矽肺患者血液流变学指标观察

矽肺患者由于肺脏受损 ,影响呼吸功能 ,导致机体相对缺氧 ,缺氧会严重影响红细胞的变形性 ,使血液的流变性发生改变[1] 。我们对 60例矽肺患者和 47例正常人进行了测试比较 ,现将检查结果报告如下。1　对象与方法1 1　对象　矽肺患者是从事矿石装卸、破碎、高炉上料等工作的在职及退休工人 60名 ,男 5 6例 ,女 4例。年龄 (5 4 2±10 8)岁 ,工龄 (2 4 8± 10 1)年。全部病例按照《中华人民共和国尘肺诊断及分期标准》诊断为Ⅰ期 2 6例、Ⅱ期 2 5例、Ⅲ期 9例 ,其中新诊断病例 5例 ,住院 3个月以上矽肺患者 5 5例。全部病例均无肺结核、肺部…     

58例矽肺患者肺功能测定分析

矽肺患者的劳动能力鉴定是测量和估计患者的劳动能力,以便提出意见,为患者安排工作或落实待遇供有关部门参考。矽肺患者早期其通气功能就可能有损害,特别是肺容积的改变较为明显 ［１］。现就 ５８例矽肺患者肺功能测定结果作一分析,供讨论。１材料及方法１．１资料来源本站１９９６—１９９９年,笔者经办测定的５８例矽肺患者的肺功能结果,其中Ⅰ期２７例（２例合并肺结核）、Ⅱ期２５例、Ⅲ期６例,均为男性,年龄最小３５岁,最大 ６８岁,平均 ４８．６岁。工种分布：井下１２４人、坑道风钻工２１人、锅炉工４人、 铸造工 ３人、…     

矽肺患者肺功能分析

目的探讨矽肺患者肺功能受损情况。方法对57例矽肺患者最大肺活量（VCmax）,用力肺活量（FVC）,1秒时间用力呼出量（FEV1）,1秒时间用力呼出量与用力肺活量之比（FEV1／FVC）,最大呼气中期流速（MMEF）,25％、50％、75％肺量时的最大呼气流量（V25、V50、V75）,肺总量（TLC）,残气量（RV）,残总比（RV／TLC）,肺弥散量（DLCO）等肺功能指标进行测定分析。结果I期与Ⅱ期矽肺患者肺功能损伤以混合型为主,且I期矽肺患者FEV1％、FEV1／FVC、V25、V50、MMEF测定值与Ⅱ期矽肺患者比较,差异有统计学意义（P〈0．05）。结论矽肺患者肺功能损伤明显,且随矽肺期别增加而加重,损伤类型以混合为主。Ⅱ期矽肺患者大、小气道的阻塞较I期矽肺病人加重。     

100例矽肺患者的肺功能分析

肺通气功能是对矽肺病人进行劳动能力鉴定的主要依据之一,国内这方面已做了不少工作。现就笔者对100例进行劳动能力鉴定的矽肺患者的肺通气功能测定结果作一分析。材料与方法1．患者来源:将我院1996、1997两年的门诊、住院矽肺病人测定的肺功能资料随机取样,取出100例,其中矽肺Ⅰ期50例(合并结核1例、合并肺气肿1例),Ⅱ期50例(合并结核4例、合并肺气肿2例)。均为男性,年龄为46~66岁,平均54岁。工种分别为井下工28例、轧石工34例、砂轮工28例、抛光工3例、翻砂工4例、养路工3例;专业工龄最长32年,最短6年,平均18年。     

382例矽肺患者肺功能检查分析

为了解各期矽肺患者肺功能损害的程度与性质 ,搞清各期矽肺与肺通气功能指标的关系及变化特点 ,提高肺通气功能检查在矽肺患者劳动能力鉴定中的应用价值 ,现对 1992年～1999年底来我站职业病房住院治疗的 382例各期矽肺患者的肺功能检查结果进行分析 ,结果如下。1　对象与方法1.1　对象　选择 1992年～ 1999年底来我站职业病房住院治疗的各期矽肺患者 ,共计 382例为观察对象 ,其中男性 2 96例 ,女性 86例 ,年龄在 35岁至 72岁 ,接尘工龄 5～ 32年 ,各期年龄均值经 t检验 ,差别无显著性。1.2　方法　采用日本产 HI- 2 98型肺功能分析仪 ,由…     

