预防医学课件：七年制预防医学2

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1、单击此处添课程名Section IIIOccupational poisoning单击此处添课程名1 introductionProductive toxicant:the toxic chemicals which may be contacted in productive processesOccupational poisoning:poisoning which is induced by productive toxicants单击此处添课程名单击此处添课程名1995年月，清华大学化工系三年级学生朱令出现了奇怪症状：秀发脱落、面肌瘫痪、发音含混、四肢无力，被送往医院，医院束手无策。

2、朱令中学同学贝至城在互联网上发贴，描述朱令病情，希望得到专家意见以确定病因。前后收到1000多封信，很多怀疑“铊中毒”。贝志城不断地把信件译成中文，送给朱令父母，希望主治大夫给朱令做一次是否铊中毒的检测，但均被以“干扰治疗”的名义拒绝 单击此处添课程名女化学教师要求情夫离婚未成女化学教师要求情夫离婚未成 用铊将其夫妇毒倒用铊将其夫妇毒倒 江某和宋某均是某中学教师。06年3月2日晚饭后，夫妻俩感觉身体乏力、四肢麻木，指尖出现莫名刺痛。两人认为是患了感冒，就在附近小诊所治疗，几日后，出现便血、呕吐等症状，被家人送往医学院附属医院诊治。医生经过详细调查，难以作出病源判断。但病人病情却逐渐恶化，逐渐吞

3、食困难，头发脱落，肝功能受损。到3月中旬，江某胃部大出血，医生下达病危通知书，家属焦急万分.单击此处添课程名广东超霸电池厂广东超霸电池厂100多职工镉中毒多职工镉中毒 这个厂有100名工人被检查出血镉和尿镉超标，并引发该厂工人的恐慌。工人们纷纷相约到医院检查。而且，工人们根据自己查阅的资料，将自己平日的腰酸背痛或盆骨痛等症状和镉中毒联系起来。因此，工人们强烈要求被诊断为职业病并获得相应的赔偿，但工厂却拒绝了工人的要求，导致劳资关系空前紧张.单击此处添课程名超霸电池的镍镉电池生产线超霸电池的镍镉电池生产线单击此处添课程名硫化镉矿（黄色部分）菱亜鉛鉱（ZnCO3）单击此处添课程名黄色環黄色環 单击

4、此处添课程名环保总局通报环保总局通报6起重大环境事件起重大环境事件 05年11月13日松花江水污染事件到06年2月1日的两个半月时间，国家环保总局接到各类突发环境事件报告45起。其中较为重大的典型事件为广东北江镉镉污染事件、辽宁浑河抚顺段水质酚浓度超标事件、广西红水河天峨段水质污染事件、湖南湘江株洲和长沙段镉镉污染事件、河南巩义二电厂柴油泄漏污染黄河事件和江西赣江水域油轮起火事故污染事件。单击此处添课程名2005年12月22日，部分下游城市停止供水。广东韶关冶炼厂封堵排污口 单击此处添课程名写真病患者小松原告。1971630富山地裁勝訴喜、骨異常、身長縮。单击此处添课程名病影響背骨曲患者毎日痛

5、 单击此处添课程名50歳以上女子人口対、病患者有病率单击此处添课程名单击此处添课程名病萎縮腎（肉眼所見）通常120g前後腎重量60g前後。单击此处添课程名病患者腎光学顕微鏡像单击此处添课程名施設館内病関展示室若者 单击此处添课程名metallothionein。水色銅。单击此处添课程名作業者鼻中隔穿孔 单击此处添课程名潰瘍潰瘍 单击此处添课程名六価接触性皮膚炎 单击此处添课程名中六価皮膚炎 单击此处添课程名化合物皮疹 单击此处添课程名慢性肺肉芽腫(铍肺）单击此处添课程名Toxic substances(1)Forms in productive processes raw material s

6、emifinished product auxiliary material product byproduct waste单击此处添课程名(2)Forms in productive environment gas vapour dust(0.1-10 m)fume(0.1 m)mistAerosolToxic substances单击此处添课程名(3)Exposure chances Raw material exploitation and abstraction Transportation and storage Treatment and preparation Material

