职业性慢性1-溴丙烷中毒性周围神经病4例临床分析  

Clinical analysis on four cases of occupational chronic toxic peripheral neuropathy caused by 1-bromopropane

作　　者：郭翔 林辉 司徒洁 何坚 郑倩玲[2] 黄振烈[2] 黄永顺[2] 

机构地区：[1]深圳市职业病防治院,广东深圳518001 [2]广东省职业病防治院,广东省职业病防治重点实验室,广州510300

出　　处：《中国职业医学》2016年第1期42-47,共6页China Occupational Medicine

基　　金：国家自然科学青年基金(81202245);深圳市卫生计生系统科研项目(201506075)

摘　　要：目的分析职业性慢性1-溴丙烷（1-BP）中毒性周围神经病的临床特点。方法回顾性分析4例职业性慢性1-BP中毒性周围神经病病例的临床资料。结果 4例病例均为某五金真空镀膜企业从事超声波清洗作业的男性工人,在工作中均接触高水平1-BP,接触时间为9~11个月。临床表现主要有不同程度的感觉、运动障碍,主要症状为渐进性加重的肢体麻木、乏力,以下肢多见,可伴有步态不稳。体格检查可见双下肢肌力减弱;双下肢或四肢痛觉和触觉减退,位置觉和振动觉减退;双侧跟腱反射多呈减弱或消失;1例病例出现感觉性共济失调。神经-肌电图检查均存在不同程度的周围神经损害,以运动和感觉神经传导速度减慢多见,且轴索和髓鞘的损害均可见。依据GBZ/T 247—2013《职业性慢性化学物中毒性周围神经病的诊断》,均诊断为职业性慢性1-BP中毒性周围神经病。结论长期接触高水平1-BP可导致以周围神经系统损害为主的慢性中毒,根据1-BP接触史、临床表现和神经-肌电图见神经源性损害可作出诊断。Objective To analyze the clinical features of occupational chronic toxic peripheral neuropathy caused by1-bromopropan（ 1-BP）. Methods Clinical data of 4 patients who suffered from occupational chronic toxic peripheral neuropathy caused by 1-BP were collected for retrospective analysis. Results The 4 male patients were ultrasonic cleaning operation workers in a hardware vacuum coating enterprise. They were exposed to high levels of 1-BP for 9-11 months. The main clinical manifestations were varying degrees of sensory disorder and dyskinesia. The main symptoms were progressive increase of numbness and fatigue in the lower extremities. These symptoms might be accompanied by unsteady gait.Physical examination showed muscle strength weakness in the double lower limbs. The hypalgesia,pselaphesia,topesthesia and pallesthesia decreased in the double lower limbs or 4 limbs. The bilateral achilles tendon reflex mainly showed reduced or disappeared. One case had sensory ataxia. Electroneuromyography examination showed different levels of peripheral nerve damage among the cases. The motor nerve conduction velocity and sensory nerve conduction velocity reduced commonly. The axon and myelin sheath damage were visible. On the basis of GBZ / T 247-2013 Diagnosis of Occupational Chronic Toxic Peripheral Neuropathy Caused by Chemicals,these cases were diagnosed as occupational chronic toxic peripheral neuropathy caused by 1-BP. Conclusion Long-term exposure to high level 1-BP can lead to chronic poisoning with peripheral nervous system damage. The diagnosis can be made based on the 1-BP exposure history,clinical features and the neurogenic damage found in electroneuromyography examination.

关 键 词：1-溴丙烷 职业中毒 周围神经病 神经-肌电图 职业病诊断 

分 类 号：R135.1[医药卫生—劳动卫生]