428例尘肺病患者3年生存情况分析

对2015年12月-2016年12月在我院住院的尘肺病患者进行3年随访并分析其生存情况.结果显示,成功随访428例,死亡33例(7.71％).尘肺壹期、贰期、叁期3年死亡率分别为1.60％、4.55％、16.99％,差异有统计学意义(P＜0.05).死亡组9个肺功能指标均较生存组差(P＜0.05).尘肺合并慢性阻塞性肺...     

Progressive massive fibrosis and simple pneumoconiosis in ex-miners.

A group of 17 738 working miners, medically examined during 1953-8, were followed up from 1974 to 1980. Of the 7118 men re-examined, 2547 were still working miners and 4526 had left the industry (45 were of unrecorded status). The incidence of progressive massive fibrosis (PMF) over an average follow up period of 22 years among men who had remained in the industry was 27 per 1000, but 94 per 1000 among men who had left. This difference was only partly related to the difference in age between the groups; for men without simple pneumoconiosis at the start of the period, and for similar age groups (45-64), the attack rate in miners was 20 per 1000 and in the ex-miners 41 per 1000. In a group of 1902 leavers who did not have PMF at a medical examination conducted at most four years before leaving, 172 had developed PMF by the time of the follow up examination. Of these, 116 had had simple pneumoconiosis at the earlier examination. Cumulative exposure to respirable dust, category of simple pneumoconiosis, and age were each found to influence the probability of developing PMF in a subgroup of the 1902 men. Among the 1902 leavers, there was no overall progression or regression of simple pneumoconiosis.     

Some factors influencing interobserver variation in classifying simple pneumoconiosis.

Three experienced physician readers assessed the chest radiographs of 743 men from a coal mining community in West Virginia for the signs of simple pneumoconiosis, using the ILO U/C 1971 Classification of Radiographs of the Pneumoconioses. The number of films categorised by each reader as showing evidence of simple pneumoconiosis varied from 63 (8.5%) to 114 (15.3%) of the 743 films classified. The effect of film quality and obesity on interobserver agreement was assessed by use of kappa-type analytic procedures for measuring agreement on categorical data. Poor film quality and obesity both affected agreement adversely. Poor quality films were disproportionately frequent in obese individuals, as defined by the Quetelet index. On control of film quality by stratification, the effect of obesity on interobserver profusion agreement was no longer evident.     

An elaboration of the I.L.O. classification of simple pneumoconiosis

Liddell, F. D. K., and Lindars, D. C. (1969).Brit. J. industr. Med.,26, 89-100. An elaboration of the I.L.O. classification of simple pneumoconiosis. Simple pneumoconiosis in chest radiographs presents a continuum of increasing abnormality. Liddell (1963) introduced a 12-point scale obtained by dividing each of the four I.L.O. categories (International Labour Office, 1959) into one central and two marginal zones. In this system, which has come to be known as the N.C.B. elaboration, readers record for each radiograph the I.L.O. category of choice (0, 1, 2 or 3), followed by an adjacent I.L.O. category if that had been seriously considered; otherwise, the same category is repeated. Very clear normals are denoted as 0/-, and `high' category 3 films as 3/4.     

老年尘肺病人的心理护理

尘肺病人的心理需要具有特殊性,该文对此类病人心理护理各个方面进行了全面分析,提出了实际工作中的护理方法和对策,有助于尘肺病人的康复.     

Coalworkers' simple pneumoconiosis and exposure to dust at 10 British coalmines.

Five physicians' radiological assessments of coalworkers' simple pneumoconiosis (CWP) in 2600 coalminers at 10 British collieries have been studied in relation to the individuals' estimated lifetime (mean 33 years) exposure to respirable coalmine dust. Estimates of exposure were based on 20 years of observations at each colliery. Radiographic classifications were clearly associated with the measures of dust exposure. Important unexplained differences between some of the collieries were disclosed. Among men with similar cumulative dust exposures those with longer exposure time had higher prevalence of CWP. In general there was no evidence that the quartz concentrations experienced (average 5% of mixed dust) affected the probability of developing coalworkers' simple pneumoconiosis. Some men reacted unfavourably (two or more steps of change on the 12-point radiological scale) over a 10-year period to coalmine dust with a relatively high quartz content.     

