目的 分析并探讨尘肺病患者合并慢性阻塞性肺疾病(COPD)的相关危险因素及其预防措施.方法 选择2019年8月-2020年1月在中国煤矿工人北戴河疗养院尘肺科入院治疗的193例尘肺病患者进行病例对照研究,根据尘肺患者是否合并COPD分为病例组和对照组,采用调查问卷与临床病历资料收集相结合的方式进行调查,并对病例组与对照组的统计资料进行统计学分析.结果 本次研究对象均为男性,其中病例组83人,对照组110人,尘肺患者合并COPD的合并率为43.01％.单因素分析结果显示,病例组与对照组患者在体质指数(BMI)、接尘时间、外周血中性粒细胞-淋巴细胞比值(NLR)、血小板-淋巴细胞比值(PLR)、C反应蛋白(CRP)浓度、民族、户籍、是否吸烟、住房类型、尘肺期别及体力活动水平因素上差异均有统计学意义(均P＜0.05).多因素logistic回归分析显示,中高强度体力活动是尘肺患者合并COPD的保护因素(P＜0.01),尘肺期别、CRP均是尘肺患者合并COPD的危险因素(均P＜0.01).结论 体力活动水平是影响尘肺患者合并COPD的独立保护因素,尘肺期别及CRP是影响尘肺患者合并COPD的独立危险因素,应加强安全培训和采取防护措施,定期进行职业健康检查,改变生活方式,提升患者的健康生活质量.

目的 探讨脉冲震荡肺功能检测在尘肺合并慢性阻塞性肺疾病(COPD)肺功能测定价值.方法 选择2018年4月 ～2019年10月在中国煤矿工人北戴河疗养院接受治疗的110例尘肺合并COPD患者,其中Ⅰ期15例,10例有吸烟史;Ⅱ期20例,16例有吸烟史;Ⅲ期75例,58例有吸烟史;均为男性;年龄36～72岁,平均(49.13±9.29)岁.检测并比较分析各期别尘肺合并慢性阻塞性肺疾病常规肺功能、脉冲震荡肺功能(IOS).结果 Ⅰ期、Ⅱ期、Ⅲ期患者常规肺功能指标FEV1Dre％,Ⅰ期、Ⅱ期、Ⅲ期患者分别为(67.21±7.82)％、(51.26±8.28)％、(46.27±16.21)％,不同期别差异有统计学意义(F=13.66,P=0.00);FEF75分别为(30.60±12.21)％、(25.17±9.27)％、(24.19±16.11)％,不同期别差异无统计学意义(F=0.16,P=0.31);MMEF75-25分别为(31.21±8.91)％、(28.32±8.32)％、(24.36±14.26)％,不同期别差异无统计学意义(F=2.19,P=0.11);Ⅰ期、Ⅱ期、Ⅲ期患者脉冲震荡肺功能检查指标R5-R20分别为(15.94±9.27)、(21.52±29.64)、(31.48±29.51),不同期别差异有统计学意义(F=5.26,P=0.00);X5分别为(-1.13±0.63)、(-1.97±0.91)、(-2.67±1.02),不同期别差异有统计学意义(F=17.88,P=0.00);Fres分别为(13.47±4.61)、(19.24±4.53)、(19.52±5.37),不同期别差异有统计学意义(F=8.84,P=0.00).结论 脉冲震荡肺功能IOS技术可用于尘肺合并慢性阻塞性肺疾病患者肺功能的变化,能够较为敏感的反映患者外周气道阻力、周边弹性阻力的增高程度,在尘肺的早期发现中具有一定价值.

