苯所致白血病的归因诊断较为困难,在诊断、鉴定过程中存在争议.通过对一起职业病诊断机构诊断结论为"职业性肿瘤(苯所致白血病)",而市级、省级鉴定机构均诊断为"无职业性肿瘤"的病例资料进行分析,探寻诊断、鉴定工作中存在的不足.认为有无职业性苯接触史的认定是该案例诊断结论与鉴定结论不一致的根本原因.通过该案例,旨在为诊断、鉴定机构工作人员提供经验借鉴.

某高科技塑业企业工作场所环境监测数据显示,工作场所空气中苯、甲苯CTWA的中位数M(P0～P100)分别为0.30 (0.30～0.53) mg/m3、0.60 (0.60～10.70) mg/m3,CSTEL的中位数M(P0～P100)分别为0.30(0.30～1.00) mg/m3、0.60 (0.60～11.40) mg/m3,二甲苯的CTWA、CSTEL检测值均小于最低检出限(3.3 mg/m3),三苯检测合格率为100.0％.31名三苯接触工人WBC计数、中性粒细胞偏低检出率分别为12.90％、6.45％.工人接触苯、甲苯和二甲苯所致的非致癌危害商数(HQ)值M (P0～P100)分别为2 849.33 (712.33,15 671.33)、34.19 (8.55, 188.06)和5 157.00 (1 282.20,28 208.40),接触苯致癌风险值为9.81×10-6～3.48×10-5.提示接触三苯的工人处于较高的非致癌和低致癌健康风险水平.

[目的]分析扬州市职业性苯暴露工人的健康状况,为苯所致职业病的预防与控制提供依据.[方法]对2015-2017年扬州市职业性苯接触工人职业病监测数据进行描述与对比分析.[结果]截至2017年11月底,扬州市共申报涉苯企业510家,苯接触工人5 207人.苯作业场所和岗位超标率分别为4.44％、1.58％,2015-2017年涉苯工作场所苯超标率逐年降低(P＜0.05),超标场所主要位于江都区.3年间,收集到248家企业的11 444份职业健康检查资料.248家企业以小型(67.74％)为主,主要来自宝应县和邗江区(均为20.97％),高邮市最少,占3.63％;行业分布以化学原料和化学制品制造业(12.10％),皮革、毛皮、羽毛及其制品和制鞋业(1 1.69％)为主.3年间共检出疑似苯中毒病人490例,职业禁忌证83例,其中2015年分别为89例、2例,2016年分别为183例、37例,2017年分别为218例、44例.3年问,疑似苯中毒、职业禁忌证检出率均有逐年升高的趋势(P＜0.01).白细胞和中性粒细胞偏低检出率逐年降低(P＜0.05).2015-2017年扬州市仅3例职业性苯中毒报告病例,且于诊断后隔年落实工伤保险待遇.[结论]扬州市职业性苯暴露工人职业健康状况不容乐观,建议继续加强职业性苯暴露所致职业病的监测工作.

对某LED生产企业2014-2016年职业病危害因素检测与健康检查资料进行汇总分析.结果显示,该企业3年累计粉尘、毒物、噪声等206个检测点,总合格率为97.09％,硫酸监测点合格率仅45.45％,3年间毒物总合格率差异无统计学意义(P=0.26).企业职业健康检查未检出疑似职业病人和职业禁忌证.不同年度间高仟伏胸片和心电图异常检出率比较,差异有统计学意义(P＜0.05).测试/目检岗位与其他岗位工人血压偏高、心电图异常率差异有统计学意义(P＜0.05).该企业应将硫酸作为重点防控的职业病危害因素,同时需加强对职工心血管疾病等慢性病的防治.

为了解某发光二极管(LED)外延片及芯片生产企业的职业病危害因素分布及危害情况,采用职业卫生学调查的方法,对其职业病危害因素进行监测并结合作业人员职业健康检查结果进行分析.结果显示,该企业主要职业性危害因素为其他粉尘、氨、氯、硫酸、氟化氢、盐酸、氢氧化钠、硫化氢、丙酮、异丙醇、噪声等.粉尘、噪声合格率均为100％,毒物合格率为91.9％,超标点均为接触硫酸的岗位.2014-2016年在岗期间职业健康检查异常检出率分别为45.8％、42.2％和52.9％,不同年度间以及各项目异常检出率比较,差异均无统计学意义(P＞0.05).提示,硫酸为该企业重点防控的职业病危害因素,应加强相关职业病防护措施.