自我管理模式在尘肺病患者中应用效果评价

目的 探讨针对尘肺病患者的慢性病自我管理模式的临床效果。
方法 选取2015年8月-2016年12月在深圳市职业病防治院及湖南省职业病防治院尘肺病科住院的169例尘肺病患者为对照组, 实施传统护理方案; 选取2017年1月-2017年10月在两医院住院的131例尘肺病患者为研究组, 在传统护理的基础上实施自我管理模式。干预8周后, 组织两组患者填写疾病认知问卷、自我效能量表及简明生存质量量表(WHOQOL-BREF)并比较干预前后两组患者健康知识水平、自我效能及生存质量改善等情况。
结果 干预前, 两组患者在疾病认知、自我效能、生存质量量表总评分, 以及各维度评分方面的差异均无统计学意义(P>0.05);干预8周后, 两组患者疾病认知、自我效能、生存质量量表总评分, 自我效能各维度评分、生存质量各维度评分均高于干预前, 同时, 干预组以上各评分均优于对照组, 除了生存质量量表的社会领域维度之外, 其他项目评分的差异均有统计学意义(P < 0.01或0.05)。
结论 传统护理和慢性病自我管理模式对提高患者的生存质量均有帮助, 而采取慢性病自我管理模式的效果更为明显, 值得在临床上推广。
     

Lung gas exchange in simple pneumoconiosis of coal workers

Cotes, J. E., and Field, G. B. (1972).Brit. J. industr. Med.,29, 268-273. Lung gas exchange in simple pneumoconiosis of coal workers. Indices of lung function and gas exchange, including some based on measurement of the arterial blood gases and physiological response to exercise, were obtained in 19 coal workers with simple pneumoconiosis of the pinhead or micronodular type, of whom 11 also had bronchitis. p-Type pneumoconiosis differed from the m-type in being associated with a smaller transfer factor, larger physiological deadspace relative to tidal volume (Vd/Vt), and increased ventilation during submaximal exercise. Vd/Vt was also raised in patients with bronchitis. The venous admixture effect (including physiological shunt) was within normal limits. Breathing oxygen increased Vd/Vt in patients with bronchitis but not with p-type pneumoconiosis. The findings are evidence for p-type pneumoconiosis being associated with abnormal function of the lung parenchyma; the changes are consistent with cystic lung.     

尘肺患者肺通气功能分析

目的观察尘肺患者肺通气功能的损害情况。方法对200例尘肺患者、100例0^＋者和80例X线胸片正常的接尘工人进行肺通气功能测试。结果0^＋及Ⅰ、Ⅱ期患者的用力肺活量（FVC）、第1秒用力呼气量（FEV1.0）、FEV1．0／FVC％、最大通气量（MVV）、25％-75％用力呼气中期流速（FEF25%-75%）均低于对照组，Ⅱ期患者的FVC、FEV1.0、FEV1.0／FVC％、MVV、FEF25%-75%显低于Ⅰ期及0^＋，差异均有统计学意义（P〈0.01）；Ⅰ、Ⅱ期尘肺肺功能损害均以混合性通气功能障碍为主，发生率分别77．6％和90．5％。与〈60岁组比较，60岁以上尘肺患者各项肺功能指标均下降，差异有统计学意义（P〈0．01）。结论尘肺患者肺功能损害以混合性通气功能障碍为主，无尘肺的0^＋者有肺功能损害。     

煤工尘肺患者肺灌洗液中肺泡巨噬细胞自噬活动的研究

目的 比较不同期别煤工尘肺患者肺泡巨噬细胞自噬活动的差别.方法 对116例行全肺灌洗的观察对象和煤工尘肺患者进行现场调查,并收集其肺灌洗液,纯化后得到肺巨噬细胞,用透射电镜观察其自噬形态,采用免疫印迹方法检测自噬标志性蛋白LC3及自噬调控蛋白beclin1、mTOR和p-mTOR的表达量,分析接尘观察对象、Ⅰ、Ⅱ、Ⅲ期煤工尘肺患者肺泡巨噬细胞自噬活动的强弱变化.结果 透射电镜观察,发现自噬活动在不同期别煤工尘肺患者肺泡巨噬细胞中Ⅱ期煤工尘肺肺泡巨噬细胞中有自噬溶酶体明显多于观察对象和Ⅰ期煤工尘肺,Ⅱ期煤工尘肺的肺泡巨噬细胞中自噬体和自噬溶酶体明显少于Ⅱ期煤工尘肺.Ⅱ期煤工尘肺患者肺巨噬细胞LC3Ⅱ/Ⅰ和Beclin1蛋白表达量明显高于Ⅰ期,Ⅲ期煤工尘肺患者肺巨噬细胞LC3Ⅱ/Ⅰ和Beclin1蛋白表达量明显低于Ⅱ期,Ⅲ期煤工尘肺患者肺巨噬细胞LC3Ⅱ/Ⅰ蛋白表达量明显高于Ⅰ期,Ⅱ期煤工尘肺患者Beclin1蛋白表达量高于接尘观察对象,差异均有统计学意义(P＜0.05).Ⅱ期煤工尘肺患者肺泡巨噬细胞mTOR和p-mTOR的表达量明显低于接尘观察对象和Ⅰ期,Ⅲ期尘肺患者肺泡巨噬细胞mTOR和p-mTOR表达量明显高于Ⅱ期,差异均有统计学意义(P＜0.05).结论 不同期别煤工尘肺患者肺泡巨噬细胞自噬活动不同.