手传振动工人冷水复温率影响因素的多因素Logistic回归分析

目的 检测和评估手传振动企业的手传振动危害,初步分析手传振动作业工人冷水复温率的影响因素。 方法 以广东省五家企业的接振工人为研究对象,现场检测振动接触水平,测定冷水复温率。通过问卷调查,了解不同岗位接振工人的一般情况。分析性别、年龄、吸烟、饮酒、高血压、接振剂量、不同岗位与冷水复温异常率的关联。 结果 所检测的48个接振岗位操作中有31个岗位的振动水平A (4)超过我国国家标准规定的5 m/s2,超标率64.6%。按国际上A (8)的分级标准,有28个点达到或超过Ⅰ级危险度。经单因素χ2检验,年龄、吸烟指数、高血压、接振剂量对冷水复温异常影响的差异有统计学意义(P均< 0.05)。Logistic回归分析发现,年龄≥ 40岁与冷水复温率关联的比值比(OR)=1.865(P < 0.05)。吸烟指数> 600与冷水复温率关联的OR=2.474(P < 0.05)。高血压与冷水复温率关联的OR=1.231(P < 0.05)。饮酒指数≤ 600与冷水复温率关联的OR=0.395(P < 0.05)。中剂量组、高剂量组与冷水复温率的关联的OR值分别为1.232、2.135(P均> 0.05)。 结论 所调查的企业手传振动危害严重。年龄、吸烟、高血压是影响冷水复温率异常的危险因素,饮酒指数≤ 600是保护因素。接振剂量与冷水复温异常无明显相关。     

煤矿掘进工手部循环功能与血管内皮活性物质的关系

[目的]探讨手臂振动对手部循环功能的影响及其与血管内皮活性物质之间的关系。[方法]以煤矿男性井下掘进工64名作为研究对象,按累积接振时间的长短分为高暴露组、中暴露组和低暴露组,并选22名非接振的健康人作为对照组,对每组进行血管内皮物质和冷水负荷试验测定,分析二者之间的相关关系。[结果]3个振动暴露组内皮素（ET）浓度、血栓素B2（TXB2）浓度均明显高于对照组（P〈0．01）;该3个暴露组的一氧化氮（NO）浓度、6．酮前列腺素Flu（6-keto-PGF1α）浓度均明显低于对照组（P〈0．01）0冷水试验前高暴露组皮肤温度明显低于对照组（P〈0．01）,冷水负荷试验后3个暴露组在5、10、30min的皮肤温度明显低于相同时间的对照组（P〈0．01）。10min复温异常率、30min复温异常率在对照组、低暴露组、中暴露组、高暴露组间差异有统计学意义（P〈0．01）;且呈明显的剂量．效应关系。将各组血管内皮物质与5min复温率、10min复温率进行相关分析,可见复温率与ET、TXB2呈明显的正相关关系（P〈0．01）,而与NO、6-keto-PGF1α呈明显的负相关关系（P〈0.01）。[结论]振动性血管内皮物质紊乱与手部复温情况具有一致性,提示振动性血管功能紊乱可以作为振动性血管损伤的评价参考指标。     

振动作业工人手部红外图像分析

目的研究振动作业人员手部红外摄像和冷水试验对手臂振动病周围循环功能的改变。方法通过对非接触振动的健康工人50名(对照组)、尚未发生振动性白指的振动作业工人50名(接振组),在冷水负荷前后,用KY-333型远红外摄像仪进行手部红外摄像,研究手部周围循环功能的变化。结果冷水试验前两组工人手部红外图像差异无显著性(P>0.05);冷水试验后5和10min接振组手指皮肤温度比对照组下降显著(P<0.05和P<0.01),两组冷水试验后5min平均皮温分别为:右手(21.5±1.7)和(23.5±1.8)℃,左手(20.5±1.1)和(24.0±1.6)℃;接振组复温时间延长。结论手部红外摄像结合冷水试验对振动作业工人周围循环功能障碍具有早期识别意义。     

振动作业工人手部红外图像分析

目的研究振动作业人员手部红外摄像和冷水试验对手臂振动病周围循环功能的改变。方法通过对非接触振动的健康工人50名（对照组）、尚无发生振动性白指的振动作业工人50名（接振组）,在冷水负荷前后,用KY-333型远红外摄像仪进行手部红外摄像,研究手部周围循环功能的变化。结果冷水试验前两组工人手部红外图像差异无统计学意义（P〉0.05）;冷水试验后5 min和10 min接触振动组手指皮肤温度比对照组下降显著（P〈0.05和P〈0.01）,两组冷水试验后5min平均皮温分别为：右手（21.5±1.7）℃和（23.5±1.8）℃,左手（20.5±1.1）℃和（24.0±1.6）℃;接振组复温时间延长。结论手部红外摄像结合冷水试验对振动作业工人周围循环功能障碍具有早期识别意义。     