矽肺患者肺功能损害浅析

本文对病退矽肺患者功能进行了测定，结果表明，患者肺功能有明显下降，随病期的增量下降越为明显，肺功能障碍多以混俣性为主，大小气道同时异常居多，肺功能损害分级也说明病期增加损害我为严重，以上结果提示我们应对这部分病退回家的患者出样应积极采取保护性措施。     

矽肺患者肺通气功能的10年动态观察

矽肺是致残性疾病,主要是肺组织广泛纤维化引起肺功能损伤,致使病人劳动力减低甚至丧失。肺通气功能随着矽肺病变的进展而呈现逐渐减退的趋势,且小气道功能指标较早地反映患者呼吸生理的改变,这已见有关报道,但动态观察肺通气功能与矽肺相关改变的报道则不多见。我们就     

矽肺病人肺功能研究

本文以110例矽肺病人和103例接触矽尘时间较长的工人为对象,对矽肺病人肺功能损害程度及特点进行了研究。结果表明:矽肺病人组各通气功能指标和弥散量都明显低于接尘工人组(P<0.01)。各期矽肺病人比较,各项肺功能指标均随矽肺期别的增加而降低。分析肺功能损害的性质表明,矽肺病人主要表现为混合性和阻塞性损害。     

60例矽肺患者肺通气功能分析

矽肺引起肺部病理损害，其形态表现于X线胸片，其功能损害表现于肺功能异常。本文通过60例矽肺肺功能测定试图探讨矽肺患者肺通气功能变化（损害）的程度和规律。     

矽肺患者26例肺功能损害分析

肺功能对于评价矽肺患者肺的损伤程度和进行劳动能力鉴定均有十分重要的作用,为了解我市矽肺患者肺功能的损伤情况,对26例矽肺患者和22例粉尘接触者进行肺功能测定,进行比较,现分析如下。 1 对象与方法 1.1 研究对象 选择经宁波市尘肺诊断组确诊的26例矽肺患者作为病例组,年龄为59～66岁,平均61.7岁,身高为149～173cm,平均159.4 cm,体重45～75 kg,平均56.7 kg。其中Ⅰ期矽肺11例,Ⅱ期矽肺9例,Ⅲ期矽肺6例。另选有相同矽尘接触史而     

Lung function in silicosis

Summary In order to assess the effect of silicosis on lung function, 61 gold miners with radiological silicosis were compared with 61 controls. Each pair was matched for age, dust exposure, and smoking habits. A full range of lung function tests was performed, and with two exceptions the results showed no significant differences between the two groups. The exceptions are the slope of the alveolar plateau (phase 3) and he closing volume, for which the silicotic cases had significantly higher values. The reason for the higher readings in the silicotic patients remains unexplained.     

肺移植治疗矽肺五例临床分析

目的 探讨肺移植治疗矽肺的手术适应证、围术期的处理及疗效.方法 对经当地职业病防治中心诊断为矽肺的5例终末期矽肺患者进行了肺移植治疗.移植前5例患者的X线胸片、CT提示不同程度的肺间质纤维化、肺气肿伴肺大泡、伴大小不等的肺结节团块影,平均肺动脉压均＞30mm Hg,心功能Ⅲ-Ⅳ级;2例术前有胸部手术史,呼吸机依赖1例.5例矽肺患者中,1例在体外膜肺氧合(ECMO)辅助下行续贯式双肺移植,4例接受单肺移植,其中3例在ECMO辅助下完成.结果 病例5于术后8 d因多器官功能衰竭死亡,其余4例均康复出院.随访中病例3术后7月死于重症感染,病例1、病例2、病例4现已分别存活5、3、2年.患者术后肺动脉压下降,肺功能得到明显改善,生活质量良好.有轻度的慢性排异,出现闭塞性细支气管炎(BOS)的表现.结论 肺移植对治疗终末期矽肺有效,单、双肺移植治疗矽肺均有较好的应用前景,患者远期的生存还需进一步观察.

