经支气管肺活检在尘肺诊断中初步应用

目的：探讨经支气管肺活检在尘肺诊断中价值。方法：对128例接尘者作经支气管肺活检及病理上对纤维化、粉尘沉着作检测。结果：尘肺待诊病例与病理确诊相关达83．9％,有助于鉴别诊断,有助于鉴别诊断,并且病理特殊染色在尘肺病因学诊断中起重要作用。结论：经支气管肺活检作为辅助手段,对尘肺诊断、鉴别诊断有一定应用价值。     

某陶瓷企业接尘工人肺功能分析

目的 了解某陶瓷企业粉尘对工人肺功能的影响，为尘肺防治提供科学依据。方法对147例陶瓷生产工人和50名对照组分别进行肺功能测定。结果 肺通气功能测定显示暴露工龄5a～组和10a～组VC、FVC、PEF、FEF 75％明显低于对照组，10a～组FEV，低于其他3组，暴露组FEF25-75、FEF25%。明显低于对照组。暴露组肺通气功能和小气道通气功能异常率高于对照组，其中10a～组与对照组的差异有统计学意义。结论 粉尘对该企业接尘工人的肺功能有危害，且随着工龄增加损伤程度加重。     

经皮肺穿刺活检与经支气管肺活检诊断价值的对比分析

目的评价两种肺活检方法对肺部常见疾病的诊断价值。方法回顾性分析一组52例X线引导经支气管肺活检和另一组38例CT引导经皮肺穿刺活检之间病理确诊阳性率之差异。结果2组患者获取标本的成功率均为100%,部分患者因取材量少,病理结果无诊断意义。经皮肺穿刺活检确诊率明显高于经支气管肺活检组,除2例患者有轻度气胸外,未发生其他不良反应。结论经皮肺穿刺活检是一种安全、有效、准确、损伤小的诊断方法,应当首选。     

铸钢与铸铁接尘工人肺功能测定的比较分析

本文对５０６名铸钢接尘工人，１５５０名铸铁接尘工人．７３８名对照工人进行了肺通气功能的测定与比较分析。结果表明：无论吸烟与否、铸钢、铸铁接尘工人ＦＶＣ、ＦＥＶ１．０等肺功能指标的实测值占预计值百分比的下降，肺功能异常率的升高，均较对照工人为明显，铸钢工人肺功能的损害尤为严重。三年追踪观察结果显示：铸钢工人ＦＶＣ、ＦＥＶ１．０的年均下降值大于铸铁工人。铸钢与铸铁接尘工人相同累计接尘量，相同接尘工龄与相同工种间的比较，亦均显示铸钢工人肺功能的损害较铸铁工人为重。     

煤矿接尘工人生命质量影响因素分析

为了解接触煤尘工人的生命质量状况及其影响因素,随机抽取某煤矿井下接尘工人597名,以问卷形式调查了接尘工人一般情况,用SF-36量表对生命质量进行评价,并分析了影响生命质量的因素。经单因素统计分析,年龄、接尘工龄、日工作时间、工作时间制度、经济水平、文化程度、饮酒情况、呼吸系统症状、福利水平、生活中所遇重大事件、人际关系及工作危险等11种因素与生命质量的各维度或大多数维度有关系。进一步作多元协方差分析发现,影响接尘工人生命质量的主要因素是呼吸道症状、接尘工龄、生活中所遇重大事件及福利情况等因素。     

某市灯饰加工工业接尘工人肺功能测定分析

目的了解某市灯饰加工工业接尘工人的肺功能损害情况。方法对某市某镇15家灯饰加工厂接尘工龄1年以上的300名男工进行肺功能测定,另选择该镇的150名非接尘男工作为对照组;并对灯饰加工厂进行粉尘测定。结果15家灯饰加工厂铝尘、矽尘浓度超标率分别为53.33%和86.67%,最高超标分别为2.2倍和16.0倍。矽尘中游离SiO2含量平均96.44%。接尘组肺通气功能的异常率显著高于对照组(P<0.01),用力肺活量(FVC)、第1秒用力肺活量(FEV1.0)、第1秒用力肺活量与用力肺活量之比(FEV1.0/FVC)、肺活量(VC)、最大呼气中期流速(FEF25-75)、最大呼气25%、50%、75%肺活量时流量(FEF25、FEF50、FEF75)均明显低于对照组(P<0.01)。肺通气功能随着接尘工龄的延长而降低(P<0.01)。结论灯饰加工工业粉尘可致接尘工人肺功能一定程度的损伤,应做好预防工作。     

