38例职业性慢性正己烷中毒的临床及神经-肌电图特点  

Clinical and EMG features of 38 cases of occupational chronic n-hexane poisoning

作　　者：樊春月[1] 黄汉林[1] 陈嘉斌[1] 王艳艳[1] 郎丽[1] 张莹[1] FAN Chun-yue HUANG Han-lin CHEN Jia-bin WANG YAN-yan LANG Li ZHANG Ying(Guangdong Provincial Center for Prevention and Treatment of Occupational Disease, Guangzhou 510300, China)

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：《中国工业医学杂志》2016年第5期323-328,共6页Chinese Journal of Industrial Medicine

基　　金：国家科技支撑计划"职业中毒与职业性肺病的诊断与治疗技术研究"(2014BAI12B01);卫生部卫生监督中心卫生标准研制与应用项目(项目编号:20140716);广东省职业病防治重点实验室(2012A061400007);国家临床重点专科建设项目(2011-09)

摘　　要：目的分析职业性慢性正己烷中毒所致周围神经病的临床特征。方法对38例住院的职业性慢性正己烷中毒病例进行病史采集,神经病学、神经-肌电图、心电图、生化和眼科检查及尿25-己二酮含量检测,并对患者工作时所使用的洗面水正己烷相对百分含量进行测定。结果患者所使用的洗面水正己烷相对含量为7.0%;发病潜伏期2～58个月,平均（8.5±2.7）个月;临床表现主要是四肢远端为主的对称性感觉异常、感觉和运动功能障碍,并可伴有自主神经功能障碍;神经-肌电图显示不同程度的神经源性损害改变;尿中均可检出25-己二酮,浓度为0.15～6.52 mg/L,不同中毒程度患者间尿25-己二酮水平的两两比较差异均无统计学意义（P〉0.05）。临床采用促进神经修复为主的综合治疗。3例（7.89%）患者遗留有双手或小腿肌肉轻度萎缩,其余临床基本康复。结论慢性正己烷中毒主要的临床表现为周围神经病变;神经-肌电图检查是周围神经病的早期、重要的诊断手段;尿25-己二酮是正己烷中毒接触指标,但不能用作诊断分级指标;临床以综合治疗为主,常规治疗基础上加用鼠神经生长因子（NGF）肌注促进周围神经恢复较有效及安全;患者预后良好。Objective To analyze the clinical characteristics of peripheral neuropathy caused by occupational chronic n-hexane poisoning. Methods Collect the disease history and the results of EMG,ECG,biochemistry,ophthalmic examination and urinary 2,5-hexanedione levels of 38 hospitalized cases of occupational chronic hexane poisoning. Meanwhile,the relative content of n-hexane in washing face water was also measured. Results The results showed that the relative content of n-hexane in washing face water the patients used was 7. 0%; the latency period were 2 ~ 58 months [the average was（ 8. 5±2. 7） months];the main clinical manifestation was the symmetrical sensory abnormalities,sensory and motor dysfunction in the distal end of the extremities,and may be accompanied by autonomic dysfunction,nerve EMG showed different degrees of neurogenic damage change as well; the 2,5-hexanedione in all patient＇s urine could be detected and the level was 0. 15 ~ 6. 52 mg / L,but there was no statistical significance of the differences of urinary 2,5-hexanedione levels among the patients with different degree of poisoning（ P 〉0. 05）. A comprehensive treatment strategy was taken mainly for promoting neural restoration,the results showed that except 3 cases（ 7. 89%） of patients with a slight atrophy of the left hand or leg muscles,all the rest got basic clinical rehabilitation. Conclusion The results suggested that the main clinical manifestation of chronic n-hexane poisoning was peripheral neuropathly; neural EMG was the early and important means of diagnosis for peripheral neuropathy; urinary 2,5-hexanedione was a exposure indicator of n-hexane but could not be used for the diagnosis and classification of n-hexane poisoning; comprehensive treatment should be the main therapeutic method at present,therapy with NGF intramuscular injection was effective and safe for promoting peripheral neuropathy restoration; and chronic n-hexane poisoning patients had good prognosis.

关 键 词：慢性 正己烷中毒 周围神经病 

分 类 号：R135.1[医药卫生—劳动卫生] O623.11[医药卫生—公共卫生与预防医学]