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国内外三甲基氯化锡中毒事故分析

Analysis on poisoning accidents by trimethyltin chloride in the world

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【作者】 唐小江黄明李斌赖关朝吴邦华李来玉

【Author】 TANG Xiao-jiang,HUANG Ming,LI Bin,LAI Guan-chao,WU Bang-hua,LI Lai-yu(Guangdong Provincial Prevention and Treatment Center for Occupational Disease,Guangzhou 510300,China)

【机构】 广东省职业病防治院

【摘要】 目的分析全球三甲基氯化锡(TMT)中毒事故的基本情况。方法收集Public Medline,Science Direct和中国期刊网等2008年前发表的与三甲基氯化锡中毒事故有关的文献进行统计学分析。结果 1974—2008年全球共发生TMT中毒事故67起(中毒1 849例,死亡23例),其中98%以上的病例发生在中国;自1998年后,中国每年都会发生TMT中毒事故,主要分布在经济快速发展的东南沿海地区及其毗邻的省份;TMT中毒全年都可发生,但以5~8月份为多发;中毒原因主要是职业接触有机锡稳定剂如有机锡稳定剂生产、塑料加工成型和回收塑料加工等,食用TMT污染的食物和水等也可引起中毒;TMT可经呼吸道、消化道和皮肤等多种途径进入体内,在各年龄段、各性别引起中毒;TMT中毒的潜伏期为2 h~3个月,多为3~6 d;TMT中毒的主要症状包括低钾血症和小脑-边缘系统症状两大方面,可伴有代谢性酸中毒、心动过缓、心肌损伤、肝损伤、肾损伤,脑CT检查可见脱髓鞘改变,可伴脑电图异常;中毒程度与尿锡水平无相关性;目前尚无特效解毒剂,早期足量持续补钾、积极防治脑水肿是主要的治疗措施。结论我国TMT中毒事故较为多发,需要加强有机锡塑料稳定剂的生产和使用管理,有效控制职业暴露。

【Abstract】 Objective To analyze the general situation of poisoning accidents induced by trimethyltin chloride(TMT)in the world.Methods The papers concerned TMT poisoning accidents in the database of Public Medline,Science Direct and China National Knowledge Infrastructure before 2008 were collected and analyzed.Results The results showed that there were 67 TMT poisoning accidents in total during 1974 to 2008 in the world according to the collected data,in which 1849 were poisoned,23 died,more than 98%(1814/1849)of the patients occurred in China.Since 1998,the poisoning accidents occurred every year there,and mainly located in the rapidly economy-developing areas of China that are the south-east coastal provinces and nearby regions.TMT poisoning may occur all the year,the peak period was May—August.The main cause of poisoning was occupational exposure to organotin stabilizer such as production of organotin stabilizer,molding of plastic,machining of recycled plastic,ingestion of organotin-polluted food or water can also induce poisoning.TMT can be absorbed through respiratory duct,digestive tract and skin,induce poisoning in all ages,both men and women,the incubation period varies from 2 h to 3 months,mostly 3d to 6d.The main clinical symptoms include hypokalemia and cerebellar-limbic syndrome,may accompany with metabolic acidosis,bradycardia,myocardial damage,hepatic injury,renal injury,abnormal electroencephalogram and brain demyelination found by CT or MRI.However,the severity of poisoning is not correlated with urinary tin level.At present,there is still no special antidote available for therapy of TMT poisoning,the main treatments were early and continuously supplying enough potassium on the basis of intimately monitoring serum potassium level,and actively preventing and curing of encephaloedema.Conclusion The data suggested that TMT poisoning accidents are more frequent in China since 1998,therefore,it is urgent to strengthen the management in production and usage of organotin stabilizer for effective control the occupational exposure and poisoning of organotin.

【基金】 国家自然科学基金项目(30771786,30972458);中国博士后科学基金(20060400224);广东省自然科学基金项目(06023421);广东省医学科研基金项目(B1999010,B2002005,A2004060,A2005067,B2006009,B2007012,A2007058,A2009060);卫生部卫生标准制(修)订项目(20100303)
  • 【文献出处】 中国工业医学杂志 ,Chinese Journal of Industrial Medicine , 编辑部邮箱 ,2010年05期
  • 【分类号】R135.1
  • 【被引频次】21
  • 【下载频次】345
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