煤矿工人中肺癌的病理观察

本文报告了13例煤矿工人中肺癌的尸解病理观察。本组煤工的平均年龄55岁,接尘工龄平均21.5年,均有吸烟史。肉眼观察,中心型肺癌9例,周围型4例,其中2例为瘢痕癌。镜检,鳞癌6例,细支气管-肺泡癌和小细胞未分化癌各3例,腺鳞癌1例。煤矿工人中肺癌的病理特征与吸烟的普通人群肺癌相似。在组织学类型与接尘时间之间存在着一定的联系,细支气管-肺泡癌和小细胞癌病例工龄较长,而鳞癌较短。本组病例均有早期尘肺和慢性支气管炎的病理改变,推测这些病变对煤工肺癌的组织发生均有一定影响。     

黄麻纺织工人肺疾患及其剂量－反应关系

在对３５３名黄麻纺织工人肺疾息的流行病学调查中发现，慢性支气管炎和不规则性胸紧患病率和发生率分别为１３．８８％和２１．２５％，明显高于对照组（均Ｐ＜０．０１），但未发现典型棉尘病患者。慢性支气管炎患病率随麻纺工人接尘时间延长和车间粉尘浓度增高而升高。对接触黄麻扮尘的剂量水平与馒性支气管炎患病率之间关系进行了分析，应用接尘量回归法，估算工人接尘３０年，慢性支气管炎息病率控制在１５％时，车间空气中黄麻粉尘最高容许浓度的建议值为４ｍｇ／ｍ３。     

老年肺部感染患者的排痰护理

肺部感染主要指下呼吸道（包括支气管、终末细支气管、呼吸性细支气管）的感染,包括慢性支气管炎急性发作、急性支气管炎、肺炎、支气管扩张感染等肺部感染性疾病。肺部感染占老年感染性疾病的57．0％,是老年人最常见的感染性疾病,往往经久不愈、病情重、死亡率高。     

慢性支气管炎合并贫血132例临床分析

目的 分析慢性支气管炎合并贫血的病因及诊治特点。方法 回顾性分析132例慢性支气管炎合并贫血患者的临床资料。结果 通过典型的临床表现、影像学、病理学及相关实验室检查，诊断合并恶性肿瘤41例，其中晚期肺癌22例(55．7％)，消化系统肿瘤12例(29．4％)，其他肿瘤7例，相对良性疾病86例，其中消化道出血32例(37．2％)，支气管扩张14例(16．3％)，结核13例(15．1％)，其他27例。另有不明原因者5例。结论 肿瘤、消化道出血、支气管扩张为慢性支气管炎合并贫血的主要原因，能否尽快确诊直接影响其治疗和预后，     

黄麻纺织工人肺疾患及其剂量—反应关系

在对３５３名黄麻纺织工人肺疾患的流行病学调查中发现，慢性支气管炎和不规则性胸紧患病率和发生率分别为１３８８％和２１．２５％，明显高于对照组，但未发现典型棉尘病患者。慢性支气管炎患病率随麻纺工人接尘时间延长和车间粉尘浓度增高而升高。对接触黄麻粉尘的剂量水平与慢性支气管炎患病率之间关系进行了分析。     

慢性尘源性支气管炎患者纤支镜检查分析

目的 探讨有接尘史的慢性支气管炎患者纤支镜下支气管黏膜的病理改变。方法 对16例有接尘史的慢性支气管炎患者通过纤支镜进行观察，并取标本行光学显微镜检查。对照组为19例无接尘史的慢性支气管炎患者。结果 有接尘史的慢性支气管炎患者和煤工尘肺患者的大气道均有散在斑片状发黑区及不同程度的管口狭窄、管腔变形，镜下见有明显的纤维组织增生、平滑肌扭曲变形。结论 上述改变是煤矽尘对大气道黏膜的直接损害所致。     

