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GBZ77-2019: Diagnosis of occupational acute toxic multiple organ dysfunction syndrome caused by chemicals
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Diagnosis of occupational acute toxic multiple organ dysfunction syndrome caused by chemicals
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GBZ 77-2019
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| GBZ 77-2002 | English | 359 |
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Diagnostic Criteria of Occupational Acute Chemicals Toxic Multiple Organ Dysfunction Syndrome
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GBZ 77-2002
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PDF similar to GBZ77-2019
Standard similar to GBZ77-2019 GBZ 20 GBZ 57 GBZ 49 GBZ 82 GBZ 68 Basic data | Standard ID | GBZ 77-2019 (GBZ77-2019) | | Description (Translated English) | Diagnosis of occupational acute toxic multiple organ dysfunction syndrome caused by chemicals | | Sector / Industry | National Standard | | Classification of Chinese Standard | C60 | | Classification of International Standard | 13.100 | | Word Count Estimation | 12,157 | | Date of Issue | 2019 | | Date of Implementation | 2019-07-01 | | Issuing agency(ies) | State Administration for Market Regulation, China National Standardization Administration | GBZ77-2019: Diagnosis of occupational acute toxic multiple organ dysfunction syndrome caused by chemicals
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Diagnosis of occupational acute toxic multiple organ dysfunction syndrome caused by chemicals
ICS 13.100
C 60
National Occupational Health Standards
Replace GBZ 77-2002
Occupational acute chemical toxicity multi-organ dysfunction
Diagnosis of syndrome
Diagnosis of occupational acute toxic multiple organ dysfunction
Syndrome caused by chemicals
Published on.2019 - 01 - 30
2019 - 07 -01 Implementation
National Health and Wellness Committee of the People's Republic of China
Foreword
Chapter 4 of this standard is mandatory and others are recommended.
This standard is formulated in accordance with the Law of the People's Republic
This standard was drafted in accordance with the rules given in GB/T 1.1-2009.
This standard replaces GBZ 77-2002 "Diagnostic Criteria for Occupational Acute Chemical Toxic Multiple Organ Dysfunction Syndrome".
Compared with GBZ 77-2002, the main changes are as follows.
-- Revised the normative reference documents;
-- Deleted the diagnostic principle and adjusted it to the diagnosis basis;
- Modify "diagnostic grading" to "judgment of organ dysfunction";
-- Modified the diagnostic indicators of cardiac dysfunction and removed sudden cardiac death;
-- Revised diagnostic indicators for respiratory dysfunction;
-- Modified diagnostic indicators for renal dysfunction;
-- Revised diagnostic indicators for liver dysfunction;
-- Revised diagnostic indicators for blood dysfunction;
-- Adjusted the content of the processing principles;
-- Revised instructions for the proper use of this standard.
-- Increased or decreased the chemical species of common toxic multi-organ dysfunction syndrome in Appendix B.
This standard was drafted. Shanghai Municipal Institute of Chemical Occupational Diseases, Second Hospital of Shanxi Medical University, Shanghai Branch of Tongji University
Hospital (Shanghai Occupational Disease Prevention and Treatment Institute), Huashan Hospital affiliated to Fudan University, Shandong Institute of Occupational Health and Occupational Disease Prevention and Treatment, Fudan University
Jinshan Hospital affiliated to the University and Qingdao Occupational Disease Prevention and Treatment Institute.
The main drafters of this standard. Weng Xuemei, Zhang Xuetao, Mu Jinjun, Zhang Guanyu, Wan Weiguo, Yan Yongjian, Wang Jie, Hou Qiang, Huang Jianyi,
Huang Hutao, Zhang Hua, Zhang Hongyu, Li Sihui.
Diagnosis of occupational acute chemical toxicity multi-organ dysfunction syndrome
1 Scope
This standard specifies the principles for the diagnosis and management of occupational acute chemical toxic multi-organ dysfunction syndrome.
This standard applies to the diagnosis and treatment of multiple organ dysfunction syndrome caused by occupational acute chemical poisoning.
2 Normative references
The following documents are indispensable for the application of this document. For dated references, only the dated version applies to this article.