手传振动作业工人暴露水平及手臂损伤影响因素分析

目的 检测和评估某新型制造企业中手传振动水平,初步探讨手传振动作业工人手臂损伤症状的影响因素。 方法 以某企业振动作业工人为研究对象,现场检测振动暴露水平,并问卷调查工人一般情况和手臂症状,测定冷水复温率;分析高血压、高血压家族史及体质指数与冷水复温率和手臂症状的关联。 结果 所测振动水平4 h等能量频率计权加速度值A (4)为4.28~15.09(7.97±3.04) m/s2;81.3%的工人自述有手臂症状;77.5%的工人冷水复温率异常。高血压、高血压家族史和体质指数≥ 28与冷水复温率关联的比值比(OR)及95%可信区间(95% CI)在校正年龄、吸烟和饮酒后分别为1.12(0.60~5.79)、0.84(0.20~3.10)和0.64(0.36~3.56);高血压、高血压家族史和体质指数≥ 28与工人手臂自觉症状关联的OR值及95% CI在校正年龄、吸烟和饮酒后分别为1.80(0.86~7.19)、1.02(0.77~4.81)和0.75(0.68~5.27)。 结论 该新型制造企业中手传振动危害严重。尚未发现高血压、高血压家族史和高体质指数与工人手臂损伤有明显关联。     

手传振动对广东省打磨作业工人血脂的影响

目的探讨手传振动对广东省打磨作业工人血脂的影响。方法以2010—2012年广东省从事打磨作业的179名工人和45名非打磨工人为研究对象,检测职业性手臂振动病病例组和接振组、对照组工人血清中的血胆固醇(CHOL)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)含量,比较不同工龄、病例组与对照组间、不同程度病例间、病例组住院治疗前后血脂的差异。结果工龄与振动病严重程度分级间无相关性;接振组HDL较对照组升高,病例组和接振组LDL都有降低,差异均有统计学意义(P0.05);轻度手臂振动病患者的CHOL和中度手臂振动病患者的HDL与对照组比较有所降低,差异均有统计学意义(P0.05);职业性手臂振动病患者住院治疗后CHOL明显降低,TG、HDL、LDL升高,差异均有统计学意义(P0.05)。结论手传振动可影响工人的血脂,血脂改变可能与职业性手臂振动病的发病机制有关。     

冷水复温试验对振动性白指检出率的影响

目的观察冷水复温试验对振动性白指检出率的影响。方法应用(10±0.5)℃浸泡10 min的改进冷水复温试验方法,观察118名局部振动作业人员的振动性白指检出率和5 min、10 min复温异常率。结果 受检组振动性白指检出率除与对照组比较,差异有统计学意义外。与《GB 4869—85》中冷水复温试验检查结果比较,差异仍有统计学意义,同时5 min、10min复温异常率显著高于原方法的检查结果。结论 改进的冷水复温试验方法可充分反映局部振动作业人员的末梢循环受损程度。     

手臂振动病病人血中肿瘤坏死因子测定及其临床意义探讨

目的检测并比较对照组和接振作业人群外周血肿瘤坏死因子-α(TNF-α)水平的差别,探讨其是否适合作为手臂振动病诊断和分级的临床实验室辅助检测指标。方法酶联免疫吸附法检测目标人群外周血TNF-α水平。结果 94.12%手臂振动病病人(病例组)TNF-α水平超过正常参考值8.1 pg/ml,手臂振动病病人(接振组)TNF-α浓度明显高于对照组(P0.01)。但手臂振动病人中白指组与非白指组及三个不同工龄组间(5年及以下、6~10年、11年及以上)TNF-α水平比较,差异均无统计学意义。结论手臂振动病病人血中TNF-α异常增高可能与病人血管损伤所致炎症有关,但未呈现出剂量—效应关系趋势。     

振动作业者手部冷水试验红外图像测温

[目的]利用红外摄像结合冷水试验了解手臂振动对手部周围循环功能的影响。[方法]通过对振动作业工人50名（接振组），非接振健康工人50名（对照组），在冷水负荷前后，用KY-333型远红外摄像仪进行手部红外摄像，对图像分析并进行对比。[结果]冷水试验前，两组工人手部红外图像差异无统计学意义（P〉0．05）；冷水试验后接振组手指皮肤温度较对照组下降，复温时间延长（P〈0．01）。[结论]振动作业对手部周围循环功能有影响，红外摄像结合冷水试验可作为检查方法之一。     

