Toxicology Consulting and Medical Translating Services, Azle and Springtown, TX, USA.
Colorado School of Public Health, University of Colorado-Denver, Denver, CO, USA.
Crit Rev Toxicol. 2019 Sep;49(8):637-669. doi: 10.1080/10408444.2019.1707773.
Corrosive chemical substance ingestions are a major problem, especially in developing countries, but also in developed countries such as the United States, France, and Belgium. Ingestions may be deliberate as suicide attempts (mostly in adolescents and adults) or accidental (mostly in children). The results can be devastating in terms of individual suffering and disability, but also in terms of resource utilization and costs. In developing countries, outcomes may be worse because of limited medical/surgical resources. Common sequelae include gastrointestinal (GI) tract (esophagus, stomach, pylorus, and duodenum) stricture formation, GI tract perforation, and hemorrhage. Systemic effects may also occur, such as disseminated intravascular coagulation (DIC), multi-organ system failure, and sepsis. Various interventions in the acute phase to reduce the severity of injury have been attempted, but there are no large controlled clinical trials to demonstrate efficacy. Dilation therapy in various forms is commonly used for the treatment of strictures and a variety of surgical procedures including esophagectomy and delayed replacement may be required in severe corrosive injury cases.
腐蚀性化学物质摄入是一个主要问题,特别是在发展中国家,但也在发达国家如美国、法国和比利时存在。摄入可能是故意的,如自杀企图(主要在青少年和成年人中)或意外(主要在儿童中)。无论在个体痛苦和残疾方面,还是在资源利用和成本方面,其后果都可能是灾难性的。在发展中国家,由于医疗/外科资源有限,结果可能更糟。常见的后遗症包括胃肠道(GI)道(食管、胃、幽门和十二指肠)狭窄形成、GI 道穿孔和出血。也可能发生全身效应,如弥散性血管内凝血(DIC)、多器官系统衰竭和败血症。已经尝试了在急性期进行各种干预以减轻损伤的严重程度,但没有大型对照临床试验来证明其疗效。各种形式的扩张治疗常用于治疗狭窄,在严重腐蚀性损伤的情况下,可能需要进行各种手术程序,包括食管切除术和延迟替换。