Pieces. For undated references, the latest edition (including all amendments) applies to this document.
GB/T 16180 Labor ability appraisal employee injury and occupational disease disability level
GBZ 59 Diagnostic criteria for occupational toxic liver disease
GBZ 71 General rules for the diagnosis of occupational acute chemical poisoning
GBZ 73 Occupational acute chemical toxicity diagnostic criteria for respiratory diseases
GBZ 74 diagnostic criteria for occupational acute chemical toxicity heart disease
GBZ 75 Occupational Acute Chemical Toxic Blood System Disease Diagnostic Criteria
GBZ 76 diagnostic criteria for occupational acute chemical toxicity neurological diseases
Diagnosis of GBZ 79 occupational acute toxic kidney disease
3 diagnosis basis
3.1 Before the onset, there is a clear history of occupational exposure to a large amount of chemicals in the short term.
3.2 The clinical manifestations of toxic damage in the target organ are present.
3.3 Two or more organ dysfunctions occur simultaneously or sequentially in the course of the disease.
3.4 Organ dysfunction is in accordance with the judgment of this standard.
3.5 Exclude multiple organ dysfunction syndrome caused by non-occupational factors.
3.6 Combine workplace occupational hygiene surveys and the incidence of the same type of work.
3.7 Refer to patient biomarkers or special effect marker tests.
4 Determination of organ dysfunction
4.1 General
Multiple organ dysfunction can occur during the course of occupational acute chemical poisoning. According to the degree of organ dysfunction, it is divided into functional
Total and functional failure.
4.2 cardiovascular dysfunction
4.2.1 Cardiovascular insufficiency
Have one of the following.
a) mean arterial pressure (MAP) ≤ 8 kPa (60 mmHg), ≥ 6.65 kPa (50 mmHg), ≥ 4 h;
b) new arrhythmia. multi-source ventricular premature contraction, paired ventricular premature contraction, QT interval prolongation, R on T ventricular phase
Pre-contraction, Mohs II degree atrioventricular block, paroxysmal ventricular tachycardia, atrial flutter or tremor;
c) Creatine kinase isoenzyme (CK-MB) reaches or exceeds the normal reference value by 5 times, and the enzyme activities such as LDH and AST increase accordingly (see GBZ ).
74);
d) significant ischemic changes in the ECG (see GBZ 74);
e) B-type natriuretic peptide (BNP) > 500 ng/L.
4.2.2 Cardiovascular Failure
Have one of the following.
a) MAP < 6.65 kPa (50 mmHg);
b) have clear symptoms and signs of acute heart failure;
c) one of ventricular fibrillation, ventricular arrest, III degree atrioventricular block, and torsades de point ventricular tachycardia (see GBZ 74);
d) The electrocardiogram is a myocardial infarction-like change with an increase in troponin of at least 99 reference value;
e) BNP > 1000 ng/L.
4.3 respiratory dysfunction
4.3.1 Respiratory insufficiency
Have the following two items.
a) When inhaling air, Pa02< 9.31kPa (70 mmHg);
b) respiratory frequency > 28 times/min;
c) Pa02/Fi02 ≤ 39.9 kPa (300 mmHg);
d) Chest X-rays show shadows in both lungs, but the range is < 3/4.
4.3.2 Respiratory failure
Have one of the following.
a) Pa02/Fi02 ≤ 26.6 kPa (200 mmHg);
b) The range of lesions in both lung fields is ≥3/4;
c) When inhaling air, Pa02< 8 kPa (60 mmHg);
d) Acute respiratory distress syndrome (ARDS) (see GBZ 73).
4.4 renal dysfunction
4.4.1 renal insufficiency
Have one of the following.
a) Urinary specific gravity < 1.012 or urine osmotic pressure < 350 mOsm/kg·H20, and urine sodium (UNA) >40 mmol/L or filtered sodium excretion
Rate (FENa) > 2, duration over 48 h (see GBZ 79);
b) serum creatinine (Scr) increased more than 1 time within 48 h; or Scr exceeded 177 μmol/L (20 mg/L), within 48 h
Up to 26.4 μmol/L (3 mg/L) (see GBZ 79);
c) urine output lasts < 0.5 mL/(kg·h) for 12 h (see GBZ 79);
d) Two-dimensional ultrasound dynamic monitoring revealed progressive renal enlargement and enhanced renal cortical echo; color Doppler ultrasound showed various arteries of the kidney
The resistance index increased (see GBZ 79).