Objective To explore the impact of welding work on human health and its relevant factors by the welders' pneumoconiosis sentinel surveillance.Methods 845 people were enrolled in the experimental group according to the " Key Occupational Disease Surveillance Technology Program",and 310 enterprises without occupational hazards were enrolled in the control group.They have conducted surveys and related health checks based on a unified questionnaire.The results were compared and conducted regression analysis.Results The prevalence of hypertension,abnormal hemoglobin,positive urinary protein and abnormal electrocardiogram was higher in the exposed group than in the control group (P ＜ 0.05).The rates of abnormal lung examination were significantly different between exposed group and control group (P ＜ 0.05).Multivariate logistic regression analysis showed that female (OR =1.89,95％ CI:1.16 ～ 3.08),age (30 ～) (OR =1.48,95％ CI:0.86 ～2.56),age ≥40 (OR =3.65,95％ CI:2.05 ～ 6.48) and not wearing protective equipment (OR =2.31,95％ CI:1.36 ～ 3.90) were risk factors.The length of service (5 ～) (OR =0.52,95 ％ CI:0.33 ～ 0.84),(≥ 10 years) (OR =0.34,95 ％ CI:0.17 ～ 0.65) were protective factors.Conclusion Welding operations can easily lead to cardiovascular damage in the working population,and female workers are more likely to cause damage to the lungs as they grow older.Regular wear of protective equipment is the key to prevent welders from pneumoconiosis.

Objective To understand the blood Results of routine examination of benzene-exposed workers and explore influence of blood test Results of the age, industry, working age and gender for the benzene-exposed workers.Methods Analysis was made on the data collected from the occupational physical examination of the 3003 benzene-exposed workers in Yangzhou City of 2014.Results Among the 3003 benzene-exposed workers,the abnormal rate of blood routine detection was 6.9%,the detection rates of reduction of WBC and neutrophils was 4.3% and 5.2%,respectively.The difference of abnormal rate of blood routine was not statistically significant in different age groups and industries (P>0.05).The detection rate of WBC reduction of workers working for ≥10a was higher than that with working for <10a,the difference was statistically significant(P<0.05).The difference of detection rate of WBC reduction between male and female was statistically significant(P<0.01).The difference of detection rate of reduction of neutrophils and PLT was not statistically significant in different working yeas and gender(P>0.05).In chemical industry,the detection rates of WBC reduction in male and female group was 5.2% and 2.0%,respectively.The difference was statistically significant (P<0.01 ).Conclusions The blood routine abnormalities of benzene-exposed workers were reduction of the WBC and neutrophils.Working years nd gender have a certain effect on the blood test Results of benzene-exposed workers.It is suggested that management and worker health protection of benzene-exposed workers should be strengthened,especially the male employees of the chemical industry.

目的：了解扬州市在岗放射工作人员健康体检结果，分析低剂量电离辐射对放射工作人员健康的影响。方法对1724名在岗放射工作人员血常规、眼晶状体、微核3个检查项目的异常率进行统计学分析。结果随着年龄和接害工龄的增加，放射工作人员Hb、RBC异常检出率增高（P<0.01）。随着年龄的增加，放射工作人员眼晶状体混浊检出率增高（P<0.01）。女性组RBC异常检出率为23.65%，高于男性组的9.89%，差异有统计学意义（P<0.01）。结论在岗放射工作人员血常规异常以RBC和Hb增多为主，年龄、接害工龄对Hb、RBC或眼晶状体的检查结果有一定影响，应加强对在岗放射工作人员的健康管理和防护。

Objective To investigate the affecting factors on abnormality rate of welders? lung examination By the welders?pneumoconiosis sentinel surveillance,in order to provide evidence for preventive and curative strategy of preventing the occurrence of welders?pneumoconiosis.Methods Occupational health examinations were taken in 909 welders who were randomly selected from four factories in the local area. welding fume concentrations were detected in the four companies fore analysing relevant factors.Results The abnormality rate of lung examination was 1 5.6%.there was statistically significant differences of personal income between the lung examination normal group and the abnormal group (P<0.05),but no differences between of age,length of service,gender,smoking and alcohol consumption,education level (P>0.05). The differences of FVC,FEV1 ,FEV1/FVC,X-ray between the two groups were statistically significant (P<0.01 ).Welders complained mostly with the disorders of the musculoskeletal system, followed by respiratory symptoms.The positive rates of neurological symptoms and autonomic of the abnormal were higher than that of the normal (P<0.05).Conclusions Welders with abnormal lung examine may have the nervous system symptoms and the psychological symptoms.

使用流行病学描述性研究方法对某LED企业2013年度的职业危害因素检测和工人健康监护结果进行统计和分析.该企业接触有毒有害工人受监护率为90.9％,筛查出重点监护对象3人,职业禁忌证3人.LED制造企业接触职业危害因素较多,企业应当积极改善工作场所的环境,完善工人的职业健康监护工作,加强对心血管疾病等慢性病的防治.

