摘要:
Objective To investigate the clinical characteristics of patients with hydrofluoric acid (HF) burns.Methods Clinical data of 316 patients with HF burns admitted to Zhejiang Quhua Hospital from January 2004 to December 2016 were retrospectively analyzed.Patients were divided into non and mild poisoning group (NMP,n =157),moderate poisoning group (MP,n =120),and severe and fatal poisoning group (SFP,n =39) based on the severity of poisoning.Occurrences of hypocalcemia,hypomagnesemia,hypokalemia,and hyperkalemia of patients within 24 hours after admission were recorded.Values of emergency urinary fluoride of patients on admission were recorded.Values of urinary fluoride of patients admitted to hospital in 4 hours post injury in groups MP and SFP at post injury hour 4,12,and 24 and on post injury day 2,3,4,5,6,and 7 were also recorded.Electrocardiographic abnormalities of patients within 24 hours after admission were recorded.Data were processed with chi-square test,Kruskal-Wallis H test,and Mann-Whitney U test.Results (1) Hypocalcemia,hypomagnesemia,and hypokalemia occurred in some patients in each of the three groups,but no patient had hyperkalemia.Taking serum calcium namely total serum calcium as reference,the incidence rate of hypocalcemia of patients in group NMP was close to that in group MP (x2 =0.05,P > 0.05).The incidence rate of hypocalcemia of patients in group SFP was significantly higher than that in group NMP or group MP (x2 =10.53,7.92,P < 0.01).The incidence rates of hypokalemia in the three groups were close (x2 =0.63,P > 0.05).Taking serum ionized calcium as reference,the incidence ratio of hypocalcemia of patients in group NMP was close to that in group MP (x2 =0.01,P > 0.05),while there were statistically significant differences in incidence ratio of hypocalcemia of patients between group SFP and each of group NMP and group MP (x2 =4.66,4.47,P < 0.05).Taking serum calcium as reference,the incidence rate of hypocalcemia of patients was 7.3% (23/316).Taking serum ionized calcium as reference,the incidence rate of hypocalcemia of patients was 60.0% (42/70),which was significantly higher than that of taking serum calcium as reference (x2 =113.74,P < 0.01).The incidence rates of hypomagnesemia of patients in groups MP and NMP were close (x2 =0.02,P > 0.05).The incidence rate of hypomagnesemia of patients in group SFP was significantly higher than that in group NMP or group MP (x2 =14.69,9.94,P < 0.01).(2) The urinary fluoride levels were tested in 288 patients,with the value of emergency urinary fluoride of patients on admission 0.2-590.0 mg/L.The values of urinary fluoride of 202 patients were above the normal value.The values of emergency urinary fluoride of patients in groups NMP,MP,and SFP were 2.15 (1.11,4.30),5.89 (1.72,14.25),and 36.0 (13.2,103.2) mg/L,respectively.The values of emergency urinary fluoride of patients in groups MP and SFP were