砂轮磨光作业工人首发症状出现时间及其与振动性白指的关系

砂轮磨光作业工人首发症状出现时间及其与振动性白指的关系林立张强张春之杨汝景聂继池王林振动性白指（Ｖｉｂｒａｔｉｏｎ－ｉｎｄｕｃｅｄｗｈｉｔｅｆｉｎｇｅｒ，ＶＷＦ）的发生，除与振动参量、寒冷、噪声等因素有关外，还与接振时间有密切关系［１］。但ＶＷＦ的潜...     

砂轮磨光作业局部振动危害剂量—反应关系及防治对策研究

要振动强度与接振时间积作为接振剂量，研究在不同接振剂量下，作业工作手部症状和ＶＷＦ的累积发生人数、发生率、ＶＷＦ的累积积分及其与接振剂量的相关关系。结果表明，手部症状和ＶＷＦ的累积发生人数与发生率均随接振剂量的增大而增高，二者呈明显的直线相关关系；ＶＷＦ的平均积分也与ＶＷＦ发生后继续接振的剂量呈正相关。从而提示：接振剂量是ＶＷＦ发生的关键因素，降低接振强度度、减少接振时间是预防ＶＷＦ的主要措施。     

砂轮磨光作业局部振动危害调查

为了解砂轮磨光局部振动作业对工人健康的影响,我们于1993～1995年的济宁市砂轮磨作业工人进行调查,现报告如下.     

手臂振动对作业工人正中神经传导速度和手部功能影响的研究

为探讨手臂振动作业工人手部功能和社会传导速度的影响其相互间的关系,我们对某砂轮磨光作业进行振动参数的现场测度。并统计作业工人手部症状,痛觉阈值,同时进行正中神经传导速度,动作电位波幅等的测试。结果表明,白指组各手部症状的发生率及痛觉阈值显著高于接振组和对照组;白指组的感觉神经、运动神经传导速度均较对照组明显减慢,动作电位波辐明显降低,白指组运动神经动作电位较接振组明显减。提示,正中神经传导性,兴奋     

磨光作业工人手传振动剂量分析

为了解工业生产中各种类型打磨工具的振动加速度 ,采用 1 2种打磨机的振动测试数据 ,分析比较各种打磨机的振动危害程度。结果表明 ,手持砂轮机和角向磨光机的频率计权振动加速度 (ahw)较高 ,波动较大 ;座式砂轮机ahw较稳定 ,棒砂轮机ahw最低。由于工人每日使用手持砂轮机的时间较长 ,其 4h等能量频率计权振动加速度 [ahw(4) ]最高 ,角向磨光机次之 ,使用这些工具的多数工人的ahw(4) 明显超过 5m/s2卫生限值 ;使用石英砂纸打磨机ahw(4) 在 5m/s2 上下波动 ;棒砂轮机的ahw(4) <5m/s2 。提示 ,减轻手传振动危害的关键是控制接振时间 ,打磨工具中尤其应控制手持砂轮机的使用时间     

手臂振动病75例振动性白指发作特征的分析

振动性白指（VWF）是手臂振动综合征的典型表现，但是，手臂振动病的VWF却很难被医生捕获，实践证明采用国外一些常用的冷激惹方法也收效甚微，尽管寒冷是其诱发的必备条件。因此，研究VWF发作的基本特征和规律，对其诊断及寻找诱发VWF的最佳方法都有重要的实际意义。目前，国内公开发表的这方面资料甚少，现将我们近20年来收集到的75例资料完整的Ⅶ汀病人分析报告如下。     

手臂振动对心率变异性及外周循环功能影响的研究

探讨手臂振动对作业工人心率变异性与外周循环功能的影响及二者之间的关系。「方法」对某金矿凿岩工人进行了心率变异性的评价指标ＳＤＡＮＮ、ＬＦ／ＨＦ分析,并测试了冷水试验前后作业工人的皮肤温度以及试验后５ｍｉｎ、１０ｍｉｎ的复温度。结论手臂振动造成的外周循环功能障碍可能与植物神经功能紊乱有一定关系。     

