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目的收集国内公开发表的涉及职业性慢性正己烷中毒的文献,分析总结正己烷中毒的临床特点,为修订GBZ 84《职业性慢性正己烷中毒的诊断》标准提供依据。方法采用文献计量学方法,从中国知网、维普数据库和万方中文期刊数据库检索1990—2014年公开发表的职业性慢性正己烷中毒的相关文献,筛选有详细临床资料的文献进行归纳分析。结果 25年间国内公开发表的符合入选标准的研究文献共68篇,共计1 027例中毒患者,均为职业性慢性正己烷中毒患者;男性165例,女性862例,年龄中位数为28.3(13.0~59.0)岁,发病潜伏期以2.0~10.0个月多见。817例(占79.6%)患者有诊断分级记录,诊断为轻、中和重度慢性正己烷中毒分别为418、241和158例。736例(占71.7%)患者相关文献报告了工作场所空气中正己烷水平,其中91.8%(676/736)患者工作场所空气中正己烷水平超过我国职业接触限值(180 mg/m~3)。慢性正己烷中毒以周围神经损害为主,626例(占61.0%)患者属感觉-运动障碍型,256例(占24.9%)患者单纯以运动障碍为主,145例(占14.1%)患者单纯以感觉障碍为主。临床表现主要以四肢远端为重的双侧对称性感觉异常或运动障碍;神经-肌电图改变均表现为神经源性损害,与病情严重程度相平行,且病情早期即可显示为神经源性损害。156例(占15.2%)患者采用气相色谱法检测了尿2,5-己二酮水平,检出率为50.6%(70/156)。慢性正己烷中毒目前尚无特效治疗药物或方法,临床上以促进神经修复的综合治疗方法为主,在常规治疗基础上加用鼠神经生长因子治疗效果更显著;954例患者报告治疗效果,治愈率为83.6%(798/954);156例(占15.2%)未治愈患者主要存在神经系统后遗症。结论慢性正己烷中毒主要临床表现为周围神经病,神经-肌电图检查是其最重要的诊断手段;目前以综合治疗法为主,患者预后良好。
OBJECTIVE To collect the domestic published literature on occupational chronic n-hexane poisoning, analyze and summarize the clinical features of n-hexane poisoning, and provide evidence for the revision of the GBZ 84 diagnostic criteria for occupational chronic n-hexane poisoning. Methods Bibliometrics methods were used to retrieve published articles about occupational chronic n-hexane poisoning published from 1990 to 2014 from China National Knowledge Infrastructure, VIP database and Wanfang Chinese Journal Database, and the documents with detailed clinical data were screened and analyzed. Results A total of 68 literatures were published in the country which met the inclusion criteria in the past 25 years. A total of 1 027 poisoning patients were enrolled in the study. All of them were occupational patients with chronic n-hexane poisoning; 165 males and 862 females, with a median age of 28.3 (13.0 ~ 59.0) years old, the incidence of incubation period of 2.0 to 10.0 months more common. Eighty-seven patients (79.6%) had diagnostic grade records and were diagnosed as mild, moderate, and severe chronic n-hexane poisoning at 418, 241 and 158, respectively. Of the 736 patients (71.7%) who reported n-hexane levels in the air of the workplace, n-hexane levels in the air of 91.8% (676/736) of patients were above the occupational exposure limits of our country (180 mg / m 3) . Chronic n-hexane poisoning was mainly peripheral nerve damage. 626 patients (61.0%) had sensory-motor dysfunction, 256 patients (24.9%) were mainly dyskinesia, and 145 (14.1%) patients were pure Mainly to sensory disturbances. Clinical manifestations mainly to the distal limbs as the most important bilateral symmetry of sensory abnormalities or dyskinesia; neuro-EMG changes are manifested as neurogenic damage, and the severity of the parallel, and the early stages of illness can be displayed as neurogenic Sexual damage. Urinary 2,5-hexanedione levels were detected in 156 patients (15.2%) by gas chromatography with a detection rate of 50.6% (70/156). Chronic n-hexane poisoning is currently no specific treatment drugs or methods, clinically to promote the comprehensive treatment of nerve repair based on conventional therapy based on the addition of mouse nerve growth factor treatment effect is more pronounced; 954 patients report the treatment effect, cure The rate was 83.6% (798/954). Of the 156 patients (15.2%) who were not cured, there were mainly neurological sequelae. Conclusion The main clinical manifestations of chronic n-hexane poisoning are peripheral neuropathy. The neuro-EMG examination is the most important diagnostic method. At present, the comprehensive treatment is the main method and the prognosis is good.