手传振动作业工人冷水复温试验临床应用研究  

Clinical application research on cool water loading test among workers exposed to hand-transmitted vibration

作　　者：刘文娟[1] 王烁[1] 周珊宇[1] 夏丽华[1] 杨爱初[1] 王恰[1] 林锦明[1] 

机构地区：[1]广东省职业病防治院,广东省职业病防治重点实验室,广东广州510300

出　　处：《中国职业医学》2014年第4期404-407,共4页China Occupational Medicine

基　　金：国家临床重点专科建设项目(2011-09);广东省职业病防治重点实验室(2012A061400007)

摘　　要：目的研究10℃的冷水复温试验（CWLT）在手传振动职业危害中的临床应用。方法以从事手传振动作业且诊断为职业性手臂振动病的42例患者为发病组,以从事手传振动作业但未能诊断为职业性手臂振动病的17名工人为接振组,以从事非手传振动作业的24名健康办公室人员为对照组。对3组人员进行10℃的CWLT,用数字皮温计测量CWLT前后手部皮温,并对结果进行统计分析。结果 3组工人手麻、手痛、手胀、手臂无力和关节疼痛的发生率分别比较,差异均有统计学意义（P〈0.01）。3组手部主要症状的发生率从小到大依次为对照组〈接振组〈发病组。3组组间手部皮温差异有统计学意义（P〈0.01）;左手和右手皮温差异无统计学意义（P〉0.05）;CWLT前和CWLT后0、5、10、15、20、25、30 min 8个时间点间手部皮温差异有统计学意义（P〈0.01）;时间和组别之间存在交互效应（P〈0.05）;时间和手别之间、组别和手别之间均不存在交互效应（P〉0.05）;时间、组别和手别三者之间无交互效应（P〉0.05）。交互效应进一步分析结果显示：无论左手还是右手,CWLT前3组皮温差异均无统计学意义（P〉0.05）;CWLT后0-30 min时,发病组皮温均低于对照组（P〈0.05）;CWLT后0-20 min时,发病组皮温均低于接振组（P〈0.05）;CWLT后0-30 min时,接振组和对照组皮温差异均无统计学意义（P〉0.05）。3组组间5 min、10 min复温异常率以及30 min未复温率分别比较,差异均无统计学意义（P〉0.05）。结论10℃的CWLT方法有待改进,建议采用皮温实测值和皮温恢复时间作为评价指标。Objective To study the clinical application of 10℃ cool water loading test （CWLT） in evaluating occupational hazard of the hand-transmitted vibration. Methods Forty-two workers exposed to hand-transmitted vibration and diagnosed as occupational hand-arm vibration disease were studied as the onset group. Seventeen workers exposed to hand-transmitted vibration but not diagnosed as occupational hand-arm vibration disease were studied as the vibration exposure group. Twenty- four healthy workers unexposed to hand-transmitted vibration were selected as the control group. Digital skin temperature meter was used to measure the hand skin temperature for all objects before and after 10℃ CWLT, and the results were ana- lyzed. Results The results showed that the differences of the incidence rates of hand nunrbness, hand pain, arm weakness and joint pain among three groups were significant respectively （P 〈0.01 ）. The incidence rate of the main hand symptoms in those three groups could be sort from small to large as control group 〈 vibration exposed group 〈 onset group. The hand skin temperature among the three groups was significantly different （P 〈 0.01 ）. The hand skin temperature between the left and right hand was no significant difference （ P 〉 0. 05 ）. The hand skin temperature among the eight time points （ before CWLT, and 0 min, 5 min, 10 min, 15 min, 20 min, 25 min, 30 min after CWLT） also showed statistical significant difference （P 〈0.01 ）. The interaction effect between groups and times was significant difference （P 〈 0. 05 ）, and there were no significant interaction effect between hands and times, and between groups and hands respectively （ P 〉 0. 05 ） ; the interaction effects among groups, times and hands was no significant difference （ P 〉 0. 05 ）. Further analysis of the interaction effect neither left hand nor right hand showed that before CWLT the hand skin temperature among the three groups had no significant difference （ P 〉 0. 05 ） ; 0-30

关 键 词：振动 冷水复温试验 皮温 复温率 手臂振动病 

分 类 号：R135.4[医药卫生—劳动卫生]