目的 通过比较双肺同期大容量肺灌洗尘肺患者灌洗前与灌洗后1周肺功能指标的变化,分析双肺同期大容量肺灌洗术对尘肺病患者肺功能的影响.方法 选取2017年10月-2018年5月在中国煤矿工人北戴河疗养院收治的尘肺病患者进行双肺同期大容量肺灌洗100例.按照《大容量全肺灌洗术医疗护理常规及操作规程》对100名患者进行双肺同期大容量肺灌洗,在灌洗术前和灌洗术后1周检测患者肺功能各项指标,比较肺功能指标肺活量(VC)、用力肺活量(FVC)、肺总量(TLC)、1秒率(FEV1％/VC)、最高呼气流量(PEF)、呼吸后期瞬间流速(MEF 75％)、呼吸中期瞬间流速(MEF 50％)、呼吸中断流速(MEF 25％)、最大通气量(MVV)、残总比(RV/TLC)和弥散功能(DLCO)的变化.结果 共纳入尘肺病患者100名,均为男性,尘肺Ⅰ期41例,尘肺Ⅱ期29例,尘肺Ⅲ期30例.平均年龄(49.07±6.65)岁,平均身高(170.62±4.94) cm,平均体重(70.23±10.05) kg,平均接尘年限(23.33±4.26)年,年龄、身高、体重及接尘工龄在不同组之间比较,差异均无统计学意义(均P＞0.05);治疗前和治疗后7周肺功能VC、FVC、TCL、FEV1.0％、PEF呼气流速峰值、MEF25％、MEF50％、MEF75％、MVV、RV/TLC和DLCO指标,除MVV外,其余治疗前后比较差异均无统计学意义(均P＞0.05);大容量双肺灌洗后1周,VC、TLC、RV/TLC各期别变化比较差异均无统计学意义(均P＞0.05);大容量双肺灌洗后1周和DLCO各期别变化比较差异无统计学意义(P＞0.05);大容量双肺灌洗后1周,PEF、MEF25％和MEF75％各期别变化比较差异均无统计学意义(均P＞0.05);MEF50％各期别变化比较差异有统计学意义(P＜0.05).结论 经过规范的双肺同期大容量肺灌洗及术后护理,尘肺病患者术后1周肺功能恢复较好,安全有效.

[Objective]To understand the effect of dust on the health of workers in the process of steelmaking and production in a enterprise in Qinhuangdao City, select the key protection objects and provide the basis for the effective prevention of pneumoconiosis. [Methods] The cross-sectional study was adopted to carry out a physical examination of 1 297 workers exposed to dust in a steelmaking plant of an iron and steel enterprise in Qinhuangdao, and the data of occupational health examination of this workers was analyzed. [Results]①The data of 1 297 workers exposed to dust was collected, including 1 295 males and 2 females, with an average age of (46.74±8.34) years old (19-60 years old) .② The abnormal detection rates of chest X-ray DR and lung function were 1.9％ (25 cases) and 23.3％ (302 cases) . In the health examination, the abnormal detection rates of blood pressure, electrocardiogram, blood routine, urine routine, alanine aminotransferase and blood glucose were 28.9％ (376 cases) , 28.8％ (374 cases) , 31.1％ (403 cases) , 8.6％ (111 cases) , 5.5％ (75 cases) and 2.4％ (21 cases) , respectively.③After the ages of workers exposure to dust were standardized, the abnormal detection rate of lung function in coking/coal chemical unit was highest, which was 35.6％ (462 cases) , followed by coal preparation/coal injection, which was 32.8％ (426 cases) , and there were statistically significant differences between the different production units (P ＜0.01) . The abnormal detection rate of chest X-ray DR in power generation unit was the highest, which was 6.6％ (86 cases) , followed by steelmaking units, which was 5.3％ (69 cases) , and there were statistically significant differences between the different production units (P ＜0.01) . The abnormal detection rate of blood pressure in raw material preparation unit was the highest, which was 44.1％ (572 cases) , followed by white ash burning, which was 43.0％ (558 cases) , and there were statistically significant differences between the different production units (P＜0.01) . The abnormal detection rate of ECG in coking/coal chemical unit was the highest, which was 35.9％ (466 cases) , followed by coal preparation/coal injection, which was 32.3％ (419 cases) , and there were statistically significant differences between the different production units (P＜0.01) . [Conclusion] The dust of different production units can damage the occupational health of the workers, especially coking and coal chemical unit, coal preparation and coal injection, iron making and raw material preparation production unit, and the abnormal detection rates of blood pressure and ECG of the dust workers in each production unit are higher. It is suggested that this study can screen high risk population and take measures to prevent occupational health in the early stage.