某化纤厂职业性慢性轻度二硫化碳中毒病例临床特征

摘要

目的 通过分析267例职业性慢性二硫化碳(CS2)中毒病例的临床特征,为修订我国CS2接触者职业性健康体检项目提供依据.方法 选择2006年4月至2010年5月某市职业病院诊断专家组依据GBZ 4-2002《职业性慢性二硫化碳中毒诊断标准》,诊断的职业性慢性轻度CS2中毒267例病例为研究对象.所有病例均来自同一化纤厂,初次诊断为CS2中毒时,由职业卫生专业人员以问卷调查采集详细病史及职业史,并进行神经系统、心血管系统检查,生化指标、神经-肌电图检测.结果 87.3％( 233/267)的病例出现腓总神经、正中神经、尺神经、胫后神经运动传导速度减慢,英中腓总神经和正中神经运动传导速度降低检出率分别为48.6％( 138/248),37.0％(155/419).中毒病例自觉症状以神经衰弱、肢体麻木、感觉异常为主,神经系统体征中跟腱反射(79.4％,212/267)、膝反射(49.8％,133/267)阳性检出率较高.心电图ST段改变(T波低平、T波倒置、ST段压低)检出率为19.1％(51/267);高血压、收缩压升高及舒张压升高检出率依次为27.3％( 73/267)、22.5％( 60/267)和21.1％( 59/267).乳酸脱氢酶、三酸甘油酯、低密度脂蛋白异常阳性检出率较高.男性病例的间接胆红素、直接胆红素、尿酸阳性检出率明显高于女性,并且尿素氮、间接胆红素阳性检出率随接毒工龄的延长而逐渐增加.结论 职业性慢性CS2中毒主要影响神经系统,对肝肾功能也有一定的影响.CS2作业人员职业性健康体检中,用神经肌-电图筛检运动神经损伤时,建议首先检查正中运动神经和腓总运动神经传导速度.%Objective To analyze the clinical characteristics of 267 cases with occupational chronic carbon disulfide (CS2) poisoning and to provide the basis for revising the items of periodical medical examination of workers occupationally exposed to CS2.Methods The subjects of present study were 267patients with mild CS2 poisoning diagnosed according to "Diagnostic Criteria of Occupational Chronic Carbon Disulfide Poisoning (GBZ4-2002)" from April in 2006 to May in 2010.All patients were from the same chemical fiber factory.When a subject was diagnosed as patient with CS2 poisoning,who should interview with questionnaire which included the illness and occupational history,symptoms,individual habits.The physical examination,nervous test,cardiovascular test,biochemical test and electromyogram were performed.Results The rate of decreased motor conduction velocity was 87.3% (233/267roots).The highest detection rate of slowing conduction velocity was the common peroneal motor nerve which was 48.6% ( 138/248 roots) and the second was median motor nerve with delay rate of 37% ( 155/419 roots).The main symptoms of the patients were neurasthenia,numbness and paresthesia.The rates of abnormal achilles tendon reflex and knee jerk reflex in patients were were 79.4% and 49.8%,respectively.The detected rates of patients with ST-segment changes and hypertension were 19.1% and 27.5%,respectively.The rates of hypertension,systolic pressure and diastolic pressure were 27.3%,22.5% and 21.1%,respectively.The rates of lactate dehydrogenase (LDH),triglycerides (TG) and low density lipoprotein (LDL) were high.The detected rates of urine acid,indirect bilirubin and total bilirubin in male patients were higher than those in female patients.In addition,the abnormal detected rate of urea nitrogen and indirect bilirubin increased with exposure years.Conclusion Occupational chronic CS2 poisoning mainly affects the nervous system,as well as liver and kidney function.Detecting the median and common peroneal motor nerve conduction velocities could be the screening indicators for the peripheral nerve injury induced by CS2 in the occupational exposure population during the periodical occupational medical examinations.