultrasound, two-dimensional echocardiography, dynamic electrocardiogram, ECT, etc. can provide in-depth understanding of changes in heart size, myocardial hypertrophy, ventricular enlargement, and cardiac function. 5 Diagnostic steps and methods
According to the history of exposure to high-concentration chemicals, on-site investigation, clinical and laboratory examination data, first confirm the acute a)
poisoning and its degree
According to the clinical manifestations and signs of myocardial damage. For patients with acute poisoning, routine electrocardiogram examinations should be performed, and for critically ill patients, continuous dynamic electrocardiogram monitoring should be performed. Myocardial enzyme spectrum, serum electrolyte examination and blood gas analysis. d)
X-ray chest film.
Echocardiogram, two-dimensional echocardiogram, dynamic electrocardiogram, cardiac color Doppler ultrasound, cardiac ECT and other examination results Based on the above data, comprehensive analysis, and exclusion of other similar diseases, a diagnosis can be made. Electrocardiogram is the most reliable basis for the diagnosis of toxic heart disease.
A.7 Naming and writing format of occupational acute toxic heart disease The diagnosis naming format can be clear at a glance, which is conducive to the accumulation of clinical data, guidance of treatment, and timely treatment and subsequent research. The standard principle of naming is to indicate the name of the type of heart disease after the diagnosis classification. The expression is as follows:
Acute mild toxic heart disease:
1) Acute mild toxic heart disease (myocardial damage): 2) Acute mild toxic heart disease (supraventricular tachycardia); 3) Acute mild toxic heart disease (myocardial damage combined with first-degree atrioventricular block). b)
Acute moderate toxic heart disease:
1) Acute moderate toxic heart disease (ventricular tachycardia); 2) Acute moderate toxic heart disease (II degree atrioventricular block); 3) Acute moderate toxic heart disease (myocardial ischemic damage combined with I degree atrioventricular block). Acute severe toxic heart disease:
1) Acute severe toxic heart disease (myocardial infarction with congestive heart failure); 2) Acute severe toxic heart disease (III degree atrioventricular block with cardiogenic shock). And so on.
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