煤矿基层接尘工人健康管理

接尘工人健康管理是尘肺病防治的基础工作。煤工尘肺由于发病人数多,加强煤矿基层(矿、处、厂)接尘工人健康管理尤其显得重要。本文介绍的表卡内容和管理方法,经我们在基层矿处近5万名工人试用,初步证明效果良好。     

某金矿接尘工人健康现状分析

[目的]了解矿山接尘作业人员尘肺患病情况;了解矿山接尘工人常见慢性病的患病情况及流行病学特征;分析不良有害因素导致各种慢性病的患病情况及其与工龄、工种之间的关系。[方法]对某金矿企业接尘工人521人进行健康体检资料的调查分析。调查方式由劳动卫生与职业病医师直接询问调查,同时测量血压、肺活量,内外科检查及胸部后前位高仟伏X线摄片等。[结果]本次体检521人中,尘肺患者为120人,占总人数的23.0%。其中井下工人患病率为26.1%,高于井上工人。120例尘肺病人接尘时间主要集中在1970～1990年,占构成的86.66%。高血压、胃炎、慢性胃炎等慢性疾病患病率井伤工人均较高。高血压、关节炎、慢性鼻炎等慢性疾病患病率都有随工龄增长而增高的趋势,除慢性胃炎、腰肌劳损、慢性咽炎、慢性支气管炎,各工龄组各种慢性病的患病率之间差异均有统计学意义(P﹤0.05或P﹤0.01)。[结论]接尘工人尘肺的发病同接尘时间,接尘种类有密切关系。工龄越长高血压、关节炎等慢性病的患病率越高;井下工人高血压、胃炎、慢性咽炎等慢性病的患病率比井上工人高;尘肺病人的慢性病患病率高于非尘肺接尘工人。     

陶瓷企业接尘工人肺功能研究

目的 探讨陶瓷粉尘作业工人肺功能损伤的特征。 方法 采用美能(日本) AS507型肺功能仪,测定某陶瓷厂"无尘肺"的967名接尘工人(接尘组)和197名非接尘健康工人(对照组)的肺通气功能。 结果 陶瓷粉尘总尘浓度为0.10~2.95 mg/m3,总尘浓度超标率为14.29%,呼吸性粉尘浓度超标率为3.57%;粉尘中游离SiO₂含量为21.3%~43.0%。接尘组VC、FVC、FEV 1、FEV 1%、FEF 25%和FEF 50%的数值均低于对照组,差异有统计学意义(P<0.05或P<0.01)。接尘组肺通气功能损伤和小气道损伤的发生率均高于对照组,差异有统计学意义(P<0.05)。接尘的吸烟者VC、FEV1和FEV1%数值与非吸烟者相比,差异有统计学意义(P<0.01)。接尘工人肺通气功能损伤发生率为7.45%(72/967),其中轻度损伤者占98.61%(71/72),限制性肺通气功能损伤占97.22%(70/72)。 结论 陶瓷粉尘可引起接尘工人肺功能的损伤,其损伤程度以轻度为多,损伤类型以限制型损伤为主。肺功能损伤主要与粉尘、接尘工龄、工种和吸烟等因素有关。     

石棉工人接尘剂量与石棉肺发病关系观察

石棉工人接尘剂量与石棉肺发病关系观察重庆市石棉制品厂职工医院王如麒，王家骅对本厂自１９３９年投产到６０年代末比较相对稳定的接尘工人５０５人、观察其石棉肺发病与剂量──反应关系。目前国内外学者在研究粉尘与尘肺发病。分析剂量与反应关系时，计算粉尘量采用的...     

经支气管肺活检在尘肺病诊断中的应用

目的 探讨经支气管肺活检在尘肺诊断中的价值.方法 以2003年1月至2010年6月在上海市肺科医院就诊、X线胸片有尘肺样改变、提供的接尘性质或累计剂量与X线胸片表现不相符或缺乏系列X线胸片、要求明确诊断并接受支气管肺活检(TBLB),取得满意标本的尘肺诊断病例379例为研究对象.进行TBLB检查和肺组织病理观察.2005年5月起对TBLB标本增加普鲁士蓝铁反应检查.根据GBZ 70-2002及GBZ 70-2009《尘肺病诊断标准》,参考病例自述和TBLB病理检查进行集体诊断.结果 在379例病例中,376例(99.2％)表现肺间质纤维化改变,228例(60.2％)粉尘沉着;111例(29.3％)的偏光镜检双折光晶粒阳性.接触矽尘、陶土尘、水泥尘、煤矽尘和铸造尘病例的偏光晶粒阳性率为37.8％(62/164),高于接触其他粉尘(电焊烟尘、石棉尘、铝尘等)者的22.7％(49/215),差异有统计学意义(P＜0.05).接触电焊烟尘或打磨尘者普鲁士蓝铁反应阳性率为53.1％(94/177),明显高于接触其他粉尘(水泥尘、铸造尘、矽尘等)者的23.2％(13/56),差异有统计学意义(P＜0.01).接触电焊烟尘尘肺组病例纤维组织增生率高于无尘肺组,差异有统计学意义(P＜0.05).接触矽尘、铸造尘、打磨尘、石棉尘的尘肺组和无尘肺组(观察对象)的肺纤维组织增生率、粉尘沉积率和偏光晶粒阳性率的差异均无统计学意义(P＞0.05).结论 经支气管肺活检能获得接触粉尘的依据和相关肺部病变,对协助尘肺病诊断具有积极意义.     

