职业性手传振动作业工人震动觉阈值测试

Measure of vibration perception threshold in hand-transmitted vibration workers

目的分析长期从事手传振动作业工人震动觉阈值特点及在振动性神经损伤诊断中的应用价值。方法对158名长期接触手传振动作业工人和50名无接触职业性危害因素的健康成人进行职业性健康检查、震动觉阈值(VPT)测试、神经传导速度(NCV)检查分析。结果 (1)与正常对照组相比,观察组双侧2指、3指、5指VPT升高(P<0.01);同侧各手指之间比较,观察组左手各指间VPT有差别(P<0.01),且比右手VPT升高(P<0.05),并随着年龄、接振工龄的增加而升高(P<0.01或P<0.05);对照组各手指之间无差别。(2)与无症状相比,有症状组第2指、3指、5指VPT升高(P<0.05或P<0.01);(3)观察组2指VPT与正中神经感觉电位波幅、SCV呈负相关,5指VPT与尺神经感觉电位波幅呈负相关(P<0.05或P<0.01)。(4)当以VPT测试值≥10为阳性标准时,VPT检查的敏感性及特异性比较理想。VPT总异常率(50.0%)高于NCV异常率(11.4%,P<0.01)。结论长期职业性接触手传振动,可使作业工人VPT增高,该指标较常规NCV检测有更高的诊断敏感性,可为振动性神经损伤的早期诊断提供参考,是常规神经传导速度检查的重要补充。

Objective Analyze the characteristic of vibration perception threshold（VPT）in workers of long engaged in hand-transmitted vibration operation and its application value in diagnosis of nerve injury by vibration.Methods Occupational medical examination was made on 158 long engaged in hand-transmitted vibration operation workers and 50 healthy adults without exposure to occupational hazard,meanwhile,VPT test and nerve conduction velocity（NCV）test were also detected.Results（1）Compared with control group,the VPT of both side 2nd,3rd,and 5th fingers were rised（P0.01）;comparison between same side fingers,the VPT of left 5th finger higher than other fingers（P0.01）,and also higher than right fingers（P0.05）,which seemed dependent on age and vibration exposure length（P0.01 or P0.05）;no difference was found in fingers of controls.（2）Comparison between symptomatic and non-symptomatic workers in observation group,the VPT of 2nd,3rd and 5th fingers＇ of symptomatic workers were increase（P0.05 or P0.01）.（2）the 2nd finger VPT showed negative relationship with sensory potential amplitude and SCV of median nerve,and the 5th finger VPT showed negative relationship with sensory potential amplitude of median nerve（P0.05 or P0.01）.（4）Taking VPT≥10 as positive standard,the sensitivity and specificity was good,the total abnormal rate of VPT was 50.0%,much higher than that of NCV（11.4%,P0.01）.Conclusion Long-term occupational exposure to hand-transmitted vibration can induce the rise of VPT,which showed more diagnostic sensitivity,will be a good early diagnostic reference for nerve injury by vibration therefore it should be a necessary supplement for routine NCV test.