手臂振动综合病征中血管痉挛的客观检查

自从１９８５年振动性白指（ＶＷＦ）被确定为一种工业疾病以来，有关其病情严重性的诊断和分级的客观检验已变得十分必要，已经对３４名处于ＶＷＦ赔偿要求医学检查范围的男性和２２名健康对照者的寒冷变化前后的手指血流和手指收缩压做了测定，这类试验先前曾在３５名已建立有Ｒａｙｎａｕｄ’ｓ（雷诺氏）综合征临床诊断的病人中产生一例假阳性结果而在４０名对照者中无假阳性出现。在局部指温从３２℃下降至２０℃时无论环境冷热     

接振时间与作业工人手部症状及振动性白指之间相互关系的研究

按照实际接振时间，将３５例振动性白指患者和１８１各接振作业工人进行了分组，分别统计和比较各组手部症状的发五率。结果表明，接振组随接振时间的延长，各项手部症状逐涟增多，在接振时间为５００１－７５００ｈ时增多最为显著，而此时正是振动性白指的高发时段；随着接振时间的延长，白指组与接震组各手部症状发生率的差异逐渐减小。     

振动性血管损伤生化机制的研究进展

振动性血管损伤（vibration-induced vascular impairment,VVI）是指长期从事手传振动作业而引起的周围血管功能紊乱,表现为指端血管的收缩、痉挛,严重者可发生振动性白指（vibration-induced white finger,VWF）.VVI是手臂振动综合征（hand-arm vibration syndrome,HAVS）的主要表现,也是目前诊断手臂振动病的主要依据.     

局部振动对周围神经与血管机能影响的研究

目的 探讨局部振动对作业工人周围神经、周围血管功能的影响。方法 对振动作业工人进行正中神经传导速度、动作电位波幅的测试,并通过１０℃、１０ｍｉｎ的冷水试验对作业工人手部皮肤温度的恢复情况进行了研究。结果 白指组正中神经的感觉神经、运动神经传导速度明显低于对照组（Ｐ〈０．０１）;冷水试验前后白指组的手部温度均显著低于接振组和对照组（Ｐ〈０．０１）,冷水试验后白指组、接振组的复温率均显著低于对照组（Ｐ     

Risk of hand-arm vibration syndrome according to occupation and sources of exposure to hand-transmitted vibration: A national survey

BACKGROUND: Although some occupational sources of hand-transmitted vibration (HTV) have been extensively investigated, the risks associated with others are poorly characterized. METHODS: A questionnaire was mailed to a community sample of 12,240 men aged 16- 64 years and 906 men from the armed forces. Questions covered current occupation, sources of HTV, numbness or tingling in the fingers in the past week, and finger blanching. In the 5,364 respondents who had been at work in the past week, associations between symptoms and exposures were examined by logistic regression, with odds ratios converted into prevalence ratios (PRs). RESULTS: Altogether, 513 men (10%) reported cold-induced finger blanching and 769 (14%) sensory symptoms in the fingers. The risk of blanching was increased in builders (PR 2.4, 95% CI 1.0-5.2), carpenters and joiners (PR 1.9, 95% CI 1.0-3.4), motor mechanics (PR 2.3, 95% CI 1.1-4.6), and laborers (PR 2.8, 95% CI 1.3-6.0); while the risk of sensory symptoms was elevated in laborers (PR 4.0, 95% CI 2.3-6.6) and plant operatives (PR 3.5, 95% CI 1.9-5.9). Use of hand-guided mowers, concrete breakers, chain saws, and jig saws was significantly associated with symptoms. CONCLUSIONS: Little attention has been paid to the risks of vibration injury in construction workers, woodworkers, motor mechanics, and laborers, or to the risks from mowers, jig saws and several other common vibratory tools. These should be a focus for further investigation and preventive measures.     