弥漫性泛细支气管炎的误诊分析

目的 总结和分析弥漫性泛细支气管炎的误诊现状,提高该病的诊疗水平.方法 回顾性分析24例确诊于中国医科大学呼吸疾病研究所的弥漫性泛细支气管炎病例和利用中国生物医学文献数据库(CBM)检索2000-2012年报道的50例弥漫性泛细支气管炎病例的临床资料.结果 所有患者确诊前均被多次误诊.误诊疾病前5名按误诊率依次为支气管扩张症、慢性支气管炎、慢性阻塞性肺疾病、支气管哮喘、肺结核.按Akira分期第1期17例,第2期14例,第3期21例,第4期22例.58.1％(43/74)的患者确诊时已经处于中晚期.铜绿假单胞菌感染率达43.2％(32/74).74例患者均有慢性鼻窦炎,仅25例(33.8％,25/74)有明确慢性鼻窦炎病史.8例(10.8％,8/74)患者咯血.结论 我国弥漫性泛细支气管炎误诊的现状仍非常严峻,支气管扩张症是最常见的误诊疾病.特征性的影像学异常和慢性鼻窦炎是与其他疾病相鉴别的重要依据.     

支气管哮喘与慢性喘息

支气管哮喘与慢性喘息性支气管炎有什么区别？ 患喘息病的人，若问他究竟患的是哪种喘息病，是支气管哮喘还是慢性喘息性支气管炎？患者往往回答不上来，并且认为这两个名称是一码事。其实，这是不同的两种疾病。     

炭墨尘致轮胎作业工人慢性支气管炎的探讨

对接触炭黑尘刚位平均浓度３９．０７ｍｇ／ｍ＾３的１４２名轮胎作业工人进行慢性支气管炎患病调查研究，结果表明：（１）观察组慢支患病率１９．７％，显著高于对照组４．２％（Ｘ＾２＝１６．１７，Ｐ〈０．０１），其ＲＲ〉１．５，ＡＲＰ〉３０％，考虑为与工作有关疾病。（２）慢支患病率有随工龄增长而呈上升趋势。（３）吸烟与炭黑尘致病存在协同作用，认为较高浓度炭黑尘对接尘工人的支气管有一定影响，应引起重视。     

慢性阻塞性肺气肿并发自发性气胸86例诊断体会

目的 对慢性阻塞性肺气肿并发自发性气胸做回顾性研究分析，以深入认识此病临床特点并减少漏误诊，降低病死率.方法 抽调我院近9年来收治的慢性阻塞性肺气肿并发自发性气胸86例之病历，就其相关临床资料进行归纳统计。结果 43例（50％）根据症状体征做出初步诊断并经X线及诊断性穿刺证实，经胸部X线或CT确诊者67例（77．91％）；在病情危重不能行X线或CT检查者15例（17．44％），误诊后经诊断性胸穿而确诊者4例（4．65％），临床漏诊及误诊23例（26.74％），漏误诊时间3～7d。结论 患者受肺气肿影响，临床表现不典型及病情危重不能及时进行X线或CT检查是漏误诊的主要原因，其病死率高的关键为漏诊误诊延误治疗，合并基础疾病依次为慢性支气管炎、支气管哮喘、慢性支气管炎和支气管哮喘所致肺心病、肺结核及结核性胸膜炎，诱发因素为呼吸道感染，用力排便、咳嗽、打喷嚏，临床表现主要为咳嗽、呼吸困难等基础疾病的症状突然或逐步加重。笔者从五个方面重点论述了该病及早诊断及如何避免漏误诊。     

Contrasting geographical distribution of mortality from pneumoconiosis and chronic bronchitis and emphysema in British coal miners.

