职业性接触粉尘工人不同结局的肺通气功能比较

目的比较职业性接触粉尘导致的不同结局工人肺通气功能及小气道损伤状况,为早期诊断职业性呼吸疾患提供依据。方法选取某矿煤工尘肺患者80例,尘肺合并结核33例,以及无尘肺矿工177例为接触粉尘后的三种不同结局。分别测定各结局对象的肺功能,指标包括FVC、FEV1、FEV1/FVC、V50、V25、MMEF,以实测值占预计值百分比进行比较分析。结果比较各组肺功能各指标实测值占预计值的百分比,尘肺合并结核组各指标显著低于其他两组(P<0.01),单纯尘肺组在FVC%、FEV1%和FEV1/FVC%上损伤分级均属正常(>80%);各组肺通气功能损伤级别构成差异有统计学意义(P<0.01),其中尘肺合并结核组肺功能在中重度损伤的比例显著高于其他组,而无尘肺组正常的肺功能级别比例显著高于其余两组(P<0.01)。小气道指标(V50%,V25%)在尘肺合并结核组和尘肺组显著减低。结论职业性接触粉尘导致的尘肺及尘肺合并结核肺通气功能显著减低;小气道功能对职业性接触粉尘肺功能损伤较敏感,对职业性接触粉尘工人有早期预警作用。     

石工尘肺合并肺结核的X线诊断

尘肺病是由于在职业活动中长期吸人生产性粉尘并在肺内潴留而引起的以肺组织弥漫性纤维化为主的全身性疾病。石工尘肺系尘肺中的一种，石工尘肺病例大都是农民工，多为临时性工作，未经职业病防护知识的培训，对尘肺认识不足，常被人们所忽视。它容易合并肺结核，是造成患者死亡的主要原因。因为粉尘和结核的病变相互促进，改变了病人的临床症状，在X线胸片上各自具有独特的征象，使病情复杂、加重，给诊断带来一定难度，一些小的可疑病灶常被忽视。造成漏诊，一旦病情加重时，才能确诊，影响了病人的生存质量。因此，对石工尘肺合并肺结核的早诊断，早期得到及时的抗痨治疗尤为重要。现将我中心1993年-2003年收集的石工尘肺合并肺结核68例X线改变作一回顾性分析。     

大容量全肺灌洗治疗尘肺的疗效观察与护理

大容量全肺灌洗（Whole Lung Lavage,WLL）是通过纤维支气管镜清洗肺内的粉尘、吞尘巨噬细胞、致纤维化因子和炎症因子,减少异物刺激,从而达到治疗尘肺的效果。近年来,我院采用大容量全肺灌洗治疗尘肺患者450例,效果良好,现报道如下。     

蜕皮甾酮对撞击致肺挫伤的影响

目的：研究蜕皮甾酮（ＥＤＳ）是否对肺损伤有治疗作用．方法：应用ＢＩＭ－Ⅱ型生物撞击机造成家兔肺挫伤，测定肺组织血管紧张素转换酶（ＡＣＥ）、血浆内皮素（ＥＴ）的水平，光镜观察肺微血管的变化，以此判定静脉注射ＥＤＳ对肺挫伤的影响．结果：撞击致家兔肺挫伤时，肺组织ＡＣＥ增多，血浆ＥＴ增加，肺毛细血管管腔变窄、内皮细胞肿胀等；伤后家兔静脉应用ＥＤＳ，则肺组织ＡＣＥ有所减少，血浆ＥＴ降低，肺毛细血管病变较单纯损伤时减轻．结论：家兔肺挫伤后静脉注射ＥＤＳ，能够减轻其撞击所致的肺损伤．提示ＥＤＳ可能对撞击所致肺挫伤有一定治疗作用，其机制有待进一步研究．     

