[A fatal case of acute occupational organic fluoride inhalation poisoning].

内容摘要

Organic fluoride compounds are a class of chemical raw materials containing fluorocarbon bonds, primarily classified into fluorinated alkanes and fluorinated olefins. Short-term high-concentration inhalation can lead to acute lung injury, acute respiratory distress syndrome (ARDS), and rapidly progressive pulmonary fibrosis, with persistently high clinical mortality rates. This study summarizes the clinical characteristics, treatment experience, and prognostic factors of acute occupational inhalation poisoning by mixed organic fluoride gases to provide reference for similar case management. A retrospective analysis was conducted on the occupational exposure history, clinical diagnosis and treatment process, and outcome data of a patient who inhaled a mixture of hexafluoropropylene and tetrafluoroethylene in a sealed, non-ventilated warehouse. The patient developed irritative dry cough and progressive dyspnea after toxin exposure. Despite symptomatic supportive treatment at another hospital, the condition continued to deteriorate, leading to admission to our hospital on 9 days post-exposure. Upon admission, the oxygenation index was 123.1 mmHg, and chest CT revealed diffuse reticular and honeycomb-like density enhancement in both lungs, confirming a diagnosis of acute severe organic fluoride poisoning with moderate ARDS. Comprehensive interventions including high-dose glucocorticoid pulse therapy, invasive mechanical ventilation, anti-infection measures, alveolar lavage, and veno-venous extracorporeal membrane oxygenation (VV-ECMO) were administered, yet the patient's condition continued to worsen. The patient ultimately died from respiratory and circulatory failure due to severe pulmonary fibrosis complicated by spontaneous pneumothorax. Acute organic fluoride poisoning has a poor prognosis, necessitating emphasis on early identification, adequate and prolonged corticosteroid therapy, and prompt initiation of ECMO support. Concurrently, occupational safety and health education in workplaces should be strengthened to reduce disease risk at the source. 有机氟化合物为含氟碳键的一类化工原料，主要分为氟烷烃、氟烯烃两类，短时间高浓度吸入可致急性肺损伤、急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）及快速进展性肺纤维化，临床病死率居高不下。总结急性职业性混合有机氟气体吸入中毒的临床特征、救治经验及预后影响因素，为同类病例诊疗提供参考。回顾性分析1例于密闭无通风仓库内吸入六氟丙烯、四氟乙烯混合气体的急性中毒患者的职业接触史、临床诊疗过程及转归资料。患者毒物接触后出现刺激性干咳、进行性呼吸困难，外院对症支持治疗后病情持续进展，于暴露后9 d转入我院；入院时氧合指数123.1 mmHg，胸部CT提示双肺弥漫性网格状、蜂窝状密度增高影，确诊为急性重度有机氟中毒、中度ARDS；予大剂量糖皮质激素冲击、有创机械通气、抗感染、肺泡灌洗及静脉-静脉体外膜肺氧合（VV-ECMO）等综合救治，病情仍进行性恶化，最终因严重肺纤维化合并自发性气胸致呼吸循环衰竭死亡。急性有机氟中毒预后差，需强调早期识别、足量足疗程糖皮质激素应用、及时启动ECMO支持的救治策略，同时应强化作业场所职业防护宣教，从源头降低发病风险。.