Quality of life in Swedish workers exposed to hand-arm vibration

The objective of the present study was to analyse whether differences existed among workers exposed to hand-arm vibration (HAV) with regard to quality of life (QoL) issues. One hundred and eight male workers from a heavy manufacturing plant, with and without HAV symptoms, and workers referred to a hand surgery department with severe HAV symptoms participated in the study. The participants attended a clinical interview, were given a physical examination of the hands and administered the G?teborg Quality of Life instrument and the Evaluation of Daily Activity Questionnaire (EDAQ). Results indicated that workers referred to a hand surgery department with more severe HAV symptoms described a lower quality of life, defined here as lower subjective well-being, more symptoms of ill-health and difficulties with activities of daily living (ADL), than workers with no HAV symptoms. Workers from a heavy manufacturing plant with HAV symptoms experienced more difficulties with ADL, especially while working outdoors in cold weather, than workers with no HAV symptoms. Limitations of the present study include the use of a subjective scale to describe HAV symptoms. Further research is recommended on a larger sample of workers at risk for HAV symptoms to develop preventative ergonomic strategies.     

Significance of finger coldness in hand-arm vibration syndrome

Objectives To evaluate the relationship between subjective symptoms of coldness in fingers and peripheral circulation in patients with hand-arm vibration syndrome (HAVS). Methods Thirty-five male patients confirmed to have HAVS as an occupational disease took part in this study. Their mean age was 62 years (SD 5) and all were chain-saw operators exposed to vibration for an average of 25 years. Their annual health examination included the history of their daily habits (smoking, drinking, and therapeutic exercise), report of subjective symptoms such as coldness, numbness and tingling in the fingers, and a physical examination; laboratory tests consisted of skin temperature measurement, and pain and vibration perception under conditions of cold provocation. A frequently used method of cold provocation, immersion of the left hand up to the wrist in water of 10°C for 10 min, was used. Results Finger coldness was classified into 3 groups according to its severity: mild group (n=8), moderate group (n=17) and severe group (n=10). There was no significant difference in age or occupational background between the groups. A significant association was found between finger coldness and prevalence of Raynaud's pheno menon (p<001, χ²). The mean skin temperature was significantly lower with the severity of finger coldness (ANOVA, p<0.05). In the cold provocation test, there was no significant difference between skin temperature and coldness at 5 min and 10 min after immersion, though a difference was observed immediately after immersion. No significant difference was observed in the relationship between finger coldness and vibrotactile threshold before, during or after the cold provocation test. Conclusions The severity of coldness in the fingers is significantly related to skin temperature. The severity of finger coldness reflects the extent of peripheral circulatory vasoconstriction. Coldness in the fingers may be a good warning of potential problems in peripheral, circulatory function.     

手指皮温对检测手传振动职业危害的意义

目的 探讨手传振动对接触者早期职业损害的指标,避免发生手传振动牟不可逆改变。方法 对１２８名暴露于不同接振剂量的工人及对照者的手指皮温和一些有关的主客观症状进行调查。结果 与对照组相比,随接振剂量的增强和工龄的延长,手批皮温显著下降,对照组及不同接振组工人手指皮温的下降率分别为５．６０％、３０．９５％、５７．５８％和７５．００％,同时受试者的痛阈降低。结论 手指皮温下降是手传振动从业者末梢血循环功     

Effectiveness of therapy with iloprost in hand-arm vibration syndrome

AIM: To evaluate the efficacy and tolerance of therapy with iloprost in hand-arm vibration syndrome. METHODS: We describe a clinical case of a male aged 53 years, who was a heavy smoker for 30 years and a mason working with vibrating tools since 1962. He presented with a history of 10 years of attacks of vasospasm, functional impairment and digital ulceration. He was diagnosed as having hand-arm vibration syndrome vascular stage 4 on the Stockholm Workshop 1986 Scale. Besides suspension from work and abstention from smoking, we began intravenous infusion of iloprost for 6 h in cycles of 3-6 consecutive days, arriving at a dose of 1.5-2.0 ng/kg/min. RESULTS: After eight cycles, he reported significant symptomatic and functional improvement. Iloprost was seen to be efficacious: the trophic skin lesions disappeared and his microcirculatory perfusion tests improved. There were no significant side effects. CONCLUSIONS: We suggest that the use of iloprost in the treatment of the most advanced stages of vascular hand-arm vibration syndrome warrants further study     

Negligent exposures to hand-transmitted vibration

Objectives

If the negligence of an employer results in the disability in an employee, the employer is responsible, in whole or in part, for the disability. The employer is wholly responsible when the worker would not have developed the disability if the employer had taken all reasonable preventative measures. The employer is only partly responsible if the worker would probably have developed some disability even if the employer had taken all reasonable precautions. The employer’s responsibility may be estimated from the difference between the actual disability of the worker and the disability that the worker would have suffered if the employer had taken all reasonable preventative measures. This paper considers alternative ways of apportioning negligent and non-negligent exposures to hand-transmitted vibration.