铁矿工人尘肺发病及影响因素分析

目的 分析铁矿接尘工人尘肺的发病规律及影响因素,为铁矿工人尘肺防制提供依据.方法 以某铁矿1960年至1974年在册且工作1年以上的所有接尘工人建立队列,随访至2003年底.尘肺诊断由职业病诊断小组确定.采用Cox比例风险模型分析危险因素.结果 队列接尘工人3647名,累积接尘132 574.4人年.诊断尘肺316例,人年发病率为0.24％.1960年前开始接尘者中发现尘肺274例(86.7％),人年发病率为0.40％,明显高于1960年后开始接尘工人尘肺人年发病率(43例,0.07‰).尘肺发病平均潜伏期是(26.0±7.3)年.尘肺晋级年限分别为0+晋Ⅰ期(5.3士3.2)年,Ⅰ晋Ⅱ期为(6.6±5.2)年,Ⅱ晋Ⅲ期为(1 1.3±5.0)年,随诊断年代的推后,各期晋级年限均有延长趋势.164例尘肺为脱尘后诊断,平均脱尘8.3年.铁矿工尘肺发病危险度随累积接尘量增加而上升,呈明显的接触剂量-反应关系.尘肺患者年平均累积接尘量为(173.7±91.6)mg/m3,远高于非尘肺接尘工人(112.1±64.8)mg/m3.除累积接尘量外,影响尘肺发病风险因素包括肺结核(HR=5.9,P＜0.01)、吸烟(HR=1.7,P＜0.01).结论 累积接尘量与尘肺发病之间存在明显的剂量-反应关系,并发结核、吸烟是影响尘肺发病的危险因素.     

接触丁二烯作业168名工人心电图结果分析

目的　对接触丁二烯作业工人的心电图改变进行分析 ,研究丁二烯对心血管系统的影响。方法　 168名接触丁二烯作业工人为观察组 ,非接触人员 70名为对照组 ,对两组的心电图进行对比和统计分析。结果　观察组与对照组心电图R -R、P -R、Q -T间期比较 ,差异有非常显著性 (P <0 .0 1) ,窦缓、心律不齐、传导阻滞及ST -T改变的发生率观察组明显高于对照组 ;工龄在 10a以上者 ,其心电图改变明显高于 10a以下者。结论　长期接触丁二烯可影响心血管系统 ,其发生率随工龄的延长而明显增加 ,对接触丁二烯作业工人的心电图检查应列为常规检查指标并动态观察。     

Chromosomal aberration analysis in workers exposed to chemical and biological hazards in research laboratories

Cytogenetic monitoring of individuals occupationally exposed to chemical and biological hazards has found increased frequencies of cells with chromosomal aberrations. During the present study we analyzed the frequency of chromosomal aberrations in cells from individuals working in various chemistry and biology research laboratories of the University of Brasilia, Brazil. When evaluated jointly and compared to a control group there was no significant increase in the frequency of chromosomal aberrations in the laboratory personnel. However, a group constituted of individuals of the Genetics Laboratory showed a statistically significant increase in the frequency of structural chromosomal aberrations of the chromatid gap type.     

Significance of urinary metallothionein in workers exposed to cadmium

Summary Cadmium in blood (Cd-B) and in urine (Cd-U) and metallothionein (Mt-U) and ₂-microglobulin in urine ( ₂m-U) were measured in 94 male Cd workers. The results were examined according to the workers' current exposure to cadmium (group C, n=73, workers currently exposed to Cd; group R, n=21, Cd workers removed from exposure or retired) and according to their renal status (group N, n=66, normal ₂m-U; group 1, n=28, ₂m-U>200 g/g creatinine). The interrelationships between Mt-U, Cd-U, Cd-B and years of cadmium exposure were examined in the various subgroups. The study of the correlations between these variables demonstrates that Mt-U is directly correlated with Cd-U but not with Cd-B or years of Cd exposure. The association between Cd-U and Mt-U is independent of the status of renal function and the intensity of current exposure to cadmium. Under moderate chronic exposure to cadmium, the fraction of Cd-U which is directly influenced by recent exposure (Cd-B) is small in comparison with that influenced by the cadmium body burden.     