7、addition and pour Package Auxiliary operation OthersToxic substances单击此处添课程名Exposure route(1)Respiratory TractMajor route of entry of the gas,vapour,aerosol Pass from the lungs directly into the bloodstream for distributing to other parts of the body单击此处添课程名Exposure route(2)Skin Fat soluble substanc

8、es absorbed easier through skin than water soluble ones Substances that are soluble in both fat and water show the greatest flux(3)Gastrointestinal Tract Not a major route for occupational exposure单击此处添课程名Metabolism(1)Distribution Blood flow and affinity Combined with blood plasma protein Storage de

9、pots Special barrierblood-brain barrierplacenta barrierblood-eye barrierblood-testicel barrier单击此处添课程名（2）BiotransformationDetoxication:from more toxic to less toxic formsActivation:increase toxicity phase I reaction:oxidation,reduction,hydrolysis increase the polarity of substratesphase II reaction:

10、conjugation add polar groups to the products of phase I reactionMetabolism单击此处添课程名(3)Excretion Kidneys:(urine)major route Respiratory Tract Gastrointestinal Tract:(bile)Others:(latex,saliva,sweat)Metabolism单击此处添课程名Factors impact on the toxicity Characteristics of the toxicants Dose,concentration,exp

11、osed duration Combination effects of toxicants Productive environment and labor intensity Individual sensitivity单击此处添课程名Clinical manifestation Nerve system Respiratory system Urinary system Digestive system Reproductive system Haematopoietic system Cardiovascular system Skin单击此处添课程名Diagnosis Occupat

12、ional history Productive environment investigation Clinical manifestation Laboratory examination单击此处添课程名Treatment First aid Prevent absorbance Accelerate excretion Eliminate toxicants in the body Acute poisoning Chronic poisoning Early detection Early diagnosis Early treatment单击此处添课程名Prevention Erad

13、icate toxicants Decrease concentration Safe management Individual prevention Improve constitution Environment and health surveillance单击此处添课程名 Pb Pb vapour lead oxide2.1 Lead Poisoning1.Physical and chemical properties Soft heavy metal Melting point:327 Boiling point:1525Soluble in acid(lead fume)mel

14、t400O2单击此处添课程名 2.Opportunities of exposure Occupational exposure Smelting of lead ore Manufacture of lead-acid accumulator Production of pigments,paints and glazes Environmental and living exposure Tail gases of automobile Drugs of lead-contained单击此处添课程名单击此处添课程名http:/ Ingestion Absorptiondust,fume,v

15、apour,3.Toxicology单击此处添课程名 Distribution soluble PbHPO4 Pb-plasm proteinSoft tissueLiver,kidney,spleen,lung,brainInsoluble Pb3(PO4)2 bone（9095%）hair teethPb3(PO4)2 PbHPO4单击此处添课程名ExcretionMain route:kidney(urine)Others:feces,hair,bile,latex,saliva etc.单击此处添课程名Mechanism of intoxication(1)Porphyrin meta

16、bolism单击此处添课程名单击此处添课程名Results of inhibited enzymes in porphyrin metabolism1.-ALA in blood and urine2.Heme synthesis3.FEP,ZPP in RBC4.Coproporphyrin in blood and urine 5.Number of young RBC (riticulocytes,basophilic,stippled)单击此处添课程名(2)Hemolysis(3)Nerve system(4)Kidney单击此处添课程名4.Clinical manifestation

17、 Chronic poisoning 4.1 Nervous system Central nerve system:Neurasthenic syndrome Peripheral neuropathy:Wristdrop Encephalopathy4.2 Gastrointestinal system Lead line-Blue-gray pigmentation on the gums Lead colic单击此处添课程名单击此处添课程名单击此处添课程名4.3 Haematopoietic system Anemia Reticulocytes,basophilic,stippled

