全(quan)身中(zhong)毒(du)在某些化學燒傷中(zhong)很突出(chu)(chu),若有(you)特效解毒(du)藥物(wu)(wu),應及時(shi)施用;一(yi)般情(qing)況下則(ze)給予全(quan)身支(zhi)持,以保護肝、腎等重要器官,加速(su)毒(du)物(wu)(wu)排出(chu)(chu)。如輸(shu)液,靜(jing)脈給予大量維生素、應用激素,以及利尿、護肝等。若為(wei)威(wei)脅生命的中(zhong)毒(du),例如液態黃磷燒傷面積較大,僅(jin)靠沖洗中(zhong)和是不夠的,還應爭(zheng)取時(shi)間果斷(duan)地切、削創(chuang)面焦痂,除去毒(du)物(wu)(wu)來(lai)源,并酌情(qing)植皮覆蓋創(chuang)面。
化(hua)(hua)學(xue)燒(shao)(shao)(shao)傷(shang)(shang)(shang)比單(dan)純熱力燒(shao)(shao)(shao)(燙)傷(shang)(shang)(shang)要復雜得多。1.化(hua)(hua)學(xue)燒(shao)(shao)(shao)傷(shang)(shang)(shang)的(de)(de)種(zhong)類和(he)性(xing)(xing)(xing)狀化(hua)(hua)學(xue)燒(shao)(shao)(shao)傷(shang)(shang)(shang)的(de)(de)傷(shang)(shang)(shang)因可分兩大類:一(yi)為(wei)強堿燒(shao)(shao)(shao)傷(shang)(shang)(shang),如石灰、苛性(xing)(xing)(xing)鈉、苛性(xing)(xing)(xing)鉀等;二為(wei)強酸(suan)(suan)燒(shao)(shao)(shao)傷(shang)(shang)(shang),如王水、鹽酸(suan)(suan)、硫酸(suan)(suan)、硝(xiao)酸(suan)(suan)、磷(lin)(lin)酸(suan)(suan)等。堿性(xing)(xing)(xing)燒(shao)(shao)(shao)傷(shang)(shang)(shang),其滲(shen)透性(xing)(xing)(xing)強,深入(ru)皮下(xia)后(hou)使(shi)(shi)細胞脫(tuo)(tuo)水、溶解組(zu)織蛋白,形成強堿蛋白化(hua)(hua)合(he)物(wu),致使(shi)(shi)創面加深,造(zao)成更嚴(yan)重(zhong)的(de)(de)深層(ceng)組(zu)織破(po)壞;強酸(suan)(suan)燒(shao)(shao)(shao)傷(shang)(shang)(shang),可立即引起組(zu)織蛋白的(de)(de)凝固(gu),使(shi)(shi)組(zu)織脫(tuo)(tuo)水形成厚痂(jia),其厚痂(jia)有利于阻止酸(suan)(suan)液(ye)繼(ji)續向(xiang)深層(ceng)組(zu)織內滲(shen)透,可減少組(zu)織損傷(shang)(shang)(shang);磷(lin)(lin)酸(suan)(suan)燒(shao)(shao)(shao)傷(shang)(shang)(shang),在戰時或(huo)工農(nong)業生產中常有發(fa)生。由于磷(lin)(lin)化(hua)(hua)合(he)物(wu)遇空氣極易燃燒(shao)(shao)(shao),氧化(hua)(hua)后(hou)變成五氧化(hua)(hua)二磷(lin)(lin),成為(wei)一(yi)種(zhong)毒(du)性(xing)(xing)(xing)很強的(de)(de)物(wu)質。磷(lin)(lin)燒(shao)(shao)(shao)傷(shang)(shang)(shang)后(hou),如果(guo)沒有徹底清除皮膚上殘(can)留(liu)的(de)(de)磷(lin)(lin)質,磷(lin)(lin)可在皮膚上或(huo)傷(shang)(shang)(shang)口內繼(ji)續燃燒(shao)(shao)(shao),造(zao)成繼(ji)發(fa)的(de)(de)更深與重(zhong)大面積的(de)(de)燒(shao)(shao)(shao)傷(shang)(shang)(shang)。皮膚上或(huo)傷(shang)(shang)(shang)口內的(de)(de)殘(can)留(liu)磷(lin)(lin)一(yi)旦被體內吸收,又可引起全(quan)身(shen)磷(lin)(lin)中毒(du)。