To explore whether the characteristics of coal mine dust that predispose to chronic airways obstruction are the same as those associated with pneumoconiosis, mortality from the two disease was compared in coal miners in 22 counties of England and Wales during 1979-80 and 1982-90. The proportional mortality ratios (PMRs) for coal workers' pneumoconiosis varied from 135 (95% confidence interval (95% CI) 16-488) in Leicestershire to 3825 (95% CI 1538-7881) in South Glamorgan. The PMRs for chronic bronchitis and emphysema were consistently higher than those in other occupations, but showed much less geographical variation and did not correlate geographically with those for pneumoconiosis. These findings indicate that the pathogenetic mechanisms by which coal mine dust causes chronic bronchitis and emphysema depend on different features of the dust from those producing pneumoconiosis. Also, they suggest that current social security regulations in Britain, which require evidence of pneumoconiosis as a condition of compensation for chronic bronchitis and emphysema in coal miners, may discriminate unfairly against claimants from some regions.     

Incidence of chronic bronchitis in coal miners

An epidemiological survey of 2000 Donbass coal miners revealed data on the initial dust bronchitis prevalence and its progress. It was established that the coal miners who work in mines with steep coal strata exhibit higher bronchitis morbidity in comparison with the miners engaged in sloping strata mines. A correlation was established between dust bronchitis prevalence and length of professional service and coal miners' labour specificity. Tobacco smokers displayed a markedly higher percentage of chronic dust bronchitis cases.     

Respiratory Status of Surface Coal Miners in the United States

The United States Public Health Service examined 1,438 surface coal miners to determine the prevalence of coal worker’s pneumoconiosis (CWP), chronic bronchitis, and ventilatory impairment among them. Four percent (fifty-nine individuals) showed some roentgenographic evidence of pneumoconiosis, but only seven miners had films interpreted as CWP of category2 or greater (according to the UlCC/Cincinnati classification system). Moreover, most of the affected miners had worked in underground coal mines for prolonged periods. Significant decrements in pulmonary function to increasing exposure to surface mine dust were demonstrated only in the forced vital capacity of smokers. Increased prevalence of chronic bronchitis with increasing exposure was found in all smoking categories. However, significant airway obstruction was an uncommon finding (6.6%) in nonsmoking miners. Employment in surface mining was not likely to cause either the development of CWP or clinically significant respiratory impairment.     

Exposure-response analysis of mortality among coal miners in the United States

The quantitative relationship between exposure to respirable coal mine dust and mortality from nonmalignant respiratory diseases was investigated in a study of 8,878 working male coal miners who were medically examined from 1969 to 1971 and followed to 1979. Exposure-related mortality was evaluated using Cox proportional hazards modeling for underlying or contributing causes of death and modified lifetable methods for underlying causes. For pneumoconiosis mortality, the lifetable analyses showed increasing standardized mortality ratios (SMRs) with increasing cumulative exposure category. Significant exposure-response relationships for mortality from pneumoconiosis (P < 0.001) and from chronic bronchitis or emphysema (P < 0.05) were observed in the proportional hazards models after controlling for age and smoking. No exposure-related increases in lung cancer or stomach cancer were observed. Pneumo coniosis mortality was found to vary significantly by the rank of coal dust to which miners were exposed. Miners exposed at or below the current U.S. coal dust standard of 2 mg/m³ over a working lifetime, based on these analyses, have an elevated risk of dying from pneumoconiosis or from chronic bronchitis or emphysema.     

Exposure-response relationships for coal mine dust and obstructive lung disease following enactment of the Federal Coal Mine Health and Safety Act of 1969.

Underground U.S. coal miners were studied cross-sectionally for the association of respirable coal mine dust exposure with pulmonary function and symptoms of airways obstruction. The study group included 1,185 miners participating in Round 4 of the National Study of Coal Workers' Pneumoconiosis who had started mining in or after 1970 when comprehensive exposure regulations first came into effect. Quantitative estimates of cumulative exposure, derived using respirable dust measurements taken by the Mine Safety and Health Administration over the entire study period, were used in linear and logistic regression models on indicators of pulmonary function and chest symptoms while controlling for smoking status, pack-years, and other potential confounders. Statistically significant associations between log cumulative exposure and decrements in FVC, FEV1, and FEV1/FVC were observed. In logistic models, statistically significant associations of cumulative exposure with increasing prevalence of FEV1 and FEV1/FVC less than 80% predicted and symptoms including chronic phlegm, chronic bronchitis, breathlessness, wheeze, and wheeze with shortness of breath were found. It is concluded that exposures to respirable coal mine dust present in U.S. mines since 1970 continue to affect respiratory health in underground miners.     

