火灾烟气的危害及其应急救治策略研究进展
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摘要
火灾烟气吸入性损伤一直以来是烧伤患者或火场受困人员主要的伤亡原因,其致病机制复杂,应急救治要求高。目前,烟气吸入性损伤的救治尚未形成统一意见。因此,了解火灾烟气的危害作用和应急救治措施对于提高火灾现场及院内伤员的救治成功率将有着积极的帮助。本文将对火灾烟气的危害及其应急救治措施进行综述,以期为医护人员和消防官兵进行应急救援提供科学的指导。
Fire smoke inhalation injury has always been the main cause of death of burned patients or victims trapped in the fire,its pathogenic mechanism is complicated.Higher level emergency treatment is required.There is no unified opinion on the treatment of inhalation injury of fire smoke at present.Understanding the harmful effects of fire smoke and emergency treatment measures will improve patients management at the fire scene or in hospital.The purpose of this review is to provide an overview of the harmful effects of fire smoke and treatment options of smoke inhalation injury based on the current literature,and also with a view to provide scientific guidance on emergency rescue for medical staff and firefighters.
Fire smoke inhalation injury has always been the main cause of death of burned patients or victims trapped in the fire,its pathogenic mechanism is complicated.Higher level emergency treatment is required.There is no unified opinion on the treatment of inhalation injury of fire smoke at present.Understanding the harmful effects of fire smoke and emergency treatment measures will improve patients management at the fire scene or in hospital.The purpose of this review is to provide an overview of the harmful effects of fire smoke and treatment options of smoke inhalation injury based on the current literature,and also with a view to provide scientific guidance on emergency rescue for medical staff and firefighters.
引文
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[2] Alarie Y.Toxicity of fire smoke[J].CRC Critical Reviews in Toxicology,2002,32(4):259-289.
[3] Stec AA,Hull TR.Fire toxicity[M].Elsevier,2010.
[4]黄恒栋,谯京旭.建筑火灾防治与救生方法[M].华中理工大学出版社,1996.
[5] Hakkarainen T,Mikkola E,Laperre J,et al.Smoke gas analysis by Fourier transform infrared spectroscopy–Summary of the SAFIR project results[J].Fire and Materials,2000,24(2):101-112.
[6] Stec AA,Fardell P,Blomqvist P,et al.Quantification of fire gases by FTIR:Experimental characterisation of calibration systems[J].Fire Safety Journal,2011,46(5):225-233.
[7] Stec A,Hull TR.Fire toxicity and its assessment:Fire retardancy of polymeric materials[M].Second edn.CRC Press,Boca Raton,FL,2010:453-477.
[8]邓光瑞,胡海清.森林火灾烟气的危害[J].林业科技,2006,31(3):38-39.
[9]岳茂兴.窒息性气体中毒的机制及特点和现场急救原则[J].中国全科医学,2003,6(2):150-152.
[10]宋莉,李晓军.窒息性气体中毒现场诊断与救援[J].中国职业医学,2011,38(6):515-517.
[11]相坤,李磊,许淑惠,等.公共交通车辆火灾烟气特性试验研究[J].消防科学与技术,2017,36(5):600-603.
[12]刘芳,高层建筑施工外墙火灾烟气特性研究[D].哈尔滨理工大学,2010.
[13]刘军军,兰彬,张文良,等.地下商业街火灾烟气成分试验研究[J].消防科学与技术,2001(1):10-12.
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[15]岳茂兴,刘志国,徐冰心,等.火场逃生自救,互救及火灾的救援和伤员救治[J].中国全科医学,2004,24.
[16]马绥华,张永明,袁宏永,等.火灾烟雾颗粒粒谱动态分布[J].中国科学技术大学学报,2006,36(1):44-48.
[17] Rhodes J,Smith C,Stec AA.Characterisation of soot particulates from fire retarded and nanocomposite materials,and their toxicological impact[J].Polymer Degradation&Stability,2011,96(3):277-284.
[18] Reisen F,Bhujel M,Leonard J.Particle and volatile organic emissions from the combustion of a range of building and furnishing materials using a cone calorimeter[J].Fire Safety Journal,2014,69:76-88.