(1)一般處理(li)原則(ze) 立即解(jie)脫被化學物(wu)(wu)質浸漬(zi)的(de)衣物(wu)(wu),連續(xu)大量清水(shui)沖(chong)(chong)洗,時間應(ying)(ying)較長。特應(ying)(ying)注意眼部與(yu)五官的(de)沖(chong)(chong)洗,因(yin)損(sun)傷后(hou)(hou)(hou)可(ke)(ke)因(yin)而(er)致盲或(huo)其他后(hou)(hou)(hou)果。急救時使用(yong)(yong)中(zhong)(zhong)(zhong)和(he)劑等并非(fei)上策,除(chu)耽誤時間外,還可(ke)(ke)因(yin)匆忙中(zhong)(zhong)(zhong)選(xuan)擇不(bu)當或(huo)中(zhong)(zhong)(zhong)和(he)反應(ying)(ying)中(zhong)(zhong)(zhong)產(chan)熱而(er)加(jia)(jia)重損(sun)害。早期輸液(ye)量可(ke)(ke)稍多(duo),加(jia)(jia)用(yong)(yong)利尿劑以排出毒(du)性(xing)物(wu)(wu)質。深度燒(shao)傷應(ying)(ying)盡早切除(chu)壞死(si)組織井植皮(pi)(pi)。已明確(que)為化學毒(du)物(wu)(wu)致傷者,應(ying)(ying)選(xuan)用(yong)(yong)相應(ying)(ying)的(de)解(jie)毒(du)劑或(huo)對抗劑。引起急性(xing)肺水(shui)腫而(er)很快(kuai)窒息或(huo)死(si)亡;磷(lin)(lin)(lin)進入傷口或(huo)皮(pi)(pi)下后(hou)(hou)(hou),可(ke)(ke)引起嚴重肝(gan)、腎中(zhong)(zhong)(zhong)毒(du),故在很小面(mian)積磷(lin)(lin)(lin)燒(shao)傷時,也常有致人于(yu)死(si)命(ming)的(de)危(wei)險(xian)。磷(lin)(lin)(lin)燒(shao)傷后(hou)(hou)(hou)可(ke)(ke)先用(yong)(yong)清水(shui)沖(chong)(chong)洗幾遍,然(ran)后(hou)(hou)(hou)用(yong)(yong)1~5%硫(liu)酸(suan)銅(tong)(tong)溶液(ye)浸濕(shi)紗布敷在傷處,使殘(can)留的(de)磷(lin)(lin)(lin)生成(cheng)(cheng)二(er)磷(lin)(lin)(lin)化二(er)銅(tong)(tong)(不(bu)再燃燒(shao)),最后(hou)(hou)(hou)再用(yong)(yong)3%雙(shuang)氧(yang)水(shui)或(huo)5%小蘇(su)打(da)水(shui)沖(chong)(chong)洗,使磷(lin)(lin)(lin)渣再氧(yang)化成(cheng)(cheng)磷(lin)(lin)(lin)酐(無毒(du))。在磷(lin)(lin)(lin)燒(shao)傷處理(li)時禁用(yong)(yong)油或(huo)凡士(shi)林(lin)紗布包(bao)扎,因(yin)磷(lin)(lin)(lin)易溶于(yu)油脂,會促使人體中(zhong)(zhong)(zhong)毒(du),故在終末(mo)包(bao)扎時,在用(yong)(yong)5%小蘇(su)打(da)水(shui)沖(chong)(chong)洗后(hou)(hou)(hou),用(yong)(yong)于(yu)紗布包(bao)扎最好(hao)。