18、 RBC4.4 Others单击此处添课程名单击此处添课程名单击此处添课程名5.Diagnosis Pb absorption Mild poisoning Moderate poisoning Severe poisoningIndexPb in the urine,bloodFEP,ZPPClinical manifestation单击此处添课程名6.Treatment7.Prevention enclosed systems local ventilation smelting temperature be controlled under 400单击此处添课程名2.2 Mercury

19、Poisoning1.Physical and chemical properties Silvery liquid metal Evaporates at room temperature secondary pollution Specific gravity:6.9 Melting point:-38.9 Dissoluble in water,soluble in lipid单击此处添课程名单击此处添课程名单击此处添课程名单击此处添课程名対照例 右大脳水平断脳重量1380水俣病 右大脳水平断 脳重量775 全体的強萎縮示、視力中枢（鳥距野印）、聴力中枢（横側頭回印）、水俣病患者共通傷害

20、部位。单击此处添课程名対照例 小脳水平断 歳男 水俣病 小脳水平断 急性発症重症長期生存例歳女 上同人小脳、強萎縮示。小脳神経細胞虫部（印）除完全失。单击此处添课程名单击此处添课程名单击此处添课程名2.Opportunities of exposure Smelting of mercury ore Manufacture of instruments and meters Amalgam used in dentistry单击此处添课程名3 ToxicologyMercuryInhalationIngestionBlood Vapour,dustAbsorption单击此处添课程名Distr

21、ibutionMercuryKidneyLiver,BrainHg+metallothionein单击此处添课程名Excretion单击此处添课程名Mechanism of intoxicationenzymeX-SHcovalent combinationcovalent combination单击此处添课程名 4.Clinical manifestation Chronic poisoning Acute poisoningMercury vapour Irritation of the bronchial mucous membranesStomatitisPneumonitis Fai

22、lure of kidneys单击此处添课程名 红细胞管型 颗粒管型 单击此处添课程名 5 Diagnosis Mercury absorption Acute poisoning Chronic poisoning单击此处添课程名 6 Treatment Accidental inorganic salt ingestionegg white,milk or soybean milk Chronic poisoning Sodium dimercaptosulfonate Sodium dimercaptosuccinate单击此处添课程名7 Prevention and control T

23、echnological innovation Nontoxic substitute Ventilation Personal protective equipment单击此处添课程名3 Benzene Poisoning1.Physical and chemical properties Boiling point:80.1单击此处添课程名2.Opportunities of exposure Distillation of coal tar or cracking of crude oil Raw material in the production of many aromatic c

24、ompounds Solvents for rubber,plastics,paints,and glues etc单击此处添课程名单击此处添课程名单击此处添课程名 Absorption&distributionbenzeneInhalationVapour50%Blood bone marrowbrainnerve system 3.Toxicology单击此处添课程名 Biotransformation&excretionbrenzcatechinbenzenediolphenolsulfuric acid glucuronic acidUrinebenzene epoxidemuconi

25、c acidCO2+H2OBenzenemixes-function oxidases单击此处添课程名 Mechanism of intoxication Bone marrow injuries:leucocyte DNA damage Immune system:autoimmunity Phenol:nuclei cleavage inhibition Oncogene activation:ras,c-fos,c-myc单击此处添课程名 4.Clinical manifestation Acute poisoning Narcotic effects of central nerve

26、system Feeling of drunkenness单击此处添课程名 Chronic poisoning Nerve system:单击此处添课程名单击此处添课程名单击此处添课程名 5.Diagnosis Observation subject Chronic mild poisoning Chronic moderate poisoning Chronic severe poisoning单击此处添课程名 她曾苦苦地挣扎了她曾苦苦地挣扎了11 11个月个月.张红入院11个月以来，一直处于危重状态，反复皮下出血及牙龈出血，随时会出现感染、败血症、颅内出血等严重并发症。头疼更如恶魔一样折磨

27、着这个脆弱的生命。她不断地说妈妈，我受不了了，受不了了”据称，医生的止痛针没有奏效，张红的头颅也开始出血了。一直熬到了傍晚7时左右，“孩子就七孔流血而死了。”张妈妈说。单击此处添课程名 6.Treatment Removed and avoid further exposure Recover the hematogenic ability Allopathy单击此处添课程名7.Prevention and Control Less harmful substitutes Technical procedure innovation Ventilation Personal protectio