[19] USDA.Health Hazards of Smoke,USDA Forest Service,Missoula Technology and Development Center,9167-2809-MTDC[R].1991:8.
[20] ISO.Fire chemistry-Generation and measurement of aerosols[S].2013.
[21] Rehberg S,Maybauer MO,Enkhbaatar P,et al.Pathophysiology,management and treatment of smoke inhalation injury[J].Expert Review of Respiratory Medicine,2009,3(3):283-297.
[22] Enkhbaatar P,Jr PB,Suman O,et al.Pathophysiology,research challenges,and clinical management of smoke inhalation injury[J].Lancet,2016,388(10052):1437-1446.
[23] Pietropaoli AP,Frampton MW,Hyde RW,et al.Pulmonary function,diffusing capacity,and inflammation in healthy and asthmatic subjects exposed to ultrafine particles[J].Inhalation Toxicology,2004,16Suppl 1(Supp 1):59-72.
[24] Rundell KW,Slee JB,Caviston R,et al.Decreased lung function after inhalation of ultrafine and fine particulate matter during exercise is related to decreased total nitrate in exhaled breath condensate[J].Inhalation Toxicology,2008,20(1):1-9.
[25] Prien T,Traber DL.Toxic smoke compounds and inhalation injury--a review[J].Burns,1988,14(6):451-460.
[26]高福启.高温热烟气在火场中的危害[J].吉林劳动保护,1999(2):17-18.
[27]郭平,唐敏珠.高温对人体心血管系统和血糖的影响[J].中国疗养医学,2015,24(2):176-178.
[28]牛洁,贾滨,胡涛,等.热损伤预防—军事训练上的展望[J].体育科技文献通报,2013,21(8):118-120.
[29]朱江,潘亮,金鑫,等.氰化物中毒的相关特征与救治[J].中国急救复苏与灾害医学杂志,2010(5):467-470.
[30]杨美燕,刘庆晓,高春生.注射用羟钴胺:一种新型的氰化物解毒剂[J].国际药学研究杂志,2009,36(5):370-372.
[31] Hamel J.A review of acute cyanide poisoning with a treatment update[J].Critical care nurse,2011,31(1):72-82.
[32] Lee SW,Kim JS.Antidotes of cyanide intoxication[J].Journal of the Korean Medical Association,2013,56(12):1076-1083.
[33] Kulig K.Cyanide antidotes and fire toxicology[J].The New England journal of medicine,1991,325(25):1801-1802.
[34] Anseeuw K,Delvau N,Burilloputze G,et al.Cyanide poisoning by fire smoke inhalation:a European expert consensus[J].European Journal of Emergency Medicine,2013,20(1):2-9.
[35] Giocanti JP.Prehospital Administration of Hydroxocobalamin for Smoke Inhalation-Associated Cyanide Poisoning:8Years of Experience in the Paris Fire Brigade[J].Clinical Toxicology,2008,44Suppl 1(Supp 1):37-44.
[36] Vlaar AP,Wolthuis EK,Hofstra JJ,et al.Mechanical ventilation aggravates transfusion-related acute lung injury induced by MHC class I antibodies[J].Intensive Care Medicine,2010,36(5):879-887.
[37] Kessel I,Waisman D,Barnet-Grinnes O,et al.Benefits of high frequency oscillatory ventilation for premature infants[J].Israel Medical Association Journal Imaj,2010,12(3):144-149.
[38]郭光华,王少根,付忠华,等.高频振荡通气和常频机械通气对吸人性损伤兔心肌功能影响的比较研究[J].中华烧伤杂志,2010,26(4):300-303.
[39]廖新成,郭光华,朱峰,等.高频振荡通气与呼气末正压递增法联用对吸入性损伤犬呼吸循环功能的影响[J].中华烧伤杂志,2013,29(3):255-260.
[40]于湘友,陈淑萍,于朝霞.两种肺复张方法治疗急性呼吸窘迫综合征的效果比较[J].中华急诊医学杂志,2010,19(7):749-752.