红外摄像应用于局部振动病早期诊断的实验研究

为寻找早期发现局部振动对机体所造成损害的新方法,我们应用红外摄像法和热电偶温度计法对选取的22名从事接振作业的亚临床期工人和15名健康对照进行了冷水负荷复温试验,分析了两组手部温度的变化并对两种方法的结果作一比较,发现楼振组与对照组相比,冷水复温试验前手部温度差异无显著意义(P>0.05),但在施加冷水负荷后接振组手部温度明显较低,复温时间延长(P<0.05)。可见局部振动在亚临床期即已经对机体微循环造成一定程度的损害;两种方法均能准确地发现这种损害,但红外摄像法更加简便易行,在局部振动病的早期诊断中具有很高的应用价值。     

Temperature and vibration thresholds in vibration syndrome

In a study to investigate whether the quantitative assessment of temperature and vibration thresholds can improve the evaluation of the neurological symptoms in vibration syndrome 37 patients with neurological symptoms (paraesthesias, numbness, pain) in the hands who had worked with hand held vibrating tools and 46 healthy controls not exposed to vibration were examined. Temperature thresholds were measured on the thenar eminence and on the volar side of the second and third fingers held together. Vibration thresholds were determined on the dorsum of the hand and on the dorsal side of the second and fifth fingers proximal to the nail. The neutral zone between thresholds for warmth and cold was much wider in the patients than in the controls. Patients older than 45 had higher vibration thresholds than controls. Electroneurography was abnormal in 18 of 34 patients and a carpal tunnel syndrome was diagnosed in six subjects. This investigation is thus indicated in patients with neurological symptoms. Seven of the patients with normal electroneurographic findings had impaired temperature or vibration thresholds or both. Determination of sensory thresholds seems to add valuable information and the methods are, by contrast with electroneurography, easily adapted to the screening of exposed groups outside hospital. Our results indicate that thin myelinated and unmyelinated nerve fibres might be damaged in the vibration syndrome.     

Temperature and vibration thresholds in vibration syndrome.

In a study to investigate whether the quantitative assessment of temperature and vibration thresholds can improve the evaluation of the neurological symptoms in vibration syndrome 37 patients with neurological symptoms (paraesthesias, numbness, pain) in the hands who had worked with hand held vibrating tools and 46 healthy controls not exposed to vibration were examined. Temperature thresholds were measured on the thenar eminence and on the volar side of the second and third fingers held together. Vibration thresholds were determined on the dorsum of the hand and on the dorsal side of the second and fifth fingers proximal to the nail. The neutral zone between thresholds for warmth and cold was much wider in the patients than in the controls. Patients older than 45 had higher vibration thresholds than controls. Electroneurography was abnormal in 18 of 34 patients and a carpal tunnel syndrome was diagnosed in six subjects. This investigation is thus indicated in patients with neurological symptoms. Seven of the patients with normal electroneurographic findings had impaired temperature or vibration thresholds or both. Determination of sensory thresholds seems to add valuable information and the methods are, by contrast with electroneurography, easily adapted to the screening of exposed groups outside hospital. Our results indicate that thin myelinated and unmyelinated nerve fibres might be damaged in the vibration syndrome.     

Clinical aspects of vibration disease caused by general vibration

The clinico-functional examination of agricultural machine-operators, truck drivers, excavator and boring machine operators revealed that, under low-frequency general vibration, polymorphic pathologic changes occur in human organism. Those include peripheral vascular and neuritic disorders and changes in the vertebral column. The most peculiar symptoms of VD are dealt with. The data obtained show to the importance of further elaboration of differential diagnostic criteria of VD, specifying its pathogenic mechanisms and prevention measures working out.     

Symptoms of contruction workers exposed to whole body vibration and local vibration

Summary To study the effects of construction machinery operation on subjective symptoms, a questionnaire survey was caried out among construction machinery operators by a self-reporting method. Subjects were 184 power shovel operators, 127 bulldozer operators, 44 forklift operators as operator groups, and 44 office workers as a control. Their ages were in a range of 30–49 years. The questionnaire contained 20 symptoms referring to fatigue, digestive problems, and upper or lower limbs or back problems. The prevalence rate and symptom characteristics were examined. The dominant symptoms of the operator groups were stiff shoulder, low back pain, and stomack symptoms. The prevalence rate of low back pain was significantly different between forklift operators and controls. No significant differences were found in the symptoms of upper limbs and fingers between operator groups and controls. The prevalence of Raynaud's phenomenon was 0.5%–2.3% in the operator groups and 2.3% in the control group.