目的 监测电焊作业场所粉尘及电焊工健康状况,为针对性干预措施提供依据.方法 对整群随机抽取909名电焊工人进行职业健康体检,同时检测以上工人所在的4家企业84个岗位工作场所电焊烟尘浓度,分析其对工人肺部损伤的影响.结果 作业场所电焊烟尘检测合格率为54.8％,X线胸片异常者31人,异常率为3.4％,主要表现为肺纹理增多增粗或紊乱及肺部小阴影.肺功能异常118人,异常率为13.0％,主要表现为用力肺活量(FVC)异常(86人),1秒钟用力呼气容积(FEV1.0)异常(84人).不同工龄组FVC、FEV1.0、FEV1.0/FVC的差异无统计学意义(P＞0.05),工龄＜10年组的X线异常率低于10～年和20～年工龄组,差异有统计学意义(P＜0.05).结论 工作场所电焊烟尘浓度超标现象较突出,随着工龄增长,电焊工X线胸片异常率增高,应当加强对肺部异常人群的观察,预防电焊工尘肺的发生。

目的 了解扬州市近8年职业病发病情况,以便更好地做好该市职业病防治工作.方法 对全市2006-2013年的职业病报告数据进行统计学分析.结果 8年间共报告新诊断职业病7大类32种246例,尘肺病、职业性耳鼻喉口腔疾病和职业中毒发病数位居前3位,分别占42.3％、26.4％和19.5％.尘肺病以电焊工尘肺、矽肺、煤工尘肺为主,主要分布于机械、煤炭和石油行业.65例职业性耳鼻喉口腔疾病中有59例(90.8％)为职业性噪声聋,主要集中于化纤、机械和煤炭等行业.急性中毒10起13例,职业性中毒性肝病、苯中毒以及铅及其化合物中毒(不包括四乙基铅)为慢性中毒病例的主要类型,病例主要分布于机械和轻工行业.结论 尘肺病、噪声聋和苯、铅等毒物引起的职业中毒为扬州市的主要职业病危害,机械、化纤、煤炭等行业应列为重点监管行业.

目的 监测电焊作业场所粉尘及电焊工健康状况,为针对性干预措施提供依据.方法 对整群随机抽取909名电焊工人进行职业健康体检,同时检测以上工人所在的4家企业84个岗位工作场所电焊烟尘浓度,分析其对工人肺部损伤的影响.结果 作业场所电焊烟尘检测合格率为54.8％,X线胸片异常者31人,异常率为3.4％,主要表现为肺纹理增多增粗或紊乱及肺部小阴影.肺功能异常118人,异常率为13.0％,主要表现为用力肺活量(FVC)异常(86人),1秒钟用力呼气容积(FEV1.0)异常(84人).不同工龄组FVC、FEV1.0、FEV1.0/FVC的差异无统计学意义(P＞0.05),工龄＜10年组的X线异常率低于10～年和20～年工龄组,差异有统计学意义(P＜0.05).结论 工作场所电焊烟尘浓度超标现象较突出,随着工龄增长,电焊工X线胸片异常率增高,应当加强对肺部异常人群的观察,预防电焊工尘肺的发生.

<正>三氯甲烷(CHCl3)又名氯仿,为无色、透明、易挥发的液体,有特殊的甜味,主要用作树脂、橡胶的溶剂和配制溶剂型胶黏剂。我市某包装企业因使用高含量氯仿的胶黏剂,刷胶车间25名员工同时出现急性肝功能损害。现就该中毒事故进行调查分析,以避免类似事故的发生。

氰化物种类很多(如氰酸盐类、有机氰类化合物等),在化学反应过程中尤其在高温或与酸性物质作用时,能放出剧毒氰化氢气体.我市某电镀厂发生一起因工人操作不慎引起的氰化氢中毒事故,造成1人中毒死亡,1人中毒昏迷,直接经济损失约46万元.现就该中毒事故进行分析,以供人们吸取教训,避免类似事故的发生.