28、n单击此处添课程名4 Aromatic amino and nitro compounds1.Physical and chemical properties High melting point Low volatility Dissoluble in water,soluble in lipid Aniline（C6H5-NH2）Nitrobenzene（C6H5-NO2）单击此处添课程名哈市停水哈市停水“多难的冬季多难的冬季”祸起何方？祸起何方？“松花江就是哈尔滨人的生命线，日均用水107万吨，来自松花江的为87万吨，采自地下的不足20万吨。事故造成苯胺装置、硝基苯储罐、2个苯储罐报废，

29、导致苯酚、老苯胺装置、苯酐装置、2、6二乙基苯胺等四套装置停产。硝基苯：无色或微黄色具苦杏仁味的油状液体。分子量123.11。相对密度1.205。熔点5.7。沸点210.9。难溶于水;易溶于乙醇、乙醚、苯和油。单击此处添课程名2006年11月14日10时，吉化公司松花江入江口水样有强烈的苦杏仁气味，苯、苯胺、硝基苯、二甲苯等主要污染物指标均超过国家规定标准。随着水体流动，污染带向下转移。11月20日16时到达黑龙江和吉林交界，硝基苯超标，最大超标倍数为29.1倍，污染带长约80公里，持续时间约40小时。单击此处添课程名中石油吉林石化公司苯胺车间爆炸事故，导致80公里长的高度污染水团顺松花江而下

30、，威胁黑、吉两省数百万民众，甚至可能波及中俄关系。单击此处添课程名Mechanism of intoxication(1):Methemoglobin formationMeHbFe2+Fe3+Bearing oxygen ability loseAffinity of Fe2+and oxygenHbindirect oxidationdirect oxidationAnilinenitrobenzeneMetabolites单击此处添课程名 Hematopoietic system:HemolysisAromatic amino and nitro compoundsGSH exhaust

31、HemolysisReact with-SH on globinHeinz body单击此处添课程名（2）Direct damage:Decomposed products deposit in liverHemolysis Toxic hepatitis Secondary damage:单击此处添课程名（3）Direct damage:Secondary damage:Decomposed products deposit in kidneyHemolysis单击此处添课程名(4)Liposoluble Blood-brain barrier(5)Contact dermatitisSen

32、sitization dermatitisBronchial asthma(6)(7)单击此处添课程名 2.Trinitrotoluene(TNT)2.1 Physical and chemical properties Primrose crystalMolecular weight:227.1 Melting point:82 Boiling point:240Specific gravity:1.65 Dissoluble in water,soluble in organic solvent单击此处添课程名2.2 Opportunities of ExposureUse as deto

33、nator in National defenceMiningDigging tunnelArchitectureDust 单击此处添课程名 2.3 Toxicology 4-amino-2,6-binitrotolueneBiomarker TNTAromatic amino and nitro compoundsUrineLiver damage单击此处添课程名2.4 Clinical manifestationToxic hepatitis单击此处添课程名2.5 Diagnosis Occupational history Clinical manifestation Productiv

34、e environment investigation Laboratory examinationToxic cataractToxic hepatitis2.6 Treatment and PreventionMethylene blue单击此处添课程名5 Poisonous gases poisoning Irritant gases poisoning Asphyxiant gases poisoning单击此处添课程名Direct irritant and corrosive effects on eyes,mucous membrane of respiratory tract,a

35、nd skin.1.Chlorine(Cl2):production of alkali,disinfectants,household cleaners 2.Ammonia(NH3):fertilizer production,refrigeration 3.phosgene(COCl2):chlorinated hydrocarbon solvents decompose 4.oxides of nitrogen(NOX):welding,auto exhaust5.hydrogen fluoride(HF):microelectronics6.sulfur dioxide(SO2):pa