[41]吴施曼,樊毫军,侯世科.烟雾吸入性损伤的治疗研究进展[J].中国中西医结合急救杂志,2013(5):318-320.
[42]高少伟.不同剂量低分子肝素雾化吸入治疗急性肺损伤/急性呼吸窘迫综合征的研究[J].现代中西医结合杂志,2014,23(22):2481-2482.
[43]邱鸣磊.有害气体中毒68例救治分析[J].基层医学论坛,2010,14(34):1087-1088.
[44]朱峰,骨髓间充质干细胞移植对烟雾吸入性损伤炎症反应及组织修复的影响[D].南昌大学,2010.
[45]王娜,经不同途径移植人骨髓间充质干细胞对热烟雾吸入性肺损伤大鼠的治疗作用[D].辽宁医学院,2012.
[46]朱峰,郭光华,陈雯,等.骨髓间充质干细胞对烟雾吸入性损伤早期血管内皮细胞生长因子的影响[J].中华急诊医学杂志,2010,19(9):938-941.
[47]陈文丽,肖培欣,董友玲,等.间充质干细胞对烟雾吸入性肺损伤NOD/SCID小鼠的作用研究[J].中国急救复苏与灾害医学杂志,2017,12(5):456-459.
[48] Tolar J,Nauta AJ,Osborn MJ,et al.Sarcoma derived from cultured mesenchymal stem cells[J].Stem Cells,2007,25(2):371-379.
[49] Corcoran KE,Trzaska KA,Fernandes H,et al.Mesenchymal Stem Cells in Early Entry of Breast Cancer into Bone Marrow[J].Plos One,2008,3(6):e2563.
[50] Fu ZH,Yang ZC,Liu L,et al.The influence of N-acetyl-L-cysteine on pulmonary injury and oxygen stress after smoke inhalation injury[J].Chinese Journal of Burns,2002,18(3):152-154.
[51] Wang Z,Li R,Liu Y,et al.Protective effects of edaravone combined puerarin on inhalation lung injury induced by black gunpowder smog[J].International Immunopharmacology,2015,26(1):125-132.
[52]肖长栓·依达拉奉对烟雾吸入性损伤大鼠的肺保护作用[D].天津医科大学,2013
[53] Murakami K,Mcguire R,Cox RA,et al.Recombinant antithrombin attenuates pulmonary inflammation following smoke inhalation and pneumonia in sheep[J].Critical Care Medicine,2003,31(2):577-583.
[54] Tasaki O,Mozingo DW,Dubick MA,et al.Effects of heparin and lisofylline on pulmonary function after smoke inhalation injury in an ovine model[J].Critical Care Medicine,2002,30(3):637-643.
[55]孙磊,李代波,曹佳.急性烟雾吸入性肺损伤药物治疗的研究进展[J].中华哮喘杂志(电子版),2011,31(4):56-61.
[2] Alarie Y.Toxicity of fire smoke[J].CRC Critical Reviews in Toxicology,2002,32(4):259-289.
[3] Stec AA,Hull TR.Fire toxicity[M].Elsevier,2010.
[4]黄恒栋,谯京旭.建筑火灾防治与救生方法[M].华中理工大学出版社,1996.
[5] Hakkarainen T,Mikkola E,Laperre J,et al.Smoke gas analysis by Fourier transform infrared spectroscopy–Summary of the SAFIR project results[J].Fire and Materials,2000,24(2):101-112.
[6] Stec AA,Fardell P,Blomqvist P,et al.Quantification of fire gases by FTIR:Experimental characterisation of calibration systems[J].Fire Safety Journal,2011,46(5):225-233.
[7] Stec A,Hull TR.Fire toxicity and its assessment:Fire retardancy of polymeric materials[M].Second edn.CRC Press,Boca Raton,FL,2010:453-477.
[8]邓光瑞,胡海清.森林火灾烟气的危害[J].林业科技,2006,31(3):38-39.
[9]岳茂兴.窒息性气体中毒的机制及特点和现场急救原则[J].中国全科医学,2003,6(2):150-152.
