GBZ 31-2002 Diagnostic criteria for occupational acute hydrogen sulfide poisoning
Some standard content:
1CS13.100
National Occupational Health Standard of the People's Republic of China GBZ31-2002
Diagnostic Criteria of Occupational Acute Hydrogen Sulfide PoisoningPublished on April 8, 2002
Implemented on June 1, 2002
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 the original standard GB8789-1988 is inconsistent with this standard, this standard shall prevail. Acute poisoning can be caused in occupational activities involving exposure to hydrogen sulfide. In order to protect the health of the contactors and effectively prevent and treat acute hydrogen sulfide poisoning, GB8789-1988 was issued. This standard is a revised version. The revised standard highlights the characteristics of acute hydrogen sulfide poisoning. The diagnostic classification has been modified according to the degree of damage to the central nervous system and respiratory system, the main target organs of hydrogen sulfide poisoning, and the damage to other common organs such as the heart and liver caused by hydrogen sulfide has been included in Appendix A of the standard. The standard also affirms the therapeutic effect of hyperbaric oxygen on acute hydrogen sulfide poisoning, especially for patients with moderate to severe consciousness disorders. The text and structure have been modified according to the requirements of GBT16584.2-1997 "Rules for the Drafting and Expression of Occupational Disease Diagnosis Standards Part 1: Basic Regulations for the Preparation of Occupational Disease Diagnosis Standards". In terms of the diagnostic system, it is connected with GBZ73, GBZ74, GBZ76, and GBZ78 to make the diagnosis clearer, more reasonable, and easier to use. 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 West China Occupational Disease Hospital of Sichuan University and the Nanjing Refinery Hospital (Occupational Disease Prevention and Control Institute) of Jinling Petrochemical Company. The participating units in the drafting are Shanghai Yangpu District Central Hospital, Urumqi Petrochemical General Plant Hospital, Shantou Occupational Disease Prevention and Control Institute, Huludao Jinxi Refining and Chemical General Plant Hospital, Anqing Petrochemical General Plant Health Department Occupational Disease Prevention and Control Institute, Maoming Petrochemical Company Hospital.
This standard is interpreted by the Ministry of Health of the People's Republic of China. Diagnostic Standard for Occupational Acute Hydrogen Sulfide Poisoning GBZ31-2002
Occupational acute hydrogen sulfide poisoning is a systemic disease with multiple organ damage mainly to the central nervous system and respiratory system caused by inhaling a large amount of hydrogen sulfide gas in a short period of time during occupational activities. 1 Scope
This standard specifies the diagnostic standards and treatment principles for occupational acute hydrogen sulfide poisoning. This standard applies to the diagnosis and treatment of occupational acute hydrogen sulfide poisoning, and the diagnosis and treatment of non-occupational acute hydrogen sulfide poisoning can also be implemented as a reference.
2 Cited Standards
The clauses in the following documents become the clauses of this standard through reference in this standard. For any dated referenced document, all subsequent amendments (excluding errata) or revisions 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 any undated referenced document, the latest version is applicable to this standard.
GB/T16180
3 Diagnostic principles
Diagnostic criteria for occupational toxic liver diseases
Diagnostic criteria for occupational chemical eye burns
Diagnostic criteria for occupational acute chemical poisoning respiratory diseasesDiagnostic criteria for occupational acute chemical poisoning heart diseasesDiagnostic criteria for occupational acute chemical poisoning nervous system diseasesDiagnostic criteria for occupational sudden chemical death
Evaluation of the degree of disability caused by work-related injuries and occupational diseases of employeesAccording to the occupational exposure history of inhaling a large amount of hydrogen sulfide in a short period of time, the clinical manifestations mainly of central nervous system and respiratory system damage appear, refer to the on-site labor hygiene survey, make a comprehensive analysis, and exclude other diseases with similar manifestations before the diagnosis of contact reaction
After exposure to hydrogen sulfide, the patient will experience eye and upper respiratory tract irritation such as eye stinging, photophobia, tearing, conjunctival congestion, burning sensation in the throat, cough, or neurological symptoms such as headache, dizziness, fatigue, nausea, which disappear within a short time after breaking contact. 5 Diagnosis and classification standards
5.1 Mild poisoning
With one of the following conditions:
Obvious symptoms such as headache, dizziness, fatigue and mild to moderate disturbance of consciousness; a)
b) Acute tracheobronchitis or peribronchitis, 5.2 Moderate poisoning
With one of the following conditions:
Disorder of consciousness manifested as shallow to moderate comawwW.bzxz.Net
Acute bronchopneumonia
5.3 Severe poisoning
With one of the following conditions:
Disorder of consciousness reaching deep coma or vegetative state: Pulmonary edema:
c) Sudden death;
Multiple organ failure.
