Kilic Ertugrul, Ortatatli Mesut, Sezigen Sermet, Eyison Rusen Koray, Kenar Levent
a Department of Anesthesia and Reanimation , Sehitkamil State Hospital , Gaziantep , Turkey.
b Department of Medical CBRN Defense , University of Health Sciences , Etlik/Ankara , Turkey.
Cutan Ocul Toxicol. 2018 Dec;37(4):332-337. doi: 10.1080/15569527.2018.1464018. Epub 2018 May 7.
Sulphur mustard (SM) is an highly toxic and vesicant chemical weapon that was used in various military conflicts several times in the history. The severity of ocular, dermal, and pulmonary symptoms that may appear following a characteristic asymptomatic period are depending on the SM concentration and exposure duration. The aim of this study is to present the clinical features and share the intensive care unit (ICU) experiences for the medical management of mustard gas victims.
Thirteen Free Syrian Army soldiers near Al-Bab region of North Syria were reportedly exposed to oily blackish smoke with garlic smell due to the explosion of a trapped bomb without causing any blast or thermal effect on 26th November 2016. None of them wore any chemical protective suits or gas masks during explosion. Since they observed skin lesions including bullous formation next day, they were admitted to the Turkish Field Hospital at the Turkish - Syrian border and then evacuated to the State Hospital of Gaziantep Province, Turkey for further management. Eight victims who were very close to point of explosion suffered burning eyes, sore throat, dry cough and dyspnoea after the chemical attack.
On admission to hospital, all cases had conjunctivitis, hoarseness and bullae on various body areas. Blepharospasm and opacity were found in 8 patients and 5 of them had corneal erosions and periorbital oedema. Temporary loss of vision in 4 cases lasted for 24 h. Multiple fluid-filled blisters were observed especially on the scalp, neck, arms and hands, where direct skin exposure to the agent occurred. A definitive clinical care and infection prophylaxis measures along with the burn treatment and bronchodilators for respiratory effects were applied in ICU. Two patients received granulocyte-colony-stimulating factor due to the SM-mediated bone marrow suppression on the 16th day of exposure and one of them died because of necrotic bronchial pseudomembrane obstruction resulting in cardiopulmonary arrest.
SM was first used during the First World War and it is still considered one of the major chemical weapons recently used by non-state actors in Syria and Iraq. In case of SM exposure, medical treatment of SM-induced lesions is symptomatic because no antidote or causal therapy does exist even though SM is very well known for over 100 years. However, clinical management in intensive care medicine of SM victims have improved since the 1980s, this study which is one of the largest recent SM-exposed case series since that time is important for the contribution to the clinical experience.
硫芥是一种剧毒且具有腐蚀性的化学武器，在历史上曾多次用于各种军事冲突。在一段典型的无症状期后可能出现的眼部、皮肤和肺部症状的严重程度取决于硫芥的浓度和暴露持续时间。本研究的目的是呈现临床特征，并分享重症监护病房（ICU）对芥子气受害者进行医疗管理的经验。
据报道，2016年11月26日，叙利亚自由军的13名士兵在叙利亚北部巴卜地区附近，因一枚被困炸弹爆炸而暴露于有大蒜气味的油黑色烟雾中，爆炸未造成任何爆炸或热效应。爆炸期间他们均未穿着任何化学防护服或佩戴防毒面具。由于次日他们观察到包括水疱形成在内的皮肤损伤，他们被送往土耳其 - 叙利亚边境的土耳其野战医院，随后被转移到土耳其加济安泰普省的国立医院进行进一步治疗。8名距离爆炸点非常近的受害者在化学袭击后出现眼睛灼痛、喉咙痛、干咳和呼吸困难。
入院时，所有病例均有结膜炎、声音嘶哑以及身体各部位出现水疱。8例患者出现眼睑痉挛和视力模糊，其中5例有角膜糜烂和眶周水肿。4例患者出现短暂视力丧失，持续24小时。尤其在头皮、颈部、手臂和手部观察到多个充满液体的水疱，这些部位皮肤直接接触了该制剂。在ICU中采取了明确的临床护理和感染预防措施，同时进行烧伤治疗并使用支气管扩张剂以应对呼吸影响。2例患者因暴露第16天出现硫芥介导的骨髓抑制而接受粒细胞集落刺激因子治疗，其中1例因坏死性支气管假膜阻塞导致心肺骤停死亡。
硫芥在第一次世界大战期间首次使用，至今仍被认为是叙利亚和伊拉克非国家行为者最近使用的主要化学武器之一。在硫芥暴露的情况下，由于即使硫芥已被知晓100多年，但仍不存在解毒剂或病因疗法，因此对硫芥所致损伤的治疗是对症治疗。然而，自20世纪80年代以来，重症医学对硫芥受害者的临床管理有所改善，本研究是自那时以来近期最大的硫芥暴露病例系列之一，对临床经验的贡献具有重要意义。
