Complicated Heart Failure Secondary to Chemical Burn Injury with Hydrofluoric Acid-A Case Report

氫氟酸腐蝕傷導致複雜性心臟衰竭－病例報告

江茂亮(Mao-Liang Chiang) ； 林鴻祥(Hung-Hsiang Lin) ； 陳天牧(Tim-Mo Chen) ； 陳錫根(Shyi-Gen Chen)

《臺灣整形外科醫學會雜誌》 21卷2期 (2012/06) Pp. 135-142

https://doi.org/10.7096/TJTSPS.201206.0135

摘要

背景：氫氟酸極端危險的化學物質，處理時應額外小心。氟離子對鈣離子影響的機轉已經眾所周知，但是它對心肌細胞直接影響卻所知有限。目的與目標：我們報告一個罕見病例並強調心臟監控的重要性。材料與方法：我們報告一個31歲男性因遭到55%氫氟酸溶液濺到，而導致左大腿及右足背約佔體表面積百分之十的灼傷。結果：入院第一天即發現血中肌酸磷化同功脢、肌酸磷酸脢及Troponin I有升高的跡象（CPK:2213.5u/l; CK-MB:563.29u/l; TroponinI: 81.18ng/ml）。住院期間，病人的心臟功能經保守治療後漸漸改善後，才開始接受傷口的清創及植皮重建。經過一個月的治療，病人整體狀況已改善且傷口穩定，始予以出院。結論：經由本病例的探討，可以讓我們知道氫氟酸腐蝕傷的病患應即早做心臟的監控，並告知使用者氫氟酸除了造成軟組織腐蝕以外，可能帶給心臟可能的風險。

並列摘要

Background: Hydrofluoric acid is an extremely dangerous chemical and should be handled with utmost caution. The influence of fluoride ions on calcium ions has been well known for decades. Aim and Objectives:The direct influence of this relationship on cardiac tissue is still unknown. We report a case with very rare clinical presentation and emphasize the importance of cardiac monitoring, which may lead to a different treatment plan.Materials and Methods:We report a case of a 31-year-old worker who sustained a second to third-degree skin burn of 10% of his total body surface area as a result of being splashed with 55% hydrofluoric acid solution over his left thigh and right foot dorsum.Results: In the first day of admission, elevated levels of cardiac enzymes were found (CPK: 2213.5 U/l; CK-MB: 563.29 U/l; Troponin I: 81.18 ng/ml). During hospitalization, his cardiac condition was improved gradually with supportive treatment. He received wound debridement and following a skin grafting 19 days after being burned. He was discharged with good wound condition and cardiac function about 1 month later. Conclusion:We emphasize the need for the immediate initiation of cardiac monitoring on the scene of injury and the distribution of information about the risks of hydrofluoric acid to users.

並列關鍵字

hydrofluoric acid ； heart failure