Abstract：

Objective To investigate the selection of recipients, operative technique, and perioperative management of lung transplantation for silicosis. Methods Lung transplantations(LTx) were performed for five end-stage silicosis in our hospital who were diagnosed in accordance with recommendations of the local Prophylactico-Therapetic Institution for Occupational Diseases.The chest roentgenogram and high resolution CT showed somewhat pulmonary interstitial fibrosis, pulmonary emphysema and massive opacities. The mean pulmonary artery pressure (mPAP) was＞30mmHg,NYHA Ⅲ or Ⅳ. Two patients received thoracic surgery prior to LTx,one patient was ventilator-dependent. One patient received bilateral sequence lung transplantation (BSLT) under extracorporeal membrane oxygenation (ECMO) support. Four patients received single lung transplantation (SLT),3 under ECMO support. Results Patient five died of multiple organ failure on postoperative day 8,the remaining four patients were discharged from hospital.During follow up,patient three died of severe infection 7 month postoperatively,the remaining three patients were alive for 5 years, 3 years and 2 years respectively,and lived good quality of life, especially with lower mPAP and improved lung function.Although our patients suffered low-grade chronic rejection with the manifestation of bronchiolitis obliterative syndrome (BOS). Conclusion Lung transplantation is a viable option for patients with end-stage silicosis,providing acceptable quality of life and survival.Both SLT and BSLT are satisfactory approach for end-stage silicosis.and long-term survival requires further investigations.     

矽肺并发慢性阻塞性肺疾病稳定期患者呼吸功能锻炼的护理干预

目的观察呼吸功能锻炼的护理干预措施对矽肺并发慢性阻塞性肺疾病(COPD)稳定期患者的临床治疗疗效。方法随机抽取2017年8月至2018年4月泰山医学院附属莱钢医院职业病科住院60例矽肺并发COPD稳定期患者并分为两组。对照组:30例,给予常规治疗加呼吸功能锻炼;观察组:30例,在对照组治疗的基础上给予护理干预措施。2个月后,比较干预前后两组患者的肺功能、血气分析、6 min步行距离。结果干预后观察组第1秒用力呼气容积(FEV1.0)、用力肺活量(FVC)、氧分压(PaO2)及6 min步行距离较对照组明显升高,差异有统计学意义(P<0.05),两组FEV1.0/FVC、二氧化碳分压(PaCO2)的差异无统计学意义(P>0.05)。 结论护理干预措施能有效改善矽肺并发COPD稳定期患者的FEV1.0、FVC、PaO2及6 min步行距离。     

Lung function and clinical findings in a cross-sectional study of arc welders

Summary An epidemiological, cross-sectional study was conducted in order to assess non-neoplasic effects on the lung due to chronic exposure to arc welding fumes and gases. The study involved 346 arc welders and 214 control workers from a factory producing industrial vehicles. These workers (welders and controls) had never been exposed to asbestos. Respiratory impairments were evaluated by using a standardized questionnaire, a clinical examination, chest radiophotography and several lung function tests (spirometry, bronchial challenge test to acetylcholine, CO transfer tests according to the breath-holding and the steady-state methods, N₂ washout test). The only significant differences between the welders overall compared to the controls were a slightly higher bronchial hyper-reactivity to acetylcholine and a lower lung diffusing capacity for CO in the welders. However, non-specific, radiologic abnormalities (reticulation, micronodulation) and obstructive signs were more frequent in the most exposed welders (welding inside tanks) than in welders working in well ventilated workplaces. The nature of the metal welded (mild-steel, stainless steel, aluminium) did not seem to have an influence on respiratory impairments. In the mild-steel welders, respiratory symptoms (dyspnoea, recurrent bronchitis) and obstructive signs were more frequent in the welders using a manual process than in the welders involved with the semi-automatic process (MIG). For all the workers (welders and controls), smoking had a markedly adverse effect on respiratory symptoms and lung function. Moreover, smoking seemed to interact with welding since CO lung transfer was more impaired in smoking welders than in smoking controls.     