significantly higher than the value in group NMP (x2 =23.28,66.03,P < 0.01).The value of emergency urinary fluoride of patients in group SFP was significantly higher than that in group MP (x2 =39.23,P < 0.01).The value of urinary fluoride of 33 patients admitted to hospital within 4 hours post injury in groups MP and SFP reached the top at 4 hours post injury and then gradually declined,which returned to normal on about 5 days post injury.The values of urinary fluoride of patients in group SFP at 4,12,and 24 hours post injury and on 2,3,4,5,6,and 7 days post injury were significantly higher than those in groupMP (Z =-4.28,-4.15,-3.81,-4.21,-2.48,-2.06,-2.31,-2.68,-3.03,P < 0.05 or P <0.01).(3) Twenty-seven patients had electrocardiographic abnormality.There were 12 patients with T wave changes (the most common),8 patients with ST-T changes,6 patients with ventricular arrhythmias,6 patients with conduction block,and 1 patient with broadened QRS waveform.There was no patient with prolonged Q-T interval.The ratios of patients with the above electrocardiographic abnormalities in group SFP were higher than those in group NMP and group MP.Conclusions Clinical manifestations of patients with HF burn are hypocalcemia,hypomagnesemia,hypokalemia,and electrocardiographic abnormality.In addition to routine serum electrolyte and electrocardiogram monitoring,the levels of serum ionized calcium and urinary fluoride can be helpful to evaluate the severity of illness of the patients.%目的 探讨氢氟酸烧伤患者的临床特征. 方法 回顾性分析2004年1月-2016年12月浙江衢化医院收治的316例氢氟酸烧伤患者的病历资料.按中毒严重程度将患者分为无和轻度中毒组157例、中度中毒组120例、重度和致命性中毒组39例.统计患者入院24 h内低钙血症、低镁血症、低钾血症、高钾血症发生情况.统计患者入院急诊尿氟值,中度中毒组、重度和致命性中毒组伤后4h内入院患者伤后4、12、24 h及伤后2、3、4、5、6、7d尿氟值.统计患者入院24 h内心电图异常情况.对数据行x2检验、Kruskal-WallisH检验和Mann-WhitneyU检验. 结果 (1)低钙血症、低镁血症和低钾血症在3组患者中均有发生,但无一例患者发生高钾血症.以血钙即血总钙为参考,中度中毒组患者低钙血症发生率与无和轻度中毒组相近(x2 =0.05,P>0.05),重度和致命性中毒组患者低钙血症发生率明显高于无和轻度中毒组、中度中毒组(x2=10.53、7.92,P<0.01).3组患者低钾血症发生率相近(x2 =0.63,P>0.05).以血游离钙为参考,中度中毒组患者低钙血症发生比例与无和轻度中毒组相近(x2 =0.01,P>0.05);重度和致命性中毒组患者低钙血症发生比例与无和轻度中毒组、中度中毒组比较,差异有统计学意义(x2 =4.66、4.47,P<0.05).以血钙为参考,患者低钙血症发生率为7.3%(23/316);以血游离钙为参考,患者低钙血症发生率为60.0%(42/70).以血游离钙诊断患者低钙血症的发生率明显高于以血钙诊断的发生率(x2 =113.74,P<0.01).中度中毒组患者低镁血症发生率与无和轻度中毒组相近(x2 =0.02,P>0.05),重度和致命性中毒组患者低镁血症发生率明显高于无和轻度中毒组、中度中毒组(x2=14.69、9.94,P<0.01).(2)288例患者检测了尿氟,入院急诊尿氟值为0.2~ 590.0 mg/L,其中202例患者尿氟值高于正常值.无和轻度中毒组、中度中毒组、重度和致命性中毒组患者急诊尿氟值分别为2.15(1.11,4.30)、5.89(1.72,14.25)、36.0(13.2,103.2) mg/L,中度中毒组、重度和致命性中毒组患者急诊尿氟值明显高于无和轻度中毒组(x2=23.28、66.03,P<0.01),重度和致命性中毒组患者急诊尿氟值明显高于中度中毒组(x2 =39.23,P<0.01).中度中毒组、重度和致命性中毒组伤后4h内入院33例患者尿氟值在伤后4h达峰值,随后逐渐下降,伤后5d左右恢复至正常值范围,其中重度和致命性中毒组患者伤后4、12、24 h及伤后2、3、4、5、6、7d尿氟值均明显高于中度中毒组(Z=-4.28、-4.15、-3.81、-4.21、-2.48、-2.06、-2.31、-2.68、-3.03,P<0.05或P<0.01).(3)27例患者出现异常心电图改变,其中最多见的是T波改变12例,其次是ST-T段改变8例、传导阻滞6例、室性心律失常6例、QRS波形增宽1例,未见Q-T间期延长病例.重度和致命性中毒组出现上述异常心电图情况的患者比例均高于无和轻度中毒组、中度中毒组. 结论 氢氟酸烧伤患者临床表现包括低钙血症、低镁血症、低钾血症和心电图异常,除常规血电解质和心电图监测外,血游离钙和尿氟检测也有助于该类患者病情严重程度判断.