Results

The equivalent daily vibration exposure, A(8), used in current EU Directives is shown to be unsuitable for distinguishing between the consequences of negligent and non-negligent exposures because the risks of developing a disorder from hand-transmitted vibration also depend on the years of exposure. Furthermore, daily exposures take no account of individual susceptibility or the practicality of reducing exposure. The consequences of employer negligence may be estimated from the delay in the onset and progression of disorder that would have been achieved if the employer had acted reasonably, such as by reducing vibration magnitude and exposure duration to the minimum that was reasonably achievable in the circumstances. This seems to be fair and reasonable for both employers and employees and indicates the consequences of negligence—the period of the worker’s life with disease as a result of negligence and the period for which their employment opportunities may be restricted as a result of the onset of the disorder due to negligence.

Conclusions

The effects of negligence may be estimated from the delay in the onset of disease or disability that would have occurred if the employer had behaved reasonably. This definition of negligence encourages employers to reduce risks to the lowest reasonably practical level, consistent with EU Directives.

     

Lessons from hand-arm vibration syndrome research

This paper addresses many of the salient issues and difficulties encountered in performing Hand-Arm Vibration Syndrome research since its discovery in the early 1900's by Alice Hamilton. The areas discussed and the resulting lessons learned include the medical, epidemiological, and control aspects of HAVS. The authors conclude with a plea to health professionals to be ever vigilant and responsive to the HAVS problem, or else it will continue unabated into the next century, an overall time span of nearly 100 years.     

Proposal for hand-arm vibration exposure limits adopted for Japanese workers operating hand-held vibrating tools

On the basis of data presented in our previous reports, the current study was undertaken to estimate frequency-weighted hand-arm vibration exposure limits for various daily exposure times. The procedures for the present study were as follows. (1) The prevalence of vibration-induced white finger (VWF) as well as the vibration exposure were investigated in various groups of workers operating hand-held vibrating tools. The vibration magnitude of various tools was measured and the results were presented as the energy-equivalent frequency-weighted root-mean-square (m/s²?rms) acceleration. There was?a statistically significant positive correlation between the prevalence of VWF and the measured vibration magnitude (R ²=0.5, P<0.05). Hence, it was concluded that in decisions concerning quantitative recommendations for vibration exposure, the prevalence of VWF should be considered. (2) By a careful selection of available publications which contain useful information on duration of vibration exposure of ?2?h/day and the occurrence of VWF, a significant correlation between the prevalence of VWF and the vibration magnitude could be observed. The regression equation was estimated as: y=?18.5+4.6 (x), R ²=0.8. On the basis of this equation, it was speculated that the prevalence of VWF in workers using vibrating tools might be restricted to the prevalence of Raynaud’s phenomenon in the Japanese general population if the 2-h daily vibration exposure is about 4.5?m/s²?rms. (3) Regarding this speculation, the equation provided in the documentation of ISO 5349 was used and modified as: [(a _h,w) _eq,t =(a _h,w)_eq,2??(2/t)^1/2 (m/s²?rms)] and then the vibration limit values for daily exposure of 1?min to 8?h were calculated. (4) In order to achieve compatibility with standards of other countries, and to formulate an easy method for using the recommended values presented here, the daily exposure time of 8, 4, 2, 1 and 0.5?h were selected. The correspondence vibration magnitudes were in the range 2.2–9.0?m/s²?rms, and the lower limit (2.2?m/s²?rms) was assumed as the permissible vibration exposure limit for an 8-h working period. The proposed daily vibration limits were then compared with those recommended by other institutions.