Pan Jo-Hui, Peng Chiung-Yu, Lo Chung-Ting, Dai Chia-Yen, Wang Chao-Ling, Chuang Hung-Yi
Department of Occupational & Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Med Case Rep. 2017 Apr 28;11(1):120. doi: 10.1186/s13256-017-1280-9.
n-Hexane is a well-known neurotoxicant. Polyneuropathy due to occupational n-hexane exposure has been reported worldwide, however, our case is the first report in the Chinese herb industry.
A 25-year-old Asian man experienced progressive weakness and numbness in his hands and feet after working as an operator in a Chinese medicine pharmaceutical plant for the manufacture of Chinese herbal pain relief patches for 10 months. Electrophysiological studies indicated a reduction in nerve conduction velocity, prolongation of distal latencies, mildly positive sharp waves, and reduced recruitment with polyphasic potentials, particularly at distal sites. Demyelination with axonal degeneration caused by occupational n-hexane exposure was strongly suspected. Through investigation of our patient's workplace, the ambient n-hexane concentration in air was found to considerably exceed the permissible exposure limit/time-weighted average for n-hexane in Taiwan. His symptoms were gradually relieved after 4 months of cessation of exposure to n-hexane. He was then confirmed as a case of occupational n-hexane intoxication. Further effective control measures should be implemented as soon as possible to prevent exposure of workers to n-hexane.
Despite a typical clinical presentation, his exposure at workplace was appropriately investigated. Chemical exposure in Chinese medicine pharmaceutical plants could be an emerging issue that may affect workers' health. The lack of knowledge and management of solvents could endanger the health of workers. This case has profound educational implications for occupational health and is worthy of further follow-up for improving hazards control.
正己烷是一种知名的神经毒物。职业性接触正己烷导致的多发性神经病在世界各地均有报道，然而，我们的病例是中草药行业的首例报告。
一名25岁的亚洲男性，在一家中药制药厂担任操作员，负责生产中草药止痛贴10个月后，双手和双脚出现进行性无力和麻木。电生理研究表明神经传导速度降低、远端潜伏期延长、轻度正锐波以及多相电位募集减少，尤其是在远端部位。强烈怀疑是职业性接触正己烷导致脱髓鞘伴轴突变性。通过对我们患者工作场所的调查，发现空气中的正己烷浓度大大超过了台湾地区正己烷的允许暴露极限/时间加权平均值。停止接触正己烷4个月后，他的症状逐渐缓解。随后他被确诊为职业性正己烷中毒病例。应尽快实施进一步有效的控制措施，以防止工人接触正己烷。
尽管临床表现典型，但仍对其工作场所的接触情况进行了适当调查。中药制药厂中的化学物质接触可能是一个新出现的问题，可能会影响工人健康。对溶剂缺乏了解和管理可能会危及工人健康。该病例对职业健康具有深刻的教育意义，值得进一步随访以改善危害控制。