[10]宋莉,李晓军.窒息性气体中毒现场诊断与救援[J].中国职业医学,2011,38(6):515-517.
[11]相坤,李磊,许淑惠,等.公共交通车辆火灾烟气特性试验研究[J].消防科学与技术,2017,36(5):600-603.
[12]刘芳,高层建筑施工外墙火灾烟气特性研究[D].哈尔滨理工大学,2010.
[13]刘军军,兰彬,张文良,等.地下商业街火灾烟气成分试验研究[J].消防科学与技术,2001(1):10-12.
[14]陶永娴.刺激性气体[J].中国社区医师,2007(18):49.
[15]岳茂兴,刘志国,徐冰心,等.火场逃生自救,互救及火灾的救援和伤员救治[J].中国全科医学,2004,24.
[16]马绥华,张永明,袁宏永,等.火灾烟雾颗粒粒谱动态分布[J].中国科学技术大学学报,2006,36(1):44-48.
[17] Rhodes J,Smith C,Stec AA.Characterisation of soot particulates from fire retarded and nanocomposite materials,and their toxicological impact[J].Polymer Degradation&Stability,2011,96(3):277-284.
[18] Reisen F,Bhujel M,Leonard J.Particle and volatile organic emissions from the combustion of a range of building and furnishing materials using a cone calorimeter[J].Fire Safety Journal,2014,69:76-88.
[19] USDA.Health Hazards of Smoke,USDA Forest Service,Missoula Technology and Development Center,9167-2809-MTDC[R].1991:8.
[20] ISO.Fire chemistry-Generation and measurement of aerosols[S].2013.
[21] Rehberg S,Maybauer MO,Enkhbaatar P,et al.Pathophysiology,management and treatment of smoke inhalation injury[J].Expert Review of Respiratory Medicine,2009,3(3):283-297.
[22] Enkhbaatar P,Jr PB,Suman O,et al.Pathophysiology,research challenges,and clinical management of smoke inhalation injury[J].Lancet,2016,388(10052):1437-1446.
[23] Pietropaoli AP,Frampton MW,Hyde RW,et al.Pulmonary function,diffusing capacity,and inflammation in healthy and asthmatic subjects exposed to ultrafine particles[J].Inhalation Toxicology,2004,16Suppl 1(Supp 1):59-72.
[24] Rundell KW,Slee JB,Caviston R,et al.Decreased lung function after inhalation of ultrafine and fine particulate matter during exercise is related to decreased total nitrate in exhaled breath condensate[J].Inhalation Toxicology,2008,20(1):1-9.
[25] Prien T,Traber DL.Toxic smoke compounds and inhalation injury--a review[J].Burns,1988,14(6):451-460.
[26]高福启.高温热烟气在火场中的危害[J].吉林劳动保护,1999(2):17-18.
[27]郭平,唐敏珠.高温对人体心血管系统和血糖的影响[J].中国疗养医学,2015,24(2):176-178.
[28]牛洁,贾滨,胡涛,等.热损伤预防—军事训练上的展望[J].体育科技文献通报,2013,21(8):118-120.
[29]朱江,潘亮,金鑫,等.氰化物中毒的相关特征与救治[J].中国急救复苏与灾害医学杂志,2010(5):467-470.
[30]杨美燕,刘庆晓,高春生.注射用羟钴胺:一种新型的氰化物解毒剂[J].国际药学研究杂志,2009,36(5):370-372.
[31] Hamel J.A review of acute cyanide poisoning with a treatment update[J].Critical care nurse,2011,31(1):72-82.
[32] Lee SW,Kim JS.Antidotes of cyanide intoxication[J].Journal of the Korean Medical Association,2013,56(12):1076-1083.
[33] Kulig K.Cyanide antidotes and fire toxicology[J].The New England journal of medicine,1991,325(25):1801-1802.
[34] Anseeuw K,Delvau N,Burilloputze G,et al.Cyanide poisoning by fire smoke inhalation:a European expert consensus[J].European Journal of Emergency Medicine,2013,20(1):2-9.