36、per manufacturing,oil refining 7.sulfur trioxide(SO3)5.1 Irritant gases单击此处添课程名The most water-soluble substances are absorbed onto conjunctiva and mucous membranes of the nose and upper respiratory tract(ammonia)The less water-soluble substances exert their harmful effects especially in the lower re

37、spiratory tract(oxides of nitrogen)Solubility of the gasToxicology单击此处添课程名Toxic pulmonary edemaToxicologyoverfull retention of water in the pulmonary interstitial and alveolus space Mechanism of onset:(1)increased permeability of alveolar wall (2)increased permeability of blood capillary wall (3)obs

38、tructed return of lymph fluid 单击此处添课程名Clinical effectsAcute poisoning:1.inflammation of eyes and upper respiratory tract reflex coughing,laryngeal spasm 2.toxic tracheitis,bronchitis and pneumonitis 3.toxic pulmonary edema(pneumochysis)Clinical stages:irritant stage latency period(2-6h)lung edema pe

39、riod convalescence period(3-4days)4.adult respiratory distress syndrome(ARDS)单击此处添课程名Clinical effectsChronic damages:symptoms of conjunctivitis rhinitis pharyngitis bronchitis单击此处添课程名Treatment(1)On the spot treatment:(2)Keep respiratory tract unobstructed:(3)oxygen therapy:(4)Toxic pulmonary edema:单

40、击此处添课程名Chlorine,Cl21.Physical and chemical properties greenish-yellow gas at room temperature and atmospheric pressure choking smell Boiling point:-34.6and organic solvents单击此处添课程名2.Opportunities of exposuresalt electrolysis production of chloride paper-making,leather,printing and dying,sterilizatio

41、n单击此处添课程名 3.ToxicologyCl2+H2O HCl+HClOLow concentration:upper respiratory tractHigh concentration:deep respiratory tract pulmonary alveoli单击此处添课程名 4.Clinical manifestationAcute poisoning:1.irritation of eyes and upper respiratory tract:2.toxic pulmonary edema:3.skin lesions:ambustion,dermatitis plic

42、ation:infection,hemorrhage,pneumothoraxChronic damages:irritation discoloration and incomplete of the teeth单击此处添课程名 5.Diagnosis&Prevention irritation reaction Mild poisoning Moderate poisoning Severe poisoning单击此处添课程名Simple asphyxiant gases:simply displace oxygen from the inspired air,causing asphyi

43、xa Carbon dioxide:fires Methane:mining Nitrogen:diving Chemical asphyxiants gases:absorbed into the systemic circulation,interfering with the process of oxygen transport and utilization Carbon monoxide:fires Cyanide:gold extraction;electroplating and fires Hydrogen sulfide:oil refining;decaying orga

44、nic matter5.2 Asphyxiating Gas单击此处添课程名 Carbon monoxide is a colourless,odourless,tasteless,combustible,and explosive gas.lighter than airCarbon monoxide(CO)1.Physical and chemical properties Produced by the incomplete combustion of carbonaceous substances.2.Opportunities of exposure单击此处添课程名Mechanism

45、 of action:In blood,CO binds with haemoglobin to form carboxyhaemoglobin(COHb).CO competes with oxygen for binding sites on hemoglobin and decreases the oxygen hemoglobin saturation and oxygen delivery to tissues.3.ToxicologyO2+Hb HbO2COCOHbhypoxiaTissueO2cytochrome a3respiratory chain interception单

46、击此处添课程名(1)acute poisoning 1.Consciousness may be lost with few symptoms.2.COHb 10%:headache and subtle changes of mental function;COHb 20%:throbbing headache and loss of dexterity;COHb 30-40%:syncope;COHb 40-50%:coma and convulsions;3.The colour of skin and mucosa in patient is cherry,not cyanosis o

47、r in pale:COHb imparts a bright red color to blood.4.Severe acute CO poisoning may permanently damage the brain and heart.4.Clinical manifestation(2)delayed encephalopathy(2-60d)(3)chronic damage 单击此处添课程名5.Diagnosis Mild poisoning(10%)Moderate poisoning (30%)Severe poisoning(50%)delayed encephalopat

