Elsafti Elsaeidy Abdallah M, Alsaleh Osama I, van Berlaer Gerlant, Alhallak Abdulrahman A, Saeed Saad S, Soliman Ashraf, Hubloue Ives
Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussels, BEL.
Emergency Department, Hamad Medical Corporation, Doha, QAT.
Cureus. 2021 Aug 28;13(8):e17522. doi: 10.7759/cureus.17522. eCollection 2021 Aug.
Background In 2014, Hama Governorate was exposed twice to chlorine gas, with 15 patients presenting to Kafr Zita Hospital in Northwest Syria. This study aimed to describe clinical manifestations of chlorine gas exposure to identify factors leading to facility admission and the need for ICU/intubation in conflict-affected areas with limited healthcare infrastructure. Methods We conducted a case-series study, using medical records of suspected chlorine-exposed patients presenting at Kafr Zita Hospital on either 11 April or 22 May 2014. Data on age, sex, initial clinical presentation, therapeutic management, and outcome were compared by hospital admission/non-admission and attack date. All patients provided verbal informed consent. Results Fifteen patients with signs of chlorine gas exposure had detailed medical records. The mean age was 25.7 years (range 2-59), eight were male (53%), and three (20%) were under age 16. At initial presentation, all experienced respiratory distress, due to severe airway inflammation confirmed by nonspecific pulmonary infiltrates on chest x-ray, and similar intestinal, neurological, dermatological, ophthalmological, and psychological signs and symptoms. Acute management consisted of oxygen and bronchodilators for all patients, hydrocortisone (93%), antiemetics (80%), and dexamethasone (13%). Seven (47%) made a rapid symptomatic recovery and were discharged the same day and eight (53%) were admitted for a median of two days (range 1-6 days), one of whom required intubation and later died. The only significant associations found were higher mean pulse rate (i.e. 138 versus 124; p=0.043) and body temperature (37.0 versus 36.5; p=0.019) among admitted patients compared to non-admitted. Conclusion Our results demonstrated that even in low-resource humanitarian settings the survival rate for chlorine gas exposed patients is fair. Despite the small sample, this study provides insight into the clinical presentation, management, and outcomes of weaponized chlorine gas exposure, though further research is required to understand any chronic consequences.
背景 2014 年，哈马省两次遭受氯气袭击，15 名患者被送往叙利亚西北部的卡弗齐塔医院。本研究旨在描述氯气暴露的临床表现，以确定在医疗基础设施有限的冲突地区导致患者入院以及入住重症监护病房/需要插管的因素。方法 我们进行了一项病例系列研究，使用 2014 年 4 月 11 日或 5 月 22 日在卡弗齐塔医院就诊的疑似氯气暴露患者的病历。通过患者是否入院以及袭击日期，比较年龄、性别、初始临床表现、治疗管理和结局等数据。所有患者均提供了口头知情同意。结果 15 例有氯气暴露迹象的患者有详细病历。平均年龄为 25.7 岁（范围 2 - 59 岁），8 例为男性（53%），3 例（20%）年龄在 16 岁以下。初次就诊时，所有患者均出现呼吸窘迫，胸部 X 光显示非特异性肺部浸润证实存在严重气道炎症，同时伴有类似的肠道、神经、皮肤、眼科和心理方面的体征和症状。急性处理措施包括所有患者均给予氧气和支气管扩张剂、93%的患者使用氢化可的松、80%的患者使用止吐药以及 13%的患者使用地塞米松。7 例（47%）患者症状迅速缓解并于当日出院，8 例（53%）患者入院，中位住院时间为 2 天（范围 1 - 6 天），其中 1 例需要插管，后来死亡。与未入院患者相比，入院患者中唯一显著相关的因素是平均脉搏率较高（即 138 对 124；p = 0.043）和体温较高（37.0 对 36.5；p = 0.019）。结论 我们的结果表明，即使在资源匮乏的人道主义环境中，氯气暴露患者的生存率也还算可以。尽管样本量小，但本研究为武器化氯气暴露的临床表现、管理和结局提供了见解，不过仍需要进一步研究以了解任何慢性后果。