4.4.2 Renal failure
Have one of the following.
a) Scr increased more than 2 times within 48 h; or Scr has reached 353.3 μmol/L (40 mg/L), and the increase in 48 h exceeded
44.2 μmol/L (5 mg/L) (see GBZ 79);
b) urine volume lasts < 0.3 mL/(kg·h) for 24 h, or no urine for more than 12 h (see GBZ 79);
c) Serum potassium (SK) persists >6.0 mmol/L.
4.5 liver dysfunction
4.5.1 Liver dysfunction
Have one of the following.
a) serum total bilirubin (STB) ≥ 51.3 μmol/L (see GBZ 59);
b) Serum alanine aminotransferase (ALT) or bile acid is more than twice the normal value.
4.5.2 Liver failure
Have one of the following.
a) hepatic encephalopathy (see GBZ 59);
b) serum total bilirubin (STB) ≥ 102.0 umol/L; or daily increase ≥ 17.1 umol/L;
c) Prothrombin activity (PTA) < 40% or international standard ratio (INR) ≥ 1.5.
4.6 brain dysfunction
4.6.1 Brain dysfunction
Have one of the following.
a) moderate disturbance of consciousness (see GBZ 76);
b) seizures of epileptic seizures (see GBZ 76);
c) obvious mental symptoms such as disorientation, hallucinations, delusions, psychomotor excitement or aggressive behavior (see GBZ 76).
4.6.2 Brain Failure
Have one of the following.
a) severe disturbance of consciousness (see GBZ 76);
b) status epilepticus (see GBZ 76);
c) Brain death.
4.7 gastrointestinal dysfunction
4.7.1 Gastrointestinal dysfunction
Have one of the following.
a) flatulence of the abdomen accompanied by a decrease or disappearance of bowel sounds;
b) Fecal occult blood test is positive.
4.7.2 Gastrointestinal failure
Have one of the following.
a) stress ulcer bleeding (vomiting coffee or black stool);
b) necrotizing or corrosive enteritis;
c) Paralytic ileus.
4.8 blood dysfunction
4.8.1 Blood dysfunction
Have one of the following.
a) Platelet count < 50x109/L with bleeding tendency. Or WBC< 3.5x109/L;
b) serum prothrombin time (PT) or thrombin time (TT) is longer than the normal reference value by > 3s, fibrinogen 2 g/L ~ 4 g/L;
c) mild hemolytic anemia (see GBZ 75);
d) methemoglobin >30 (see GBZ 75).
4.8.2 Blood failure
Have one of the following.
a) disseminated intravascular coagulation (DIC);
b) blood WBC < 2.0x109/L or >30x109/L;
c) severe hemolytic anemia (see GBZ 75);
d) Platelets ≤ 20x109/L, with extensive bleeding.
5 Processing principles
5.1 Principles of treatment
5.1.1 Etiology treatment. According to the treatment principle in GBZ 71 and various chemical poisoning diagnostic criteria, acute poisoning is treated.
5.1.2 Pay attention to the treatment of the incubation period, timely monitor the patients with high risk factors and critically ill patients, and identify the occurrence of multiple organ dysfunction early.
And control its progress.
5.1.3 For patients with multiple organ dysfunction or failure, according to the GBZ 71 and the corresponding system standards and treatment principles of various disciplines.
5.1.4 Control secondary infections.
5.2 Other treatment
If labor capacity is required, it shall be handled in accordance with GB/T 16180.
6 Correct use of the instructions of this standard
See Appendix A.
7 Common chemicals causing acute toxic multi-organ dysfunction and their vulnerable organs
See Appendix B.