(2)酸(suan)(suan)燒(shao)傷 急救時(shi)用(yong)(yong)大(da)量(liang)清(qing)水(shui)(shui)沖洗傷處,隨后按一般燒(shao)傷處理(li)。此外,有(you)些腐蝕性酸(suan)(suan)燒(shao)傷:如石炭酸(suan)(suan),其脫水(shui)(shui)作用(yong)(yong)不如上述強酸(suan)(suan),但可吸收進入血循環而損(sun)害(hai)腎(shen)。石炭酸(suan)(suan)不易溶(rong)解于水(shui)(shui),清(qing)水(shui)(shui)沖洗后,可以70%酒精清(qing)洗。又如氫(qing)氟酸(suan)(suan),其穿透(tou)性很(hen)強,能溶(rong)解脂質,繼續向周圍和深(shen)處侵入,擴(kuo)大(da)與加(jia)深(shen)的損(sun)害(hai)作用(yong)(yong)明顯。立即(ji)處理(li)仍為(wei)大(da)量(liang)清(qing)水(shui)(shui)沖洗,隨后用(yong)(yong)5%一10%葡萄(tao)糖酸(suan)(suan)鈣(0.5ml/cm2)加(jia)入1%普魯(lu)卡(ka)因(yin)刨周浸(jin)潤注射(she),使(shi)殘(can)存(cun)的氫(qing)氟酸(suan)(suan)化合成氟化鈣,可停止其繼續擴(kuo)散與侵人(ren)。
(3)堿(jian)燒(shao)傷(shang)(shang) 急救時(shi)應(ying)大(da)量清(qing)水沖洗,沖洗時(shi)間更應(ying)延(yan)長。深度堿(jian)燒(shao)傷(shang)(shang)適合早期切癡與植皮。堿(jian)燒(shao)傷(shang)(shang)中(zhong)的(de)生石(shi)灰(氫氧化鈣(gai))和電石(shi)(c2Ca)的(de)燒(shao)傷(shang)(shang)必須在清(qing)水沖洗前,先(xian)去除傷(shang)(shang)處(chu)的(de)顆粒或粉末(mo),以(yi)免加水后產熱。
(4)磷(lin)(lin)燒(shao)傷 急救時應將(jiang)傷處浸(jin)入水(shui)中(zhong)(zhong),以(yi)(yi)隔(ge)絕(jue)氧(yang)氣,切忌暴(bao)露(lu)于(yu)空氣中(zhong)(zhong),以(yi)(yi)免繼(ji)續(xu)燃燒(shao)。應在(zai)水(shui)下移(yi)除磷(lin)(lin)粒,用l%硫酸(suan)銅(tong)涂(tu)布,可(ke)形成無毒(du)性(xing)的(de)磷(lin)(lin)化鍋(guo),便于(yu)識別和移(yi)除。但必須控(kong)制硫酸(suan)銅(tong)的(de)濃(nong)度(du)不超過(guo)1%,如濃(nong)度(du)過(guo)高,反可(ke)招致銅(tong)中(zhong)(zhong)毒(du)。忌用油質敷(fu)料,因磷(lin)(lin)易(yi)溶于(yu)油脂,而更易(yi)吸收;適用3%一5%碳酸(suan)氫鈉濕敷(fu)包扎。深(shen)度(du)創面盡早切除與(yu)植皮。磷(lin)(lin)燒(shao)傷應特(te)別注(zhu)意全身中(zhong)(zhong)毒(du)問題。
(5)如(ru)誤服(fu)強堿、強酸類腐蝕劑,不(bu)論服(fu)量多少,均(jun)可(ke)燒壞(huai)口腔、咽喉(hou)、食管與(yu)胃(wei)的(de)(de)粘膜(mo),嚴重者可(ke)燒壞(huai)肌(ji)層直至穿(chuan)孔。因此,解救時(shi)(shi)不(bu)可(ke)立即催吐或(huo)洗胃(wei),以(yi)免食道與(yu)胃(wei)破裂或(huo)穿(chuan)孔;可(ke)針對服(fu)用的(de)(de)強堿或(huo)強酸種類,將相應的(de)(de)中(zhong)和溶液(ye)灌(guan)入,同時(shi)(shi)灌(guan)入牛奶、雞(ji)蛋清(qing)、植物油或(huo)面糊等流體,以(yi)求保護(hu)好食管與(yu)胃(wei)粘膜(mo),贏(ying)得搶救時(shi)(shi)間。
(6)無論何(he)種化學(xue)燒傷,也無論是外燒傷或內(nei)燒傷,均(jun)應(ying)迅速、安全地(di)送醫(yi)院救治,萬(wan)不可留在家(jia)庭(ting)自行處理。
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