[Objective]To study the effect of welding fumes and metal dust on the health of workers in container industry.[Methods]Totally 158 welding sites in the container enterprises of Yangzhou were selected,based on the national hygiene standards.Sampling machines(BFC-35E)and Laser Dust Monitor(LD-IH)were adopted to detect levels of welding fumes.One year later,3044 workers who participated in health examination were divided into control group(Administrative Staff),over-standard group(workers)and standard group(workers)based on the dust levels in monitoring sites.The results of health examination of the 3 groups were compared.[Results]TWA pass rate of welding fumes was 40.1%(57/142)and STEL was 20.4%(29/142)in all monitoring sites of welding workshops.TWA pass rate was 56.0%(9/16)and STEL was 50.0%(8/16)in all monitoring sites of polished workshops.The pass rate of automatic welding site reached up to 92.8%(13/14).14 cases of welder pneumoconiosis were newly diagnosed in 2006,the incidence was 0.41%.Other health problem were abnormalities of heart or lung medical examination(18.8%),abnormal ECG(14.7%),abnormal chest film examination with high kilovolt(14.2%),turbinate hypertrophy(12.7%),hypertension(8.7%),hearing impairment(3.9%),eye injuries(3.7%),abnormal interleukin(3.4%).Differences of chest film,turbinate hypertrophy,hearing impairment and eye injuries were significant between all groups(P0.05).[Conclusion]Welding fumes and metal dust which have not been well controlled in container industry cause health impairments on workers,it is necessary to eliminate fumes and strengthen protection.

[Objective] To explored the occupational risk factors of welder pneumoconiosis in confirmed and suspected patients of Yangzhou container business. [Methods] A 1 ︰ 2 matched case control study was designed and 62 cases were welder pneumoconiosis in confirmed and suspected patients. 124 welders with the working age and types within five years and without heart and lung diseases served as controls. The occupational surveillance and physical information were investigated by self-designed questionnaires. The risk factors were extracted with K-means cluster analysis and evaluated with conditional logistic regression analysis. [Results] Multi-factorial conditional logistic regression analysis showed that length of service in fume (OR=1.276, 95%CI: 1.080-1.507), huddled posture (OR=1.343, 95%CI: 1.107-1.629), feeling of work strength (OR= 1.505, 95%CI: 1.389-1.631), fume concentration exceeded the standard (OR=5.701, 95%CI: 3.872～8.394) and implementation of the dustproof (OR=.748, 95%CI: 0.624-0.897) were significantly positively correlated with welder pneumoconiosis. [Conclusion] The most important role of preventing welder pneumoconiosis was to control the produce and discharge of smoke, and prevention of welder pneumoconiosis needs to take equipment, knowledge and the self elevating capacity of welders.

目的 研究扬州市集装箱企业作业产生的电焊烟尘对作业工人健康的影响.方法 选择性地检测了扬州市8家大、中型集装箱企业158个电焊作业点的电焊烟尘和其他粉尘总粉尘浓度.并以机关行政人员作为对照组,作业工人按测定点粉尘浓度分为超标组和达标组,比较3组健康检查结果.结果 全部电焊测定点电焊烟尘浓度的时间加权平均浓度(TWA)达标率为40.1%(57/142),短时间接触浓度(STEL)达标率为20.4%(29/142).3 044名工人中新诊断Ⅰ期电焊工尘肺14例,患病率0.46%.粉尘浓度超标组工人与达标组和空白对照纽工人在高千伏胸片检查、鼻甲肥大、眼损伤的异常率差异有显著性(P<0.05).结论 集装箱企业电焊烟尘控制仍然存在不足,并导致工人相关系统发生健康损害,需要加强除尘和防护工作.

三氯乙烯作为清洗剂,广泛应用于电子、皮革、五金等行业,随着使用单位和接触新工人的增加,以及对三氯乙烯皮肤损害认识的提高,三氯乙烯药疹样皮炎屡有报道[1-2],现就我市发现的首例三氯乙烯致药疹样皮炎病例分析如下.

[目的]分析"九五"、"十五"期间(1996～2005年)扬州市职业健康监护和职业病发病的特点,为扬州市"十一五"期间职业病防制决策提供依据.[方法]对全市1996年至2005年职业健康监护和职业病发病状况进行描述性研究.应用灰色关联分析法对职业病的发展态势进行量化比较.[结果]"九五"、"十五"期间职业健康监护化学因素和物理因素所致职业病的检出率,差异有统计学意义(P＜0.005);尘肺病检出率第2组明显高于第1组,差异有统计学意义(P＜0.05)."九五"期间职业病以慢性苯中毒、慢性铅中毒为主,"十五"期间以集装箱行业电焊工尘肺为主.1O年来我市共发生各类职业病96例,急性中毒7例,占73%,慢性职业病89例,占92.7%,慢性职业病以尘肺和慢性职业中毒为主(各占42.7%、41.7%).尘肺、职业中毒和总的职业病患者随着时间的推移,发病的平均年龄均趋于年轻,发病的平均工龄均缩短,差异均有统计学意义(P＜0.01).[结论]该市已初步建立一个规范的职业健康监护体系,各类职业病、职业禁忌证等检出率巳明显上升.目前应加强对集装箱、制鞋等行业的卫生工作.