窒息性毒剂-课件

第六章窒息性毒剂PulmonaryagentsChokingAgents1ppt课件Thelarge-scalechlorineattackinWWI2ppt课件March16,2007Threeseparatesuicideattacksonthisdayusedchlorine.

Bombersdetonatedthreechlorine-filledtrucksinAnbarprovince.Theattacksatleastkilledtwopoliceofficersandsickenedabout

350Iraqisandsixcoalitionforcemembers.3ppt课件Oct21,2006:Acarbombcarrying12120mmmortarshellsandtwo100-poundchlorinetanksdetonated,wounding3IraqipolicemenandacivilianinRamadi.Jan28,2007:Aadumptruckwithexplosivesandaone-tonchlorinetankintoanemergencyresponseunitcompoundinRamadi.Nooneinjuredbychlorine,but16peoplewerekilledintheblast.Feb19,2007:AsuicidebombinginRamadiinvolvingchlorinekilledtwoIraqisecurityforcesandwounded16otherpeople.Feb20,2007:AbombblewupatankercarryingchlorinenorthofBaghdad,killing9and148othersill(incl.42women,52kids).Feb21,2007:ApickuptruckcarryingchlorinecylindersexplodedinBaghdad,killingatleast5andhospitalisingover50.Mar16,2007:Threeseparatesuicideattacksusedchlorine.ThefirstatacheckpointnortheastofRamadi,wounded1USservicememberand1Iraqicivilian.ThesecondinFalluja,killing2policemenandleavingchlorineexposed100Iraqis.Fortyminuteslater,thethirdattheentrancetoahousingestatesouthofFalluja,injuring250andaccordingtosomereportskilling6.ChlorineAttacksinIraqDuring2006-20074ppt课件Mar28,2007:Suicidebombersdetonatedapairoftruckbombs,onecontainingchlorine,aimedattheFallujahGovernmentCenter.left14Americanforcesand57Iraqiforceswounded.Apr6,2007:Achlorine-ladensuicidetruckbombdetonatedatapolicecheckpointinRamadi,leaving27dead.Thirtyhospitalized.Apr25,2007:AchlorinetruckbombdetonatedatamilitarycheckpointnearBaghdad,killingoneIraqiandwoundingtwoothers.Apr30,2007:AtankerladenwithchlorineexplodedneararestaurantwestofRamadi,killingsixpeopleandwounding10.May15,2007:Achlorinebombexplodedinanopen-airmarketinthevillageofAbuSaydainDiyalaprovince,killing32peopleandinjuring50.May20,2007:AsuicidetruckbomberexplodedhisvehicleSundaynearanIraqipolicecheckpointoutsideRamadi,killingtwopoliceofficersandwounding11others.Jun3,2007:AcarbombexplodedoutsideaU.S.militarybaseinDiyala,unleashinganoxiouscloudofchlorinegasthatsickenedatleast62soldiersbutcausednoseriousinjuries.5ppt课件June15,2004Fuzhou6ppt课件7ppt课件IntroductionRepresentativesPhysicochemicalcharacteristicsToxicityMechanismoftoxicityClinicaleffectsDiagnosis&differentialdiagnosismedicalmanagementContents8ppt课件IntroductionRepresentativesPhysicochemicalcharacteristicsToxicityMechanismoftoxicityClinicaleffectsDiagnosis&differentialdiagnosismedicalmanagementContents9ppt课件窒息性毒剂亦称肺刺激剂(lungirritants)，是一类损伤呼吸道，引起急性中毒性肺水肿，导致急性缺氧和窒息的化学战剂。IntroductionConception10ppt课件光气于1812年由JohnDavy首次合成氯气在一战中交战双方都大量使用光气首次战场使用：德国1915年12月于凡尔登(Verdun)；后来双方都使用(36600吨,80%死于肺水肿)二战中除日本针对中国外，没有使用美国在朝鲜战争中使用(1951,Nampo,1379中毒,480死亡).现已无库存History/MilitaryRelevance11ppt课件IntroductionRepresentativesPhysicochemicalcharacteristicsToxicityMechanismoftoxicityClinicaleffectsDiagnosis&differentialdiagnosismedicalmanagementContents12ppt课件Representative氯甲酸三氯甲酯DP双光气(diphosgene)二氯化碳酰CG光气(phosgene)化学名称结构式美军代号毒剂名称ClCOCCl3OClCClO13ppt课件Phosgene

Chemicalindustry

foamplastic(isocyanates)herbicides,pesticidesdyesUSAproducesoverbillion

poundsperyearforindustrialuseBurningofplasticscarbontetrachloridemethylenechloride(paintstripers)degreasersOthers—“dualuseagent”