[35] Giocanti JP.Prehospital Administration of Hydroxocobalamin for Smoke Inhalation-Associated Cyanide Poisoning:8Years of Experience in the Paris Fire Brigade[J].Clinical Toxicology,2008,44Suppl 1(Supp 1):37-44.
[36] Vlaar AP,Wolthuis EK,Hofstra JJ,et al.Mechanical ventilation aggravates transfusion-related acute lung injury induced by MHC class I antibodies[J].Intensive Care Medicine,2010,36(5):879-887.
[37] Kessel I,Waisman D,Barnet-Grinnes O,et al.Benefits of high frequency oscillatory ventilation for premature infants[J].Israel Medical Association Journal Imaj,2010,12(3):144-149.
[38]郭光华,王少根,付忠华,等.高频振荡通气和常频机械通气对吸人性损伤兔心肌功能影响的比较研究[J].中华烧伤杂志,2010,26(4):300-303.
[39]廖新成,郭光华,朱峰,等.高频振荡通气与呼气末正压递增法联用对吸入性损伤犬呼吸循环功能的影响[J].中华烧伤杂志,2013,29(3):255-260.
[40]于湘友,陈淑萍,于朝霞.两种肺复张方法治疗急性呼吸窘迫综合征的效果比较[J].中华急诊医学杂志,2010,19(7):749-752.
[41]吴施曼,樊毫军,侯世科.烟雾吸入性损伤的治疗研究进展[J].中国中西医结合急救杂志,2013(5):318-320.
[42]高少伟.不同剂量低分子肝素雾化吸入治疗急性肺损伤/急性呼吸窘迫综合征的研究[J].现代中西医结合杂志,2014,23(22):2481-2482.
[43]邱鸣磊.有害气体中毒68例救治分析[J].基层医学论坛,2010,14(34):1087-1088.
[44]朱峰,骨髓间充质干细胞移植对烟雾吸入性损伤炎症反应及组织修复的影响[D].南昌大学,2010.
[45]王娜,经不同途径移植人骨髓间充质干细胞对热烟雾吸入性肺损伤大鼠的治疗作用[D].辽宁医学院,2012.
[46]朱峰,郭光华,陈雯,等.骨髓间充质干细胞对烟雾吸入性损伤早期血管内皮细胞生长因子的影响[J].中华急诊医学杂志,2010,19(9):938-941.
[47]陈文丽,肖培欣,董友玲,等.间充质干细胞对烟雾吸入性肺损伤NOD/SCID小鼠的作用研究[J].中国急救复苏与灾害医学杂志,2017,12(5):456-459.
[48] Tolar J,Nauta AJ,Osborn MJ,et al.Sarcoma derived from cultured mesenchymal stem cells[J].Stem Cells,2007,25(2):371-379.
[49] Corcoran KE,Trzaska KA,Fernandes H,et al.Mesenchymal Stem Cells in Early Entry of Breast Cancer into Bone Marrow[J].Plos One,2008,3(6):e2563.
[50] Fu ZH,Yang ZC,Liu L,et al.The influence of N-acetyl-L-cysteine on pulmonary injury and oxygen stress after smoke inhalation injury[J].Chinese Journal of Burns,2002,18(3):152-154.
[51] Wang Z,Li R,Liu Y,et al.Protective effects of edaravone combined puerarin on inhalation lung injury induced by black gunpowder smog[J].International Immunopharmacology,2015,26(1):125-132.
[52]肖长栓·依达拉奉对烟雾吸入性损伤大鼠的肺保护作用[D].天津医科大学,2013
[53] Murakami K,Mcguire R,Cox RA,et al.Recombinant antithrombin attenuates pulmonary inflammation following smoke inhalation and pneumonia in sheep[J].Critical Care Medicine,2003,31(2):577-583.
[54] Tasaki O,Mozingo DW,Dubick MA,et al.Effects of heparin and lisofylline on pulmonary function after smoke inhalation injury in an ovine model[J].Critical Care Medicine,2002,30(3):637-643.
[55]孙磊,李代波,曹佳.急性烟雾吸入性肺损伤药物治疗的研究进展[J].中华哮喘杂志(电子版),2011,31(4):56-61.