GBZ 76-2002《职业性急性化学物中毒性神经系统疾病诊断标准》实施情况的跟踪评价  

Evaluation of the implementation of Diagnostic Criteria of Occupational Acute Neurotoxic Diseases Caused by Chemicals(GBZ 76-2002)

作　　者：王吉 宋莉 石冬梅 邹海梁 李丹丹 朱秋鸿[2] Wang Ji;Song Li;Shi Dongmei;Zou Hailiang;Li Dandan;Zhu Qiuhong(Department of Occupational Toxicology,Heilongjiang Institute of Labor Health and Occupational Diseases,Harbin 150000,China;Chinese Center for Disease Control and Prevention,Occupational Health and Poison Control Institute,Beijing 100000,China)

机构地区：[1]黑龙江省劳动卫生职业病研究院职业中毒医学科,哈尔滨150000 [2]中国疾病预防控制中心职业卫生与中毒控制所,北京100000

出　　处：《中华劳动卫生职业病杂志》2022年第10期742-746,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：强制性职业病诊断标准实施评估(20192007)。

摘　　要：目的调查GBZ 76-2002《职业性急性化学物中毒性神经系统疾病诊断标准》的实施情况,为标准修订积累依据。方法于2020年2月,选取39家医疗卫生机构的85名职业病及神经内科专家为调查对象,采用改良德尔菲法建立标准评价指标体系,组织专题小组讨论预调查,进行问卷调查,分析调查对象对标准的掌握、应用情况和修改建议。结果调查对象对标准相关知识的掌握主要来源于工作经历(84.7%,72/85)、标准学习(81.2%,69/85)和培训(75.3%,64/85);调查对象所在机构中,98.8%(84/85)可开展CT检查,96.5%(82/85)可开展神经传导速度及肌电图检查,89.4%(76/85)可开展脑电图检查,80.0%(68/85)可开展诱发电位检查,72.9%(62/85)可开展核磁共振成像;参与诊断为职业性急性中毒性脊髓病的毒物中,主要为有机磷(10.6%,9/85)和窒息性气体(9.4%,8/85);诊断为迟发性周围神经病的毒物中,主要为农药类(25.9%,22/85)和窒息性气体(12.9%,11/85);调查对象中,85.9%(73/85)认为急性中毒性脑病分级依据需要补充客观证据,80.0%(68/85)认为周围神经病诊断分级依据中的神经肌电图异常指标需细化。结论现行标准应用周期较长,分级标准指标中客观检查依据少,标准的适用性有待提升。Objective To investigate the implementation of Diagnostic Criteria of Occupational Acute Neurotoxic Diseases Caused by Chemicals(GBZ 76-2002)for accumulating basis of standard revision.Methods In February 2020,85 experts in occupational diseases and neurology from 39 medical and health institutions were selected as the respondents.The modified Delphi method was used to establish the standard evaluation index system and special group was organized for discussing the pre-survey and completing the questionnaire survey.Questionnaire survey was performed to investigate the grasp of the standards,application and modification suggestions of respondents.Results The respondents'mastery of standard-related knowledge mainly came from work experience(84.7%,72/85),standard learning(81.2%,69/85)and training(75.3%,64/85).Among the institutions in which the respondents worked,98.8%(84/85)could carry out CT examinations,96.5%(82/85)could carry out nerve conduction velocity and electromyography examinations,89.4%(76/85)could carry out EEG examinations,80%(68/85)could carry out evoked potential examinations and 72.9%(62/85)could carry out MRI examinations.Among the toxicants diagnosed as occupational acute toxic myelopathy,10.6%(9/85)were organic phosphorus and 9.4%(8/85)were asphyxiating gas;Among the toxicants diagnosed as delayed peripheral neuropathy,pesticides accounted for 25.9%(22/85)and asphyxiating gases accounted for 12.9%(11/85).85.9%(73/85)of the respondents believed that the basis for the classification of acute toxic encephalopathy needed to supplement objective evidence;80.0%(68/85)of the respondents thought that the diagnosis and classification of peripheral neuropathy should be refined according to the abnormal indexes of neuroelectromyography.Conclusion The applicability of the criteria needs to be improved because the current criteria has a long application cycle without enough objective investigation bases in classification criteria index.

关 键 词：职业病 中毒 神经系统疾病 诊断标准 实施评估 

分 类 号：R135.1[医药卫生—劳动卫生]