6 Treatment principles
6.1 Treatment principles
6.1.1 Leave the scene quickly, breathe oxygen, keep quiet, rest in bed, observe closely, and pay attention to changes in the condition. 6.1.2 Rescue and treatment principles are mainly symptomatic and supportive therapy, actively prevent and treat cerebral edema and pulmonary edema, and use adrenal glucocorticoids in early, sufficient, and short-term. For moderate and severe poisoning, hyperbaric oxygen therapy should be arranged as soon as possible if conditions permit. 6.1.3 For patients with respiratory and cardiac arrest, immediately perform cardiopulmonary resuscitation. After breathing and heartbeat are restored, hyperbaric oxygen therapy should be performed as soon as conditions permit, and symptomatic and supportive treatment should be actively performed. 6.2 Other treatments
Patients with acute mild and moderate poisoning can resume their original work after recovery. Patients with severe poisoning should be transferred from their original jobs after treatment and those who need to undergo labor capacity assessment should be treated in accordance with GB/T16180. 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 of acute poisoning caused by exposure to hydrogen sulfide gas, and attention should be paid to the differentiation from acute poisoning caused by carbon monoxide, cyanide and cyanide compounds, carbon dioxide, inert gas, acute central nervous system infectious diseases and cerebrovascular accidents.
A.2 If the on-site concentration that causes acute hydrogen sulfide poisoning cannot be determined, as long as the production process in the patient's environment can produce hydrogen sulfide, and hydrogen sulfide gas is subsequently measured, or the patient smells rotten eggs at the time and then develops neurological symptoms, eye and respiratory mucosal irritation symptoms, the possibility of acute hydrogen sulfide poisoning should be considered. A.3 The classification of acute hydrogen sulfide poisoning is based mainly on the clinical manifestations of the main target organs, the central nervous system and the respiratory system. The classification of consciousness disorders refers to GBZ76. Because hydrogen sulfide can cause damage to multiple organs, in moderate and severe poisoning, in addition to the manifestations of damage to the nervous system and respiratory system, it is often accompanied by damage to the heart or liver. In particular, there have been many reports of damage to the heart in recent years, mainly manifested by ST depression and flat or inverted T waves on the electrocardiogram, bundle branch block, ventricular premature beats, I-II atrioventricular block, sick sinus syndrome or sinus tachycardia, a few "myocardial infarction" patterns, and abnormal myocardial enzyme spectrum. When damage to the heart or liver occurs, its diagnosis, classification and treatment should refer to GBZ74 and GBZ59. A.4 The sudden death rate of acute hydrogen sulfide poisoning is high, and on-site rescue should refer to GBZ78. Rescuers should pay attention to their own protection, which is very important to avoid multiple acute hydrogen sulfide poisoning accidents or sudden death; those who have stopped breathing due to poisoning should use artificial respirators as much as possible, and rescuers should avoid mouth-to-mouth artificial respiration to prevent poisoning of rescuers. A.5 The principle of treatment is mainly symptomatic and supportive treatment, which can be referred to GBZ76 and GBZ732. However, in places where hyperbaric oxygen conditions are available, it is emphasized that hyperbaric oxygen therapy should be performed as soon as possible. Hyperbaric oxygen therapy plays an important role in preventing and treating cerebral edema, pulmonary edema, and promoting the awakening of comatose patients. In order to prevent the "rebound" of the disease, hyperbaric oxygen therapy needs to be combined with supportive and symptomatic treatment, among which early, sufficient, and short-term application of adrenal glucocorticoids is crucial. A.6 Animal experiments have confirmed that 4-dimethylaminophenol (4-DMAP) has a detoxifying effect on acute hydrogen sulfide poisoning, but there are few clinical case reports, and there is no unified regulation on whether to use 4-DMAP. A.7 Acute conjunctivitis and keratitis after exposure to hydrogen sulfide should be treated in accordance with GBZ54.
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