Appendix A
(informative appendix)
Instructions for the correct use of this standard
A.1 Any serious poisoning caused by various chemicals that can cause damage to the target organ or cause a major blow to the body may lead to multiple devices.
The occurrence of official dysfunction.
A.2 Occupational acute chemical toxicity multi-organ dysfunction, can be divided into primary (single-phase rapid-onset) and secondary (bipolar delayed).
Primary multiple organ dysfunction is the result of direct action of chemicals, so it appears earlier, systemic inflammatory response (SIRS) may not be significant;
Multiple organ dysfunction is caused by chemicals that cause SIRS first, and then cause distant organ dysfunction on the basis of SIRS.
After birth, there is a period of smooth remission.
A.3 Multiple organ dysfunction is a clinical syndrome that can be caused by various causes. Diagnosis of occupational acute chemical toxicity in multiple organ dysfunction
The obstructive syndrome should rule out multiple organ dysfunction caused by serious infection, extensive burns, trauma, acute cerebrovascular disease and other causes.
A.4 This standard classifies the severity of various organ dysfunction into two levels of dysfunction and functional failure, the standard of insufficiency and the functions of each system.
The indicators of moderate poisoning in the diagnosis of industrial acute chemical poisoning are similar, and the indicators of functional failure are similar to those of severe poisoning.
A.5 Determination of cardiovascular dysfunction. cardiovascular dysfunction is not in occupational acute chemical toxicity, multiple organ dysfunction
Rare, common myocardial damage, arrhythmia, heart failure or cardiogenic shock. See GBZ 74 for details. Arrhythmia with electrocardiogram or
Dynamic electrocardiogram as the main means of examination; myocardial damage, ischemia and myocardial infarction, heart failure, etc. should be combined with clinical symptoms, signs, ECG
Figure and comprehensive evaluation of myocardial enzymology, cardiac ultrasound, and troponin. Mean arterial pressure (MAP) can be (systolic and diastolic pressure × 2) ÷ 3
Calculation. BNP is an objective biological indicator for determining heart failure and its severity. It has been the heart of the European Heart Association (ESC), the United States.
The Association (ACC) and the American Academy of Clinical Biochemistry (NACB) have included the “gold standard” for the diagnosis of heart failure, so they are included as diagnostic indicators.
A.6 Respiratory function needs to be evaluated from ventilation, ventilation, perfusion, dispersion, etc., so choose respiratory rate, Pa02, Pa02/Fi02 and chest X
Line performance is the main observation indicator. See GBZ 73 for details.
A.7 The commonly used renal function indicators are. serum creatinine, osmolality (Uosm), urinary sodium, filtered sodium excretion rate, kidney imaging
Learning and pathology examinations, etc. In recent years, the international nephrology community officially launched an observation period of 48h, comparing the changes of serum creatinine and urine volume.
The method of judging renal damage is more helpful for early detection of damage to renal function. See GBZ 79 for details.
A.8 Acute liver dysfunction is common in occupational acute chemical toxicity multi-organ dysfunction due to exposure to larger amounts of chemistry in the short term
Obstruction or decompensation of liver synthesis, detoxification, excretion, and biotransformation, with coagulopathy, jaundice, liver
Sexual encephalopathy and the like are the main manifestations of clinical syndrome. Laboratory tests mainly choose serum alanine aminotransferase (ALT), total bilirubin, and clotting
Blood zymogen activity, etc. as a diagnostic indicator, please refer to GBZ 59 for details.
A.9 Brain injury is mainly determined by the degree of disturbance of consciousness, the type of mental disorder, the manifestation of increased intracranial pressure and the situation of convulsions.
See GBZ 76 for classification and classification criteria for disturbance of consciousness. For patients with transient coma, the classification should be combined with its clinical manifestations
Whether it is brain failure.
A.10 Gastrointestinal dysfunction is mainly based on clinical manifestations, vomit, fecal occult blood test, fiber endoscopy, etc. to observe digestive tract adhesion
Membrane ulcer bleeding. Intestinal obstruction and the like can be determined by physical examination, ultrasonic, X-ray and laboratory test indicators.