14ppt课件Canyouimagine?虽是剧毒气体，但被广泛地应用于化工领域。以光气为基本原料制成的化学品不下上千种，有“工业金矿”之称;由光气合成的聚碳酸酯是一种性能优良的无毒工程塑料，是五大工程塑料中唯一具有良好透明性的产品，汽车的车窗、洗衣机的内缸、电脑的外壳，甚至超音速飞机的机头都由这种塑料制成的;此外太阳镜、光盘、台灯、手机、香料、染料…光气就是生产它们的最基本原料;在医药和农药领域：青霉素、紫杉醇和杀虫剂等的生产.15ppt课件PFIB(Perfluoroisobutylene，全氟异丁烯)有机氟聚合物的高温毒性裂解产物聚四氟乙烯(Polytetrafluoroethylene,“Teflon”)有很多工业用途Usedinarmoredvehicles,aircraft导致肺水肿，同光气类似16ppt课件IntroductionRepresentativesPhysicochemicalcharacteristicsToxicityMechanismoftoxicityClinicaleffectsDiagnosis&differentialdiagnosismedicalmanagementContents17ppt课件PhysicalCharacteristics

1206.9-57128无色或微黄色液体双光气难溶于水，易溶于有机溶剂63403.5-1268.2烂苹果或烂干草味无色气体光气溶解度挥发度(mg/1，20℃)蒸气比重(20℃)凝固点（℃）沸点（℃）气味状态毒剂名称18ppt课件Veryeasytohydrolyze:

COCl2+2H2O→CO2+2HClChemicalCharacteristics

Stability:

CG150℃开始分解，800℃完全分解成CO和Cl2；

DP沸点开始分解，300-350℃完全分解成CG。19ppt课件(1)withsodiumhydrateCOCl2+4NaOH→2NaCl+Na2CO3+2H2O(2)withsodiumcarbonateCOCl2+Na2CO3

→2NaCl+2CO2(3)withammonia

COCl2+4NH3

→O=C(NH2)2+2NH4Cl(4)withsodiumsulfideCOCl2+Na2S→2NaCl+COS(5)withurotropine(hexamine)---protectionnotantidoteCOCl2+2(CH2)6N4→COCl2.[(CH2)6N4]2

Veryeasytoreactwithalkali:20ppt课件IntroductionRepresentativesPhysicochemicalcharacteristicsToxicityMechanismoftoxicityClinicaleffectsDiagnosis&differentialdiagnosismedicalmanagementContents21ppt课件毒性(光气)嗅觉阀值：1.5mg/m3

粘膜刺激阀值：4mg/m3LCt50:3,200mg·min/m3氯气LCt50:6,000mg·min/m322ppt课件光气对人的毒性浓度（mg/m3）效应2～4可闻到气味19刺激引起咳嗽22暴露30min严重中毒50暴露30～60min危及生命80暴露1～2min严重肺损伤100暴露30～60min,50％死亡5000暴露5min，2～3h内全部死亡*我国卫生标准规定：生产场所空气中光气最高允许浓度为0.5mg/m323ppt课件双光气对人的毒性浓度（mg/m3）效应0.41可闻到气味40暴露数秒钟引起明显刺激160暴露1～2min引起严重损伤250暴露30min引起死亡500～700暴露15min引起死亡1100暴露5min引起死亡24ppt课件IntroductionRepresentativesPhysicochemicalcharacteristicsToxicityMechanismoftoxicityClinicaleffectsDiagnosis&differentialdiagnosismedicalmanagementContents25ppt课件Peripherallyactingagents:

Phosgene,NOx,andPFIBCentralactingagents:

HCl,NH326ppt课件光气肺毛细血管壁、

肺泡壁损伤

(直接损伤学说)肺泡表面活性

物质受损

(酰化学说)细胞内环腺苷酸

(cAMP)含量下降

(cAMP下降学说)神经反射

(神经反射学说)毛细血管通透性增强

毛细血管压力增加

肺泡通透性增强中毒性肺水肿MechanismofToxicity27ppt课件28ppt课件IntroductionRepresentativesPhysicochemicalcharacteristicsToxicityMechanismoftoxicityClinicaleffectsDiagnosis&differentialdiagnosismedicalmanagementContents29ppt课件Mildexposure

--mildcough--dyspnea(呼吸困难)--chesttightness(胸闷)Moderateexpoure

--abovesymptomsplus--ocularirritation(眼部刺激)--smoketobaccoproducesbadtasteClinicaleffects30ppt课件Severeexposure

--severecough,dyspnea(呼吸困难)--onsetofpulmonaryedemawithin4hours--mayproducelaryngospasm(喉痉挛)Extremesevereexposure