60Co-γ射线照射对大鼠肺一氧化氮合酶和内皮素系统基因表达的影响

探讨一氧化氮合酶（ｎｉｔｒｉｃｏｘｉｄｅｓｙｎｔｈａｓｅ，ＮＯＳ）和内皮素（ｅｎｄｏｔｈｅｌｉｎ，ＥＴ）及ＥＴ转换酶（ｅｎｄｏｔｈｅｌｉｎｃｏｎｖｅｒｔｉｎｇｅｎｚｙｍｅ，ＥＣＥ）等在受照射肺中的基因表达变化，揭示其在肺纤维化发生中的参与作用。方法用６０Ｃｏ对大鼠肺进行３０Ｇｙ照射，照后４，８，２４天提取总ＲＮＡ，分别做ＲＴ－ＰＣＲ；对照射后１，３，５个月肺组织进行ＥＴ肽的Ｗｅｓｔｅｒｎｂｌｏｔ和ＮＯＳ－ｍＲＮＡ原位杂交。结果照射后肺ＮＯＳｍＲＮＡ转录减弱，ＥＴｍＲＮＡ增强，ＥＣＥｍＲＮＡ在第８和２４天增强，ＥＴＢ－ＲｍＲＮＡ在第２４天转为阴性。照射后１，３，５月肺组织ＥＴ肽合成增加。照射后５个月ＮＯＳｍＲＮＡ原位杂交呈阴性。结论ＥＴ和ＮＯ之间平衡失调可能与肺纤维化发生有关。     

兔海水淹溺肺水肿肺Na~ -K~ -ATP酶和细胞色素氧化酶活性变化的图像定量分析(论著)

目的：探究海水淹溺肺水肿（ＰＥ－ＳＷＤ）的典型症状及其病理生理变化。方法：通过向兔肺进行海水灌注诱导ＰＥ－ＳＷＤ。用细胞化学和图像定量分析方法测定兔肺组织Ｎａ＋－Ｋ＋－ＡＴＰ酶和细胞色素氧化酶（ＣＹＴＯ）活性。结果：ＰＥ－ＳＷＤ组兔肺中，以上两种酶活性均显著降低。结论：酶活性的降低可能与淹溺造成肺组织缺氧有关，同时缺氧引起ＡＴＰ减少导致一系列肺组织代谢、功能与结构的变化，造成肺不张和ＰＥ－ＳＷＤ。     

室内生活性污染粉尘对肺损害的临床观察

在工农业生产过程中,长期吸入高浓度的某些生产性粉尘所引起的以肺组织纤维化为主的职业性疾病(矽肺),早已为人们所熟知,而长期吸入室内生活性污染粉尘是否致病尚无人论及。作者在纤支镜检查中发现12例叶、段肺不张是由于炭末粉尘的沉积或堆集而堵塞管腔所致,全部病例无生产性粉尘接触史及职业性尘肺史,为提高认识,总结报道如下:     

尘肺病检查的影像学成像技术

尘肺病(pneumoconiosis)是由于在职业活动中长期吸入生产性粉尘并在肺内潴留而引起的以肺组织弥漫性纤维化为主的全身性疾病。也是我国最主要的职业病，不仅患病人数多，而且是严重降低劳动能力、致残和影响寿命的疾病。据职业病统计数字表明，2000年底我国累计已发生尘肺病人558608例，并且新尘肺病例还以每年1—2万的速度递增。我国目前尘肺病人数目之多、增长速度之快位居世界之首。     

烟雾吸入伤后肺表面活性物质蛋白A含量的动态变化及意义

目的探讨烟雾吸入伤后肺表面活性物质蛋白Ａ（ＳＰ－Ａ）含量的变化、可能机理及其与肺表面活性物质（ＰＳ）活性抑制和肺功能损害的关系。方法采用大鼠烟雾吸入伤模型，分别检测正常对照及致伤２ｈ、６ｈ、１２ｈ和２４ｈ动物的动脉血气，肺水量，静态肺顺应性（Ｃｓｔ），支气管肺泡灌洗液（ＢＡＬＦ）表面张力特性，ＢＡＬＦ中ＳＰ－Ａ、丙二醛（ＭＤＡ）、总蛋白（ＴＰ）含量及弹性蛋白酶（Ｅｌａ）活性。结果动物伤后出现急性呼吸衰竭和肺水肿，Ｃｓｔ显著降低；ＢＡＬＦ的最小表面张力（ＳＴｍｉｎ）升高，滞后环面积下降；ＢＡＬＦ中ＳＰ－Ａ、ＭＤＡ、ＴＰ含量及Ｅｌａ活性明显升高，但ＳＰＡ－Ａ的相对含量（％ＴＰ）降低，且与Ｅｌａ、Ｃｓｔ和ＳＴｍｉｎ的变化相关显著。结论烟雾吸入伤早期ＳＰ－Ａ相对含量减少，可能是导致肺表面活性物质活性抑制及肺功能障碍的主要原因之一。氧化及Ｅｌａ可能是引起ＳＰ－Ａ含量和（或）功能异常的重要因素。     