Thioether excretion of workers exposed to bitumen fumes

Summary The excretion of thioethers was determined in the urine of workers involved in road paving operations and in the preparation of asphalt mixing in an asphalt plant. An occupationally nonexposed group served as control. From the results it was observed that there was no significant difference in urinary thioether levels between the exposed and nonexposed groups, however, smokers of both exposed groups had significantly higher urinary thioether levels than the nonexposed smoking workers. These results suggested that higher urinary thioether excretion could be only due to a difference in smoking behaviour. There were also significant differences in urinary thioether levels between the exposed smoking and nonsmoking workers. The authors suggest that these workers have a low mutagenic/carcinogenic risk and smoking is responsible for the majority of thioether excretion, as has been found by other investigators.     

Biologic monitoring of workers exposed to silver

Summary Air-lead levels (PbA) and biological indices were studied in three ceramic factories (185 workers altogether). A difference in the pattern of lead exposure was found in the largest factory (A) and the other two smaller factories (B and C). PbA never exceeded 67 g/m³ in factory A, but reached values as high as 378 g/m³ in factory B. 19% of PbB values were higher than 40 g/100 ml in factory A, 63% in factory B and 35% in factory C. As was expected, a closer analysis of the jobs confirmed a higher exposure level in people directly in contact with lead glazes (glazers and kiln operators). In factories B and C, however, there was also a significant lead uptake in selection and maintenance staff, who worked in areas at some distance from the glazing lines. This may be due in part to pollution spread over all departments, but also to the lack of hygiene and washing facilities whose importance is stressed for effective prevention. Biological monitoring is suggested as being useful for all workers, whatever the lead-air level, bearing in mind the possibility of lead intake orally through soiling.     

Mortality of Dutch workers exposed to carbon disulfide

Epidemiological studies carried out in Great Britain, Scandinavia and the United States indicate that workers exposed to carbon disulfide are at an increased risk for cardiovascular disease (CVD) mortality, and in particular for ischemic heart disease (IHD) mortality. In the epidemiological study reported here a retrospective cohort design was used. The total study population consisted of 3322 workers from a Dutch viscose textile plant who had all been employed for at least half a year between 1 January 1947 and 1 January 1980. Only production and maintenance workers were selected for the study. A group of 1434 workers who had been exposed to carbon disulfide was identified from the files available at the plant. The remaining 1888 workers who had not been exposed to carbon disulfide were used as a reference group. The total study population was followed for mortality until 1 January 1988. For the 762 workers who had died before that date, the causes of death were checked at the Central Bureau of Statistics. The results show a slightly but significantly increased risk for CVD mortality (CVD-specific SMR of 115), despite the observation of the socalled healthy worker effect and the statistical uncertainties inherent to this type of study. The results are in accordance with those reported by other investigators. The results indicate that exposure to relatively low levels of carbon disulfide increases the risk of CVD mortality.     

二甲基甲酰胺作业工人皮肤污染量研究

目的 建立二甲基甲酰胺(DMF)接触工人皮肤污染量的测定方法,并对DMF接触工人皮肤污染情况进行研究.方法 选择不同岗位的37名DMF接触工人,随机分成异丙醇组(16人)和去离子水组(21人),分别以异丙醇和去离子水为擦拭溶剂,采用气相色谱法测定DMF的皮肤污染量,同时测定工人班末尿中甲基甲酰胺(NMF)含量,并对皮肤污染总量与尿中NMF进行相关分析.结果 异丙醇组均能检测出DMF含量,去离子水组均未检出DMF,样品图谱中其他杂峰与DMF峰能完全分离,无干扰.湿法岗位工人皮肤污染总量最高[(2.844±1.31)mg],后处理岗位[(2.50±0.95)mg]和干法岗位[(1.95±0.61)mg]次之,后处理三版印刷、干法配料和湿法配料岗位工人经呼吸道累积接触剂量分别为351.3、201.3、135.2 mg.3个岗位空气中DMF平均浓度为60.2、89.6、156.4 mg/m3,皮肤DMF污染总量与尿中NMF无明显相关,差异无统计学意义(r=0.176,P>0.05).结论 异丙醇是测定DMF皮肤污染较有效的擦拭溶剂;当工作场所空气中DMF浓度高于职业接触限值时,DMF以呼吸道吸收为丰要途径,但其皮肤吸收也不容忽视.