A.11 Occupational acute chemical toxicity The blood dysfunction of multiple organ dysfunction is mainly characterized by coagulopathy, toxic hemolysis
Anemia, toxic methemoglobinemia, etc., coagulation disorders and fibrinolysis indicators mainly choose platelets, prothrombin time, thrombin time
And fibrinogen, etc., for the determination of other damage to the blood system, white blood cells, methemoglobin, and the like are selected. See GBZ 75 for other details.
A.12 The treatment of acute chemical toxic multi-organ dysfunction should first be actively treated according to the principles of detoxification and treatment of different chemical poisoning
The primary disease, and the use of comprehensive treatment methods such as symptomatic and organ support, focus on prevention.
A.13 Examples of writing criteria for the diagnosis of occupational acute chemical toxicity multi-organ dysfunction. occupational acute chemicals (XX)
Multiple organ dysfunction caused by poisoning [(gastrointestinal failure), respiratory function (incomplete), renal function (incomplete)].
AA
Appendix B
(informative appendix)
Common chemicals causing acute toxic multi-organ dysfunction and their vulnerable organs
Common chemicals causing acute toxic multi-organ dysfunction and their vulnerable organs are shown in Table B.1.
Table B.1 Common chemicals causing acute toxic multi-organ dysfunction and their vulnerable organs
Chemical cardiovascular lung kidney liver brain blood gastrointestinal tract
Lead acetate - - - ( )
Mercuric sulfate - ( ) ( ) - -
Mercury chloride ( ) ( ) ( ) ( ) ( )
Organic Mercury ( ) ( ) -
Dichromate ( ) ( ) -
Nickel carbonyl - - - - -
Nickel carbonate ( ) ( ) - -
Copper sulfate ( ) - ( ) ( )
Arsenic - -
Arsenic trioxide -
Arsine- ( ) ( )
Yellow phosphorus ( ) - - ( )
Phosphorus oxychloride ( ) ( ) - ( ) - -
Hydrogen sulfide ( ) ( ) - ( )
Methyl mercaptan ( ) - - - ( )
Organic fluorine - ( ) - - -
Hydrofluoric acid ( ) ( ) ( ) - ( )
Chlorine chlorine - - - - ( )
Phosgene- ( ) ( ) - ( )
Ammonia - ( ) ( ) - ( )
Bromide ( ) - ( ) - -
Carbon monoxide ( ) - -
Carbonyl chloride - - - ( )
Benzene- ( ) - ( )
Vinyl chloride - - ( )
Chloroform ( ) ( ) - ( )
Carbon tetrachloride - - ( )
Trichlorofluoromethane - - ( ) ( ) - -
Dichloroethane ( ) - - -
Dibromochloropropane ( ) - - ( ) -
Gasoline - ( ) - -
Phenylaminonitro compound - - -
Table B.1 (continued)
Ethanol ( ) ( ) - ( )
Methanol ( ) ( ) ( ) - -
Phenols ( ) ( ) ( ) ( )
Ethylene oxide ( ) -
Glacial acetic acid ( ) ( ) - ( ) ( )
dimethylformamide( ) - ( ) ( ) ( )
Dimethyl sulfate ( ) ( ) - - ( )
Hydroxymethyl acrylamide - ( ) ( ) ( ) -
Adiponitrile ( ) ( ) - ( ) - ( )
Organophosphorus pesticides -
Paraquat ( ) ( ) -
Herbicidal ( ) - - ( ) ( ) -
Sodium fluorosilicate - ( ) ( )
禾大壮 ( ) ( ) - - -
2,4-D Butyl Ester ( ) - - -
Chloroacetic acid ( ) ( ) - -
Trichloroethylene ( ) - ( ) -
Nitrogen oxides( ) - ( ) - - -
Acryl alcohol - ( ) ( ) -
Difluorochloromethane - - ( ) - -
O-toluidine - - - -
P-chlorocyanobenzyl ( ) - - -
Note. 1. The toxic multi-organ dysfunction chemicals in the table are derived from clinical case report data.
2. “ ” is the primary injury organ, “( )” secondary injury organ, “-” is no damage.
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