煤尘对呼吸系统危害的研究

本研究对8个煤矿、两个选煤厂和一个煤炭装卸作业区进行劳动卫生、流行病学调查，煤尘浓度为10．2－200．0mg/m^3，煤尘中游离Sio2为2．4－7．3％，检查了6，373名煤尘作业工人，煤肺患病率为0．26－15．2％，慢性支气管炎患病率为21．9－36．9％，肺气肿为11．85，18例煤尘作业的尸检病例中，17例有慢性支气管炎改变，16例有肺气肿，结果显示，在防治中煤尘危害时，除应注意煤肺外，还应对煤工的慢支和肺气肿给予足够的重视。     

脱尘矿工肺通气功能损害及其影响因素的调查分析

本文对３２６名脱尘矿工和６９名不接触尘毒的健康工人分别进行了肺通气功能测定，并对影响脱尘矿工肺通气功能损害的因素进行了分析，结果表明：无论是肺通气功能的实测值、实测值占预计值的百分比，还是肺通气的异常率，或是最大呼气流速容量曲线的比较分析，均显示脱尘矿工的肺气功能损害较对照工人为严重。多因素分析结果表明：接尘起始年代、慢性支气管炎对脱尘工人肺通气功能损害的影响尤为明显。即接尘起始年代越早或有慢性支     

煤矿尘肺的尘斑气肿

对８６例煤工尸检肺组织呼吸性细支气和及所属肺泡道发生的尘斑气肿进行了观察。前述部位不同程度煤尘沉着构成尘斑或尘灶。尘灶系呼吸性细支气管壁及肺泡间隔内煤尘沉着不断增多，气腔壁增厚，闭塞或靠扰融合而成。少数尘灶亦可由局灶性肺泡内煤尘细胞聚集填充所致尘斑或尘灶处伴发的肺气肿，意味着组织破坏，肺功能受损。因此，尘斑气肿和尘灶气肿具有同样涵义。     

离尘矿工肺通气功能和呼吸系统症状的配对研究

对１５６名离尘矿工进行了肺通气功能和呼吸系统症状的配对研究，结果表明：无论是ＦＶＣ、ＦＥＶ１．０、ＦＥＦ２５％～７５％、Ｖ７５、Ｖ５０等肺通气功能指标的实测值，还是肺通气功能异常率均显示离尘矿工肺通气功能损害较对照工人严重，除ＦＶＣ外，均有统计学意义；呼吸系统症状阳性人数和慢性支气管炎患病人数离尘矿工也均显著高于对照工人。     

Associations of symptoms related to isocyanate, ureaformol, and formophenolic exposures with respiratory symptoms and lung function in coal miners

The respiratory effects of diphenylmethane diisocyanate (MDI)-based resins and ureaformol- and formophenolic-based resins, used in coal mining, are unknown. This cross-sectional study of 354 miners evaluated respiratory health in miners with MDI-related symptoms (IS) and ureaformol/formophenolic-related symptoms (UFS). The protocol included clinical examination, chest radiograph, questionnaire on respiratory symptoms, smoking habit, job history, resin handling, and spirometry. Resin handling concerned 27.7% of the miners. IS affected 5.6%, and 1.4% also after work. UFS affected 22.6%, and 2.3% also after work. Wheezing affected 35.6%; chronic cough, expectoration, or bronchitis about 10%; dyspnea 5.4%; and asthma 2.8%. The miners with UFS had significantly more frequent chronic cough, expectoration, chronic bronchitis, dyspnea, and wheezing, whereas those with IS at and after work had markedly lower FVC, FEV1, MMEF, FEF50%, and FEF25%. These findings raise the possibility of deleterious effects of exposures to MDI and ureaformol/formophenolic resins on respiratory health and lung function in coal miners during their working life.