--deathalmostinstantaneous31ppt课件恢复期中毒轻者经治疗，肺水肿可于发病后2~4天开始吸收，7~8天后罗音消失，2~3周内恢复健康。但仍可有头晕、乏力、食欲不振等后遗症状。刺激期症状（眼和上呼吸道刺激症状）：流泪、咳嗽、胸闷、气促，继之恶心呕吐、头晕、乏力、烦躁不安。体征：眼及咽喉充血，呼吸音粗糙。持续时间：离开毒区1~2h后可消失。潜伏期自觉症状好转，但病理过程仍在发展，肺水肿正在逐渐形成，潜伏期越长，中毒越轻；反之则中毒越重。ClinicalEffects刺激期轻度中度重度潜伏期(h)8~12h4~10h1~6h潜伏期肺水肿期恢复期32ppt课件PulmonaryEdema呼吸道症状：呼吸浅快，咳嗽，烦躁不安，头晕乏力，恶心呕吐等;体征：呼吸音减弱，肺底部细湿罗音，或捻发音，X线检查已有肺水肿征象；继之，典型肺水肿症状出现，气喘，呼吸困难，咳嗽频繁，咳出大量粉红色泡沫样痰

(一昼夜可达1～2升)。叩诊肺部呈浊音、鼓音，肺下界降低，心浊音界消失，听诊为满肺干、湿罗音。33ppt课件根据循环系统机能可分为两个阶段：①青紫型缺氧期(呼吸性血缺O2)：血O2↓，皮肤紫绀，但循环机能尚能代偿，血压、脉搏基本正常，神清，肺水肿使CO2排出障碍，血CO32-↑，导致呼吸性酸中毒；也可因过度换气使CO2排出过多而至呼吸性碱中毒。②苍白型缺氧(或休克)期(呼吸+循环性血缺O2)：出现循环衰竭，血压、心率均↓，皮肤苍白、冷汗、昏迷，血O2及CO2↓，酮体、乳酸等氧化不全产物蓄积，pH↓导致代谢性酸中毒。PulmonaryEdema34ppt课件Pulmonaryedema(肺水肿)VentilationdisturbanceairexchangedisorderEarly:(青紫型缺氧期)Late:(苍白型缺氧期)缺氧心肺缺氧组织缺氧酸中毒，水电解质紊乱中枢缺氧始兴奋后抑制shock血液浓缩血栓栓塞心肺衰竭右室负荷左室负荷35ppt课件IntroductionRepresentativesPhysicochemicalcharacteristicsToxicityMechanismoftoxicityClinicaleffectsDiagnosis&differentialdiagnosismedicalmanagementContents36ppt课件Diagnosis:中毒史和毒剂侦检:

sweet,newly-mownhayodor临床表现:

高浓度时粘膜刺激症状,呼吸困难(dyspnea),迟发的肺水肿(pulmonaryedemaofdelayedonset)

chestX-ray

实验室检查37ppt课件X线检查是早期发现肺水肿和监测肺水肿发展的最好方法，是光气中毒最有意义的临床检验措施。Diagnosis38ppt课件39ppt课件连续X线检查：对中度以上中毒者应争取在中毒后8小时每2小时拍摄X线胸片一张。如果8小时内的胸片均正常，其病情可能较轻。40ppt课件预后不佳的指征:中毒后很快出现进行性的缺氧和低血压；中毒后4小时内出现肺水肿（死亡的高危因素）41ppt课件40,male2hpostexposuremilddyspneanormalphysicalexamCXR:normal7hpostexposuremod.dyspneaatrestfewcracklesCXR:mildinterstitialedemasurvived42,female2hpostexposurerapidlyinc.dyspneaCXR:overtedemadeath6hpostexp.42ppt课件刺激剂：强烈；全身中毒性毒剂：迅速，无潜伏期；糜烂性毒剂：除此之外还有皮肤、全身损伤。DifferentialDiagnosis43ppt课件IntroductionRepresentativesPhysicochemicalcharacteristicsToxicityMechanismoftoxicityClinicaleffectsDiagnosis&differentialdiagnosismedicalmanagementContents44ppt课件

Terminateexposureasavitalfirstmeasure:脱离毒区

佩戴合适的面具如果衣服及皮肤上有液体毒剂，即刻洗消45ppt课件综合治疗原则：

二防、二纠、一维持、一控制二防：防治肺水肿，防治休克。二纠：纠正缺氧，纠正酸中毒。一维持：维持电解质平衡。一控制：控制感染。46ppt课件肺水肿发生前：半卧位安静休息、保温、间歇吸氧有咳嗽等刺激症状时对症处理：雾化吸入、可待因口服尽早使用糖皮质激素颈封静注高渗糖液“严密观察24~48h，防止肺水肿发生”