48、hyIndex:COHb单击此处添课程名 In acute poisoning,immediately remove the patient from further exposure to CO and administer oxygen.Further treatment should be symptomatic.Patients with after-effects of acute poisoning should not be further employed in occupation involving exposure to CO.6.Treatment单击此处添课程名a f

49、lammable colourless gas with a typical rotten-egg odour.Olfactory fatigue develops quickly,diminishing ones abilityto detect the odor.Hydrogen sulfide(H2S)1.Physical and chemical properties 2.Opportunities of exposureoil refining decaying organic matter单击此处添课程名Mechanism of actionInhibiting cellullar

50、 respiration in a similar fashion to HCN,blocking the utilization of oxygen,and anoxia develops in spite of normal quantities of oxygen in the blood.3.ToxicologyH2SInhalationH2S Na2SRespiratory tractNa+BloodH2S combine with Fe3+-S-S-Respiratory chain blockurineSO42-S2O32-Respiratory center单击此处添课程名 C

51、entral nervous system EyesRespiratory system In severe poisoning,coma,convulsions,and death may occur,sometimes within a few seconds(a sudden death).4.Clinical manifestation acute poisoning chronic damage 单击此处添课程名Treatment In acute poisoning immediately remove the patient from exposure and start sym

52、ptomatic treatment.Artificial respiration may be necessary.5.Diagnosis&Treatment Mild poisoning Moderate poisoning Severe poisoningDiagnosis单击此处添课程名Hydrogen cyanide(HCN)1.Physical and chemical properties 2.Opportunities of exposure colourless gas with atypical odour of bitter almonds one of the most

53、 rapidly lethal poisons electroplating metallurgy chemical engineering 单击此处添课程名Mechanism of action HCN has a strong affinity for trivalent iron and binds firmly to cytochrome oxidase of the mitochondrial respiratory chain.Since cytochrome oxidase is present in all cells,all aerobic cellular respirat

54、ion is impaired,and anoxia develops in spite of normal quantities of oxygen in the blood.3.Toxicology单击此处添课程名HCN rapidly causes vertigo,convulsions,confusion,altered speech,coma,and death(sudden death).Initial symptoms of acute HCN poisoning include weakness,headache,confusion,and occasionally nause

55、a and vomiting.Arterialization of venous blood,and the colour of skin and mucosa in patient is cherry.4.Clinical manifestation(1)acute poisoning (2)chronic damage prodromal perioddyspnea periodspasm periodparalysis period单击此处添课程名 Acute HCN poisoning can be treated very efficiently.The patient should

56、 be immediately removed from further exposure,and contaminated skin should be washed with warm water and soap.An effective treatment is sodium nitrite(NaNO2)given intravenously,forming methaemoglobin(MHb)which binds firmly with free cyanide ions to form cyanmethaemogolbin.Thereafter sodium thiosulfa

57、te(Na2S2O3)is given intravenously to increase the rate of conversion of cyanide to thiocyanate.5.Diagnosis&TreatmentNaNO2+Hb MHbCN-MHbCNNa2S2O3SCN-单击此处添课程名单击此处添课程名患者张某，女，患者张某，女，36岁，某皮鞋厂工人。因头痛、乏力、失眠、月经岁，某皮鞋厂工人。因头痛、乏力、失眠、月经过多、牙龈出血而入院。入院查体：神志清楚，呈贫血貌，皮肤粘过多、牙龈出血而入院。入院查体：神志清楚，呈贫血貌，皮肤粘膜无淤点，体温膜无淤点，体温37.2，脉搏

58、，脉搏74次次/min，呼吸，呼吸21次次/min，血压，血压110/65mmHG；心电图正常；胸部；心电图正常；胸部X线片未见异常改变。骨髓检查线片未见异常改变。骨髓检查诊断为再生障碍性贫血；血象检查诊断为急性粒细胞型白血病。诊断为再生障碍性贫血；血象检查诊断为急性粒细胞型白血病。1.该患者最有可能接触的是哪种有害物质该患者最有可能接触的是哪种有害物质2.要确定其为职业性中毒，还需调查什么要确定其为职业性中毒，还需调查什么3.该种毒物慢性中毒的主要临床表现是什么该种毒物慢性中毒的主要临床表现是什么单击此处添课程名1.皮鞋黏合剂主要成分中含有苯皮鞋黏合剂主要成分中含有苯2.空气检测结果表明：空

