目的调查一起由氮氧化物引起的职业性急性中毒事故发生的原因,提出有效的预防措施。方法开展现场职业卫生学调查,查阅接诊医院病例临床资料,结合毒物接触史,综合分析该起中毒事故特点。结果该例患者被确诊为职业性急性氮氧化物中毒,事故主要原因为作业者违反安全操作制度,未佩戴个人防护用品,未开启通风排毒设备,接诊医院处置不当。结论企业应加强对作业人员的职业卫生安全监管及职业卫生知识培训,综合医院应加强临床医生对急性职业中毒病人的处置能力。 Objective To investigate the causes of occupational acute poisoning caused by nitrogen oxides and propose effective preventive measures. Methods To carry out on-the-spot occupational hygiene investigation, consult the clinical data of admissions clinic cases, combined with the history of poison contact, comprehensively analyze the characteristics of the poisoning accident. Results The patient was diagnosed with occupational acute nitrogen oxide poisoning. The accident was mainly caused by breach of safe operation system by operators, wearing of personal protective equipment, ventilation and detoxification equipment, and inappropriate treatment at the admissions hospital. Conclusion Enterprises should strengthen the occupational health and safety supervision of occupational health workers and occupational health knowledge training. The general hospital should strengthen the ability of clinicians to dispose of acute occupational poisoning patients.