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[目的]了解粉尘作业对员工呼吸功能的影响,探讨小气道功能测定在粉尘作业人员职业健康监护及尘肺风险评估中的应用。[方法]2009年对某机械制造企业粉尘作业车间进行生产环境调查、粉尘浓度检测,对216名粉尘作业人员进行肺功能测定等职业健康检查及问卷调查。[结果]粉尘作业人员用力呼气75%肺活量的瞬间流量(forcedexpiratory flow at 75%of forced vital capacity,FEF75%)的中位数为79%,低于正常值,用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in one second,FEV1)、1秒率(FEV1/FVC)、最高呼气流量(peakexpiratory flow,PEF)、用力呼气25%肺活量的瞬间流量(forced expiratory flow at 25%FVC,FEF25%)、用力呼气50%肺活量的瞬间流量(forced expiratory flow at 50%of FVC,FEF50%)的均数或中位数都在正常范围内,PEF、FEF25%、FEF50%和FEF75%异常的人员比例明显增高,分别为21.30%、30.56%、45.37%和50.00%,而且这些参数异常人员接尘工龄较短,中位数分别为3.5年、4年、5年和5年。FVC、FEV1、FEV1/FVC、PEF、FEF25%、FEF50%、FEF75%异常人员的胸片检查异常比例分别为55.56%、60%.00、0、21.74%、15.15%、23.47%、25.00%。将胸片异常组与正常组的肺功能进行比较,胸片正常组的PEF、FEF25%、FEF50%的参数值低于异常组,差异有统计学意义(P<0.05)。工龄10年以上的粉尘作业人员FEV1、FEF25%和FEF75%异常比例高于工龄较短组(P<0.05)。[结论]粉尘作业人员存在气流受限、小气道功能障碍。随着接尘工龄的增加,FEV1、FEF25%和FEF75%异常人员有增多的趋势。该人群肺功能检查结果与胸片表现并不同步。在职业健康监护工作中,应对粉尘作业人员的肺功能尤其是小气道功能进行重点观察和动态对比分析,并将其作为尘肺风险评估的指标之一。建议在职业健康检查中将FEF25%、FEF50%、FEF75%等反映小气道功能的参数增设为监测指标。
[Objective] To understand the effect of dust work on respiratory function of workers and explore the application of small airway function test in occupational health monitoring and pneumoconiosis risk assessment for dust workers. [Method] In 2009, the production environment investigation and dust concentration of dust workshop in a machinery manufacturing enterprise were conducted. Occupational health examination and questionnaire survey of 216 dust workers in lung function test were conducted. [Result] The median of forced vital capacity 75% of forced vital capacity (FEF75%) was 79%, lower than normal, forced vital capacity (FVC ), Forced expiratory volume in one second (FEV1), 1 second rate (FEV1 / FVC), peakexpiratory flow (PEF), forced expiratory volume of 25% forced expiratory flow at 25% FVC, FEF25%), forced expiratory flow at 50% of FVC (FEF50%) were within the normal range, PEF, FEF25 %, FEF50% and FEF75% were 21.30%, 30.56%, 45.37% and 50.00% respectively, and the shortest length of service for those with abnormal parameters was 3.5 years, 4 years, 5 years and 5 years. The abnormal rates of chest X-ray examination of FVC, FEV1, FEV1 / FVC, PEF, FEF25%, FEF50% and FEF75% were 55.56%, 60% .00,0,21.74%, 15.15%, 23.47% and 25.00% respectively. Compared with normal group, the parameters of PEF, FEF25% and FEF50% of the normal group were lower than those of the abnormal group, the difference was statistically significant (P <0.05). The abnormal proportions of FEV1, FEF25% and FEF75% of the dust workers who worked longer than 10 years were higher than those of the shorter working group (P <0.05). [Conclusion] Dust workers had limited air flow and small airway dysfunction. With the increase of the service life of dust, FEV1, FEF25% and FEF75% of the abnormal staff have an increasing trend. The crowd pulmonary function test results and chest radiograph performance is not synchronized. In the occupational health monitoring work, the dust function personnel should be emphatically observed and compared dynamically with the lung function, especially the small airway function, and it should be taken as one of the indexes of pneumoconiosis risk assessment. It is suggested that parameters reflecting the function of small airways, such as FEF25%, FEF50% and FEF75%, should be added as monitoring indicators in occupational health examination.