Fischer M, Hellmann A, Wohlrab J, Marsch W C
Klinik und Poliklinik für Hautkrankheiten, Martin-Luther-Universität Halle-Wittenberg.
Dtsch Med Wochenschr. 1998 Feb 6;123(6):151-4. doi: 10.1055/s-2007-1023920.
Two temporary labourers, on piece work without sufficient prior instructions, were employed to clean a house facade. During the work, at first limited to 5-10 minutes, they sustained chemical burns from the hydrofluoric and hydrochloric acids contained in the liquid used to clean the stone. Both workers had been left uniformed about the danger or kind of the material being used, because of their short-time employment. They only sought medical help several hours later.
At the areas of contact with the cleansing liquid (hands, lower arms and thighs, in case 1; additionally at first well circumscribed and very painful areas of erythema, developing within a few hours into blisters, in case 2; also erosions in both).
Chemical burns by hydrofluoric acid were only elucidated as the cause 24 hours after exposure. Repeat tests (ECG, blood gas analysis, electrolyte levels) provided no evidence of deep-seated burns at the contact areas or systemic poisoning. Radiology of the hand was normal.
As there was at first no indicative history, toxic contact dermatitis was suspected and treated topically with Clobetasol-17-propionate. Once the true cause became known treatment consisted of compresses with 10% calcium gluconate solution. All lesions healed completely within 4 and 6 days, respectively.
Temporary workers are often insufficiently instructed, despite clear legal regulations. Such lack of informations increases the risk of harm to workers and makes appropriate treatment more difficult.
两名临时工受雇清洁房屋外立面,他们从事计件工作,事先未得到充分的指示。工作期间,起初持续了5至10分钟,他们被用于清洁石材的液体中所含的氢氟酸和盐酸灼伤。由于工作时间短,两名工人都未被告知所使用材料的危险性或种类。数小时后他们才寻求医疗帮助。
在与清洁液接触的部位(病例1为手部、下臂和大腿;病例2除这些部位外,起初还有界限清楚且疼痛剧烈的红斑区域,数小时内发展为水疱,两人均有糜烂)。
氢氟酸化学灼伤在接触24小时后才被确认为病因。重复检查(心电图、血气分析、电解质水平)未发现接触部位有深部灼伤或全身中毒的证据。手部X线检查正常。
起初由于没有提示性病史,怀疑为中毒性接触性皮炎,外用丙酸氯倍他索治疗。一旦明确真正病因,治疗改为用10%葡萄糖酸钙溶液湿敷。所有皮损分别在4天和6天内完全愈合。
尽管有明确的法律法规,但临时工往往未得到充分的指导。这种信息缺失增加了工人受到伤害的风险,也使恰当的治疗更加困难。