59、气中苯浓度最低为空气检测结果表明：空气中苯浓度最低为120mg/m3，最，最高达高达360mg/m3，是标准值的，是标准值的20-60倍。（苯的倍。（苯的PC-TWA：6mg/m3）3.工作间和休息间均在同一房间。工作时无任何防护措施，工作间和休息间均在同一房间。工作时无任何防护措施，室内无通风排毒装置。室内无通风排毒装置。4.无在岗期间健康检查制度，未接受过职业卫生宣传教育。无在岗期间健康检查制度，未接受过职业卫生宣传教育。上岗前未进行健康检查。上岗前未进行健康检查。职业卫生现况调查结果：职业卫生现况调查结果：单击此处添课程名 Chronic poisoning Nerve system:o

60、thers:skin,reproduction,immunology 单击此处添课程名单击此处添课程名单击此处添课程名患者陈某，男，患者陈某，男，47岁，某军工厂工人，工龄岁，某军工厂工人，工龄15年。近期内常感乏力、年。近期内常感乏力、食欲减退、恶心、腹痛；皮肤常感瘙痒伴脱屑。入院查体：神志清食欲减退、恶心、腹痛；皮肤常感瘙痒伴脱屑。入院查体：神志清楚，面色苍白，体温楚，面色苍白，体温37，脉搏，脉搏72次次/min，呼吸，呼吸20次次/min，血压，血压110/80mmHG；肝大肋下；肝大肋下1.5cm，有压痛、扣痛；肝功能检查转氨，有压痛、扣痛；肝功能检查转氨酶水平增高；血象检查见血红蛋

61、白、中性粒细胞水平下降；眼晶体酶水平增高；血象检查见血红蛋白、中性粒细胞水平下降；眼晶体检查见晶体周边呈环形混浊；心电图正常；肺功能正常；胸部检查见晶体周边呈环形混浊；心电图正常；肺功能正常；胸部X线片线片未见异常改变。未见异常改变。1.该患者最有可能接触的是哪种有害物质该患者最有可能接触的是哪种有害物质2.监测该种有害物质接触水平的生物监测物是什么监测该种有害物质接触水平的生物监测物是什么单击此处添课程名【毒理毒理】尿尿肝微粒体、线粒体肝微粒体、线粒体氧化、还原、结合氧化、还原、结合生物监测指标：生物监测指标：4-氨基氨基-2，6-二硝基甲苯二硝基甲苯（4-A）、）、TNT消耗还原性物质（消

62、耗还原性物质（GSH、还原型辅酶、还原型辅酶II）诱发脂质过氧化诱发脂质过氧化与生物大分子与生物大分子共价结合共价结合 （细胞内钙稳态紊乱，膜结构与功能破坏，（细胞内钙稳态紊乱，膜结构与功能破坏，细胞代谢紊乱甚至死亡）细胞代谢紊乱甚至死亡）TNT硝基硝基阴离子自由基阴离子自由基单击此处添课程名PbtoxicologyPorphyrin metabolismClinical manifestationAcute&chronicDiagnosis&TreatmentCaNa2-EDTAHgtoxicologyelectrophilicClinical manifestationAcute&chro

63、nicDiagnosis&TreatmentSodium dimercaptosulfonateBenzeneClinical manifestationchronictoxicologyAromatic amino and nitro compoundstoxicologyelectrophilicClinical manifestationTNT chronic poisoningDiagnosis&TreatmentMethylene blueIrritant gasestoxicologyClinical manifestationAcute ARDSDiagnosis&TreatmentAsphyxiating GasclassificationCO、HCN、H2S单击此处添课程名