论文部分内容阅读
目的分析长期从事手传振动作业工人震动觉阈值特点及在振动性神经损伤诊断中的应用价值。方法对158名长期接触手传振动作业工人和50名无接触职业性危害因素的健康成人进行职业性健康检查、震动觉阈值(VPT)测试、神经传导速度(NCV)检查分析。结果 (1)与正常对照组相比,观察组双侧2指、3指、5指VPT升高(P<0.01);同侧各手指之间比较,观察组左手各指间VPT有差别(P<0.01),且比右手VPT升高(P<0.05),并随着年龄、接振工龄的增加而升高(P<0.01或P<0.05);对照组各手指之间无差别。(2)与无症状相比,有症状组第2指、3指、5指VPT升高(P<0.05或P<0.01);(3)观察组2指VPT与正中神经感觉电位波幅、SCV呈负相关,5指VPT与尺神经感觉电位波幅呈负相关(P<0.05或P<0.01)。(4)当以VPT测试值≥10为阳性标准时,VPT检查的敏感性及特异性比较理想。VPT总异常率(50.0%)高于NCV异常率(11.4%,P<0.01)。结论长期职业性接触手传振动,可使作业工人VPT增高,该指标较常规NCV检测有更高的诊断敏感性,可为振动性神经损伤的早期诊断提供参考,是常规神经传导速度检查的重要补充。
OBJECTIVE: To analyze the characteristics of vibration threshold of workers engaged in hand-transmitted vibration for a long time and its value in the diagnosis of vibration-induced nerve injury. Methods Occupational health examination, Vibration perception threshold (VPT) test and nerve conduction velocity (NCV) examination were performed on 158 long-term exposure to hand vibration workers and 50 healthy adults without exposure to occupational hazards. Results (1) Compared with the normal control group, the VPT of two fingers, three fingers and five fingers on the two sides of the observation group increased (P <0.01); the VPT of each finger in the observation group differed P <0.01), and higher than the VPT of the right hand (P <0.05), and increased with age and vibration duration (P <0.01 or P <0.05). There was no difference between the fingers of the control group. (2) Compared with asymptomatic group, VPT and median nerve sensory potential amplitude in group 2 and 3 and 5 were increased (P <0.05 or P <0.01) The negative correlation between VPT and ulnar nerve sensory potential was negative (P <0.05 or P <0.01). (4) When the VPT test value ≥ 10 as a positive standard, the sensitivity and specificity of VPT examination is ideal. The total abnormality rate of VPT (50.0%) was higher than that of NCV (11.4%, P <0.01). Conclusion Long-term occupational exposure to hand-transmitted vibration can increase the VPT of operative workers. This index has higher diagnostic sensitivity than conventional NCV detection and may provide reference for the early diagnosis of vibrational nerve injury. It is important for routine nerve conduction velocity examination supplement.