慢性咳嗽患者小气道功能的改变及其临床价值

目的 初步评价肺功能检测中反映小气道功能的指标对慢性咳嗽患者鉴别诊断的临床价值.方法 对109例慢性咳嗽患者进行常规肺功能检测和支气管激发试验,观察支气管激发试验阳性患者与阴性患者小气道功能指标的差异,以及小气道功能异常与正常患者肺功能指标差异和支气管激发试验的阳性率.结果 109例患者中支气管激发试验阳性60例,阴性49例.支气管激发试验阳性患者峰值呼气流速、最大呼气中期流速75/25、呼气中段流速(FEF)25、FEF50、FEF75较阴性患者低,差异有统计学意义(P<0.05),肺活量、用力肺活量、第1秒用力呼气容积、第1秒用力呼气容积占用力肺活量百分比两者比较差异无统计学意义.109例患者中有48例提示小气道功能异常,其中39例支气管激发试验阳性,占81.2%;而小气道功能正常的6l例患者中,有21例支气管激发试验阳性,占34.4%,两者阳性率比较差异有统计学意义(P<0.01).结论 肺功能中反映小气道功能的指标能预测气道高反应性,对于大量不能开展支气管激发试验的基层医院,有助于发现早期咳嗽变异型哮喘患者,尤其对于合并小气道病变的年轻患者更重要.     

Lung function and respiratory symptoms among workers in a soft paper mill

Summary The aim of the present cross-sectional study was to investigate whether long-term exposure to soft paper dust causes impairment of lung function. Exposed workers (n = 287) and referents (n =79) were investigated, using spirometry and questionnaires. Personal samplings of total dust showed that the actual mean concentrations did not exceed 3 mg/m³. The exposed subjects were divided into three categories according to historical and present exposure to paper dust; low exposure, moderate exposure and high exposure. The study did not show any lung function impairment due to exposure to paper dust. However, the exposed subjects had a significantly increased prevalence of symptoms from both the upper and lower airways as well as an increased prevalence of reported asthma. On the basis of our study, we conclude that lung function impairment does not occur among workers exposed to mean levels of soft paper dust below 5 mg/m³.     

Lung function predicts mortality: 10-year follow-up after lung cancer screening among asbestos-exposed workers

Purpose

To assess the predictive value of lung function impairment on mortality among asbestos-exposed workers.

Methods

A total of 590 workers originally screened for occupational lung disease including spirometry and pulmonary diffusing capacity measurements were followed up for mortality data (ICD-10 classification). The mean follow-up time was 10.5 years. Associations of different lung function parameters with mortality from all causes and from cardiovascular (I00-I99) and non-malignant respiratory diseases (J00-J99) were analysed. Factor analysis was used to create obstructive and restrictive factors.

Results

A total of 191 deaths were found altogether. Most measured lung function variables were associated with increased mortality when studied separately. Both decreased forced expiratory flow in one second (hazard ratio/measurement unit = 0.977, 95 % CI 0.969–0.988, p < 0.001) and impaired diffusing capacity (0.973, 0.965–0.981, p < 0.001) were independently associated with mortality from all causes, as well as from cardiovascular and non-malignant respiratory diseases. Both obstructive factor alone and the sum of obstructive and restrictive factors were associated with all studied mortality categories. The restrictive factor alone was associated with all-cause and respiratory mortality.

Conclusions

Deteriorated lung function predicts deaths. The reasons for impaired lung function should be medically explored to enable restoring measures aiming thus to prevent premature deaths.     

71例儿童非典型哮喘肺功能改变及意义

目的 探讨非典型哮喘患儿肺功能改变及不同肺功能指标评价该类患儿支气管舒张试验阳性率的差异.方法 对71例非典型哮喘患儿进行常规肺通气功能检测,后进行支气管舒张试验,观察患儿气道指标变化情况.结果 71例非典型哮喘患儿大气道指标第1秒用力呼气容积、第1秒用力呼气容积占用力肺活量的百分比基本正常,而反映小气道功能指标用力呼气25％肺活量的瞬间流量、用力呼气50％肺活量的瞬间流量、用力呼气75％肺活量的瞬间流量、用力呼气25％～75％肺活量的瞬间流量均有不同程度的下降,且主要为中、重度损害.以第1秒用力呼气容积作为评价指标,支气管舒张试验阳性例数为34例,阳性率为47.9％（34/71）,而以用力呼气25％～75％肺活量的瞬间流量作为评价指标,支气管舒张试验阳性例数为49例,阳性率为69.0％（49/71）,两种评价指标阳性率比较差异有统计学意义（x2=8.086,P=0.004）.结论 非典型哮喘患儿肺功能改变主要以小气道为主,且主要为中、重度损害,评价该类患儿支气管舒张试验阳性情况时,用力呼气25％～75％肺活量的瞬间流量可以辅助第1秒用力呼气容积,降低误诊率和漏诊率.