煤工尘肺58例肺门淋巴结蛋壳样钙化的X线分析

目的：探讨煤工尘肺肺门淋巴结蛋壳样钙化的X线特征。方法：回顾性分析58例经职业病诊断组确诊的煤工尘肺X线影像资料。结果：58例中在肺门区钙化影呈现圆形，椭圆形或不整形23例，环形或蜂窝形35例。两侧肺门区钙化影呈对称性出现51例，于左侧肺门区出现5例，2例出现在右肺。结论：肺门淋巴结蛋壳样钙化是煤工尘肺在某种特定条件下的表现之一，对尘肺综合诊断有重要参考价值。     

Determination of multi-element profiles of street dust using energy dispersive X-ray fluorescence (EDXRF).

Street dust samples have been collected in different areas in Hong Kong associated with various levels of traffic and pedestrian flow, and the concentrations of 23 chemical elements have been determined using energy dispersive X-ray fluorescence (EDXRF). The 23 studied elements were Na, Al, Si, Cl, Ti, Ba, V, Cr, Mn, Fe, Co, K, Ca, Ni, Cu, Zn, As, Pb, Rb, Sr, Y, Zr and Sn. A profile for average street dust for Hong Kong has been determined by taking average values for different areas. The values for the Hong Kong street dust are commensurate with the values derived in previous investigations or for other countries, except that Hong Kong street dust has much higher Cl, Ca and As concentrations. A factor analysis gives four sources for the street dust in Hong Kong: namely, mixture of metallic dust and crustal material, vehicles, road pavement materials, and mixture of marine aerosols and crustal material.     

House dust mites in naval ships, military barracks, and homes in the Hampton Roads area of Virginia

This survey was undertaken to determine the possible exposure of military personnel to house dust mites in ships, barracks, and homes in the Hampton Roads area of Virginia. During the period from April 1, 1982 through August 31, 1983, 524 dust samples were collected with vacuum cleaners. Mites were extracted from aliquots of dust, counted, and identified as to species and life stage. Dermatophagoides pterynssinus (European house dust mite) was more common in private homes, while Dermatophagoides farinae (North American house dust mite) was more common on ships. Berthing compartments had the highest density of mites of areas sampled aboard ships. There appears to be a trend between the density of personnel and mites. Ships had a smaller percentage of mite-infested samples than houses.     

85例变应性鼻炎飞行人员变应原谱检测分析

目的应用血清学检测方法对沈阳军区85例变应性鼻炎(AR)飞行人员进行变应原检测,了解该地区AR飞行人员的变应原谱分布情况。方法应用苏州浩欧博公司的变应原特异性IgE抗体检测试剂盒,采用体外血清学酶联免疫检测方法,对85例AR飞行人员进行13种食入性及吸入性变应原检测,了解其种类和发生率。结果 85例AR飞行人员中,76例血清样本至少检测出一种变应原阳性,占89.4%。吸入性变应原阳性率前3位为:屋尘螨/粉尘螨50.0%、树组合(柏树/榆树/梧桐/柳树/杨树)39.5%、屋尘34.2%;食入性变应原阳性率前3位为:水果组合(芒果/菠萝/苹果/桃子/草莓)21.1%、海鲜组合(虾/蟹/扇贝)17.1%、鱼类组合(鳕鱼/鲑鱼/鲈鱼)11.8%。强阳性反应多见于吸入性变应原,列前3位的变应原分别为:树木组合11.1%,屋尘螨/粉尘螨9.9%,动物皮毛6.6%;食入性变应原多为弱阳性反应。结论沈阳军区AR飞行人员的变应原以吸入性变应原为主,屋尘螨/粉尘螨和水果组合(芒果/菠萝/苹果/桃子/草莓)分别是主要的吸入性和食入性变应原,据此针对性的防治有利于提高AR飞行员的防治效果。     

