职业性慢性正己烷中毒临床特点分析  

Clinical analysis on occupational chronic n-hexane poisoning cases

作　　者：樊春月[1] 陈嘉斌[1] 宋燕芹 王艳艳[1] 程樱[1] 郎丽[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》2016年第3期275-280,284,共7页China Occupational Medicine

基　　金：国家科技支撑计划项目(2014BAI12B01);国家卫生和计划生育委员会卫生监督中心卫生标准研制与应用项目(20140716);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：目的收集国内公开发表的涉及职业性慢性正己烷中毒的文献,分析总结正己烷中毒的临床特点,为修订GBZ 84《职业性慢性正己烷中毒的诊断》标准提供依据。方法采用文献计量学方法,从中国知网、维普数据库和万方中文期刊数据库检索1990—2014年公开发表的职业性慢性正己烷中毒的相关文献,筛选有详细临床资料的文献进行归纳分析。结果 25年间国内公开发表的符合入选标准的研究文献共68篇,共计1 027例中毒患者,均为职业性慢性正己烷中毒患者;男性165例,女性862例,年龄中位数为28.3(13.0~59.0)岁,发病潜伏期以2.0~10.0个月多见。817例(占79.6%)患者有诊断分级记录,诊断为轻、中和重度慢性正己烷中毒分别为418、241和158例。736例(占71.7%)患者相关文献报告了工作场所空气中正己烷水平,其中91.8%(676/736)患者工作场所空气中正己烷水平超过我国职业接触限值(180 mg/m^3)。慢性正己烷中毒以周围神经损害为主,626例(占61.0%)患者属感觉-运动障碍型,256例(占24.9%)患者单纯以运动障碍为主,145例(占14.1%)患者单纯以感觉障碍为主。临床表现主要以四肢远端为重的双侧对称性感觉异常或运动障碍;神经-肌电图改变均表现为神经源性损害,与病情严重程度相平行,且病情早期即可显示为神经源性损害。156例(占15.2%)患者采用气相色谱法检测了尿2,5-己二酮水平,检出率为50.6%(70/156)。慢性正己烷中毒目前尚无特效治疗药物或方法,临床上以促进神经修复的综合治疗方法为主,在常规治疗基础上加用鼠神经生长因子治疗效果更显著;954例患者报告治疗效果,治愈率为83.6%(798/954);156例(占15.2%)未治愈患者主要存在神经系统后遗症。结论慢性正己烷中毒主要临床表现为周围神经病,神经-肌电图检查是其最重要的诊断手段;目前以综合治疗法为主,患者预后良好。Objective To collect,analyze and summarize the clinical characteristics of occupational chronic n-hexane poisoning cases reported in the literatures published in domestic open public periodicals in order to provide evidence for the revision of GBZ 84 Diagnostic Criteria of Occupational Chronic n-Hexane Poisoning. Methods By the bibliometrics method,the databases of CNKI,VIP and WANFANG were used to retrieve literatures on the occupational chronic n-hexane poisoning published from 1990 to 2014. The literatures with detailed clinical data were screened and selected for summary and analysis. Results A total of 68 reference literatures meeting the inclusion criteria were chosen in 25 years of domestic publication. These literatures reported 1 027 cases of occupational n-hexane poisoning,including 165 males and 862 females. The median of age was 28. 3（ 13. 0-59. 0） years. Most of the cases had a disease incubation period of 2. 0-10. 0months. The diagnostic classification was made in 817 cases（ 79. 6%）,with mild,moderate and severe chronic n-hexane poisoning in 418,241 and 158 cases,respectively. The n-hexane levels in workplace air were reported in 736 cases（ 71. 7%）,91. 8%（ 676 /736） of which had exceeded the national occupational exposure limit. Chronic n-hexane poisoning was mainly characterized by peripheral nerve damage,626 cases（ 61. 0%） had feeling and movement disorders,256 cases（ 24. 9%） had movement disorder and 145 cases（ 14. 1%） had feeling disorders. The clinical characteristics of these disorders were bilaterally symmetric feeling or movement disorders in distal limbs. The nerve-electromyography examination showed the neurogenic damage,which was parallel with the severity of patients＇ condition and could be detected at early stage of illness. The gas chromatography was used to detect the 2,5-hexanedione level of 156 cases（ 15. 2%） of patients and the positive detection rate was 50. 6%（ 70 /156）. Currently,there was no specific medication or other therapy for treatmen

关 键 词：正己烷 慢性 中毒 周围神经病 临床表现 诊断 治疗 文献计量学 

分 类 号：R135.1[医药卫生—劳动卫生]