化學灼傷－除污劑的安全性和有效性評估

Chemical burn-Evaluation of the Safety and Effectiveness of Decontamination Solutions

范文誌(Wen-Chih Fann) ； 鄧昭芳(Jou-Fang Deng)

《中華職業醫學雜誌》 25卷3期 (2018/07) Pp. 163-172

摘要

台灣大小工廠內多多少少會使用化學品，故適當的化學灼傷緊急處理與預防為工廠內職業安全衛生的重要課題。化學灼傷如果未接受工廠現場除污的手續，仍必須在急診室立即接受除污的手續。因此，除污劑在急診室的備用是必需的。而要在醫療院所內使用除污劑，需考量到除污劑的安全性和有效性。本篇文章試圖比較各種除污劑的安全性和有效性。目前巿面上的除污劑有三種：敵腐靈®(Diphoterine®)、磷酸鹽緩衝劑(Phosphate buffer)和硼酸鹽緩衝劑(borate buffer)。針對除污劑的有效性，從化學實驗顯示，各類除污劑對於酸的緩衝能力，敵腐靈®比磷酸鹽緩衝劑佳。對於鹼的緩衝能力，敵腐靈®和硼酸鹽緩衝劑相當，但皆比磷酸鹽緩衝劑為佳。除污劑對眼睛及皮膚化學灼傷的效果，動物實驗研究及人體研究顯示，相較於生理食鹽水，只有敵腐靈®能減少眼睛傷害，改變皮膚pH及減輕皮膚症狀。除污劑對住院及工作天數的影響，研究顯示相較於水，唯有敵腐靈®可能可以減少住院及工作天損失。而對於除污劑的安全性，敵腐靈®至目前為止，無副作用的發生。而磷酸鹽緩衝劑的安全性，有眼角膜鈣化的案例報告及風險，特別是含鈣的化學品灼傷。

關鍵字

化學灼傷 ； 除污劑 ； 敵腐靈® ； 緩衝劑 ； 角膜鈣化

並列摘要

Chemicals are used in the majority of factories in Taiwan, Adequate emergent management of chemical burn is a critical issue of occupational health and safety in the factory. If patients with chemical burn do not receive on-site decontamination in the factory, they still need it in the emergency room. Therefore, preparing rinsing solutions for chemical burn is necessary in the emergency room. This article aims to compare the efficacy and safety of different rinsing solutions, including Diphoterine®, phosphate buffer, and borate buffer. Regarding efficacy, Diphoterine® has better acid buffering capacity than phosphate buffer in beaker experiment. Diphoterine® has similar alkali buffering capacity to borate buffer, and both appear better than phosphate buffer. For ocular and cutaneous chemical burn, Diphoterine® can reduce ocular injury and severity of skin burn. Diphoterine® probably decrease the days of hospitalization and work loss. Regarding safety, Diphoterine® has not had any side effect so far. In contrast, phosphate buffer had case report and the risk of corneal calcification, especially with calciferous burning agents.

並列關鍵字

chemical burn ； decontamination ； Diphoterine® ； buffer ； corneal calcification