屋尘螨变应原疫苗安脱达治疗过敏性哮喘457例的疗效及安全性分析

目的观察标准化屋尘螨变应原疫苗(安脱达,Alutard)特异性免疫疗法(SIT)治疗过敏性哮喘的疗效及安全性。方法比较457例对屋尘螨过敏的哮喘患者在接受3年免疫治疗前、后的疗效及免疫治疗过程中的局部和全身不良反应情况。结果治疗后过敏性哮喘患者的症状评分等多项指标均比治疗前有显著改善(P<0.05)。患者的应急用药量较治疗前明显减少(P<0.05)。治疗期间未发生严重不良事件。结论安脱达免疫治疗是一种安全、有效的治疗方法。     

MEBO治疗粉尘爆炸复合烧伤

目的：克服常规方法治疗粉尘爆炸复合烧伤的繁杂程序、上带来的痛苦。方法：采用ＭＥＢＯ外涂及特制带刃不锈钢压舌板反复多次刮除液化物及创面粉尘，共治疗２４例。结果：嵌于创面的偻尘异物随液化物分期分批切除，加速创面愈合，无瘢痕形成，亦无外伤性纹射形成。结论：利用ＭＥＴＢ／ＭＥＢＯ治疗粉尘爆炸复合烧伤，可彻底清除创面粉尘，消除粉尘残留给患知心造成的损害。且方法简便易行，无痛苦，具有传统治疗方法无法替代的作     

Air pollution at an urban traffic tunnel in Lisbon, Portugal—an INAA study

In this study, the results of chemical concentrations inside and outside of a Lisbon (Portugal) traffic tunnel were compared, during one week. They were obtained by Instrumental Neutron Activation Analysis (INAA). The tunnel values largely exceed the Air Ambient legislated values and the Pearson Correlations Coefficients point out to soil re-suspension/dispersed road dust (As, Ce, Eu, Hf, Fe, Mo, Sc, Zn), traffic-markers (Ba, Cr), tire wear (Cr, Zn), break wear (Fe, Zn, Ba, Cu, Sb), exhaust and motor oil (Zn) and sea-spray (Br, Na). On all days these elements inside the tunnel were more enriched than outside; significant statistical differences were found for Co (p=0.005), Br (p=0.008), Zn (p=0.01) and Sb (p=0.005), while enrichment factors of As and Sc are statistically identical. The highest values were found for As, Br, Zn and Sb, for both inside and outside the tunnel.     

Determination of multi-element profiles of soil using energy dispersive X-ray fluorescence (EDXRF).

The source profile for soil in Hong Kong is important both for determination of the main air pollutant source in Hong Kong and for assessment of the impact of Asian dust storms on Hong Kong. Soil associated with different rock types have been sampled, and the concentrations of 19 chemical elements, Na, Al, Si, Ti, V, Cr, Mn, Fe, Co, K, Ca, Ni, Cu, Zn, Pb, Rb, Sr, Y and Zr, have been determined using energy dispersive X-ray fluorescence. A profile for the average soil for Hong Kong has been determined by taking average values for the different soil categories. The values for the Hong Kong soil are commensurate with values for rural soil derived by other workers, except that Hong Kong soil has much lower Fe and Ca concentrations. The abundance of Al, Ca and Fe in the average Hong Kong soil are 9.23%, 0.11% and 0.85%. We conclude that Ca provides a good marker element for identifying dust episodes in Hong Kong while Al does not.     

