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[目的]调查一起发生在某钢瓶回收工厂内造成两死一伤的职业中毒事故的原因,为临床救治提供依据。[方法]运用职业卫生现场调查方法,结合患者临床资料,并检测中毒现场空气、水样中砷化氢、磷化氢、氟化氢浓度,对结果进行分析。[结果]3名患者均有明显的溶血症状。现场空气中砷化氢、磷化氢、氟化氢未检出,来自现场两个水桶的水样中砷的质量浓度分别为67.7 mg/L及13.6 mg/L,氟化物质量浓度分别为0.5 mg/L及0.2 mg/L,磷化物未检出,患者尿砷浓度均高于一般人群。经过现场调查和实验室检测,结合患者的临床症状,确认本次事故是砷化氢引起的职业性急性中毒。[结论]没有安全操作规程,缺乏必要的通风、排毒设备,缺乏个人防护措施,缺乏安全教育、安全意识,是引起本次事故的原因。用人单位要吸取教训,避免类似事故再次发生。
[Objective] To investigate the causes of occupational poisoning that caused two deaths and one trauma in a cylinder recycling factory together to provide the basis for clinical treatment. [Methods] The occupational health field survey method was used to analyze the clinical data of the patients and to detect the concentration of arsine, phosphine and hydrogen fluoride in the air of the poisoning site and in the water samples. [Results] All three patients had obvious hemolytic symptoms. Arsenic, phosphine and hydrogen fluoride were not detected in the air at the scene. The concentrations of arsenic in water from two buckets were 67.7 mg / L and 13.6 mg / L respectively, and the concentrations of fluoride were 0.5 mg / L and 0.2 mg / L, phosphide was not detected in patients with urinary arsenic concentrations were higher than the general population. After field investigation and laboratory tests, combined with the clinical symptoms of patients to confirm this accident is caused by arsine occupational acute poisoning. [Conclusion] The reason of this accident is that there is no safe operation procedure, lack of necessary ventilation and detoxification equipment, lack of personal protective measures, lack of safety education and safety awareness. Employers should learn lessons to avoid similar accidents happen again.