壹期电焊工尘肺肺部HRCT表现及病理学对照

目的探讨壹期电焊工尘肺肺部不同HRCT表现的病理学基础。方法对比分析15例确诊为壹期电焊工尘肺的肺部HRCT资料和经支气管肺活检的病理资料。HRCT检查和经支气管肺活检的间隔时间在3～50天。15例中男性13例,女性2例,平均年龄(35±6.8)岁,电焊工工龄(8.8±3.5)年。将标本粉尘的量分为无、少量、中量和大量,将纤维化的程度分为无、轻度、中度和重度。结果 HRCT上7例主要表现为小叶中心小叶核影的增大、增多,呈分支状线影;3例表现为小叶中心的磨玻璃密度的结节影,约4～8mm大小;5例表现为磨玻璃结节与分支状线影混合存在。其中5例有轻度小叶间隔增厚,6例可见小叶中央型肺气肿。病理学表现为呼吸性细支气管及其肺泡群内大量尘斑,并可见肉芽组织和少量的胶原纤维,支气管粘膜下肺组织和肺泡间隔纤维组织弥漫增生,胶原纤维沉积。偏光镜和普鲁士蓝铁染色证明尘斑中铁颗粒存在。弥漫性以分支状线影为主要表现的纤维化程度重于弥漫性磨玻璃密度结节为主的病例(t=9.00,P=0.00),但粉尘量以磨玻璃密度结节为主的病例较重(t=-4.71,P=0.001)。结论 HRCT可以显示电焊烟尘所致的肺内尘斑及其纤维化的程度。     

Australian dust storm: impact on a statewide air medical retrieval service

Introduction

The Australian dust storm during the week of September 22, 2009, resulted in the grounding of a large portion of the air medical retrieval fleet in Queensland. We sought to determine whether during this event an increase occurred in cases requiring retrieval as a result of the dust storm, and whether the grounding of the retrieval fleet resulted in any adverse outcomes as a result of its inability to respond.

Methods

A retrospective review of respiratory and injury cases referred to the Queensland Emergency Medical System Coordination Centre from September 8 to October 5, 2009 was conducted. All cases with any respiratory or injury complaints were included. The number of cases, priority for retrieval, and the ability to retrieve these cases within the allocated time were examined and compared with those for a similar time frame in the previous year.

Results

A 62.5% increase in respiratory cases was seen, and 13.3% increase in injury cases during the week of the dust storm event, when compared with the previous year. Neither of these results reached statistical significance, but they demonstrate a practically important difference. For the month surrounding the dust storm event, a 48.5% (P = .04) increase in respiratory cases occurred, but no increase in injury cases when compared with the previous year. Only one urgent case was unable to be air medically retrieved during the study period as a result of grounding of the aircraft because of the dust storm event, but contingency arrangements were made for alternative transport. No adverse events were recorded during the study period.

Conclusion

An increased demand on retrieval services was demonstrated during the period of the dust storm event. Despite grounding of the air medical fleet, all cases except one were able to be retrieved within clinically appropriate time frames or by alternative transport methods. Contingency plans need to be developed to cope with the possibility of similar events in the future, to prevent adverse events from occurring.     

Exposure to soda-lime dust in closed and semi-closed diving apparatus.

BACKGROUND: Chronic exposure to hyperbaric hyperoxia and venous gas microembolism have been shown to contribute to the long term health effects of diving, especially diver's lung function. Factors related to special diving equipment may add to these effects. This study was conducted to evaluate possible additional hazards for respiratory function of divers employing closed and semi-closed diving apparatus. METHODS: We analyzed soda-lime dust found in the air-intake loop of a closed-circuit oxygen rebreathing diving apparatus which had passed through the filter screen of the diving apparatus's soda-lime cartridge. The geometrical characteristics were evaluated by scanning electron microscopy. The amount of dust that passed through the screen during a normal dive profile was measured by an artificial airflow through a filter membrane. After dives by subjects using these devices, the pH-value of water condensate in the air-intake hose was measured. RESULTS: There was a relevant amount of residual soda-lime dust found in the air-intake loop. The dust particles showed diameters down to 1 micron and a rounded structure. The total amount of dust averaged 9.6 mg.m-3 of breathing mixture. During diving, the mean pH-value of condensate in the hose is estimated at 8.87 (+/- 0.12). CONCLUSION: There is a relevant exposure to soda-lime dust in divers using closed-circuit rebreathing apparatus. This occupational exposure may contribute to chronic airway